CARE Health Insurance Company Limited

Policy Conditions & BENEFITS

Particular	Details
Entry Age – Minimum to Maximum	91 days to 70 years
Cover Type	Individual basis
Geographical Scope	India excluding city of residence
Trip type	One way trip, not exceeding 24 Hours

Benefits	Sum Insured Limit	Deductible	Pay-out
Medical Emergency	INR 1000	NIL	Indemnity
Flight Delay or Trip Delay	INR 3000	2Hrs and 30 Mins	Fixed Benefit
Missed Connection	INR 5000	3 Hrs	Indemnity
Delay in checked-in-baggage (only flight)	INR 3000	2Hrs and 30 Mins	Fixed Benefit
Flight cancellation (Trip Cancellation)	INR 10000	NIL	Indemnity
Bounce Booking	INR 10000	NIL	Indemnity

Trip Delay

If the departure of a Common Carrier in which the Insured Person is scheduled to travel on a valid ticket during the Period of Insurance is delayed for more than consecutive hours as specified in the Certificate of Insurance from the later of the declared time of departure or expected time of departure

The Company will pay the amount as specified against this benefit provided that the Company or the Assistance Service Provider is given written notice of the delay immediately and in any event within 30 days of the commencement of the delay and immediate alternative arrangements are made by the Insured Person for progressing the journey as scheduled.

Exclusions:

Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to any of the following shall not be admissible under this Benefit unless expressly stated to the contrary elsewhere in the Policy terms and conditions:

The Common Carrier is taken out of service on the instructions of the Civil Aviation Authority or any similar authority;
A Claim has already been made under Missed Connection Benefit

Documents to be submitted in support of the Claim:

It is a condition precedent to the Company’s liability under this Benefit that the following information and documentation shall be submitted to the Company or the Assistance Service Provider immediately and in any event within 30 days of the event giving rise to the Claim under this Benefit:

Certificate from the Common Carrier confirming the delay and detailing the circumstances of delay

Loss of Checked-in Baggage

The Company will indemnify the Insured for the value of the Checked-In Baggage totally lost whilst in the custody of the Common Carrier during the period of the journey provided that:

Coverage under this Benefit shall commence only after the Checked-in Baggage is entrusted to the Common Carrier and a receipt obtained and coverage under this Benefit shall terminate automatically after 24 hours of the Common Carrier reaching the Place of Destination specified in the ticket of the Insured Person during the Period of Insurance;
If more than one (1) piece of Checked-In Baggage has been checked-in under the same ticket of the Insured Person, the Company’s liability shall be restricted to 50 % of the Sum Insured if all the pieces of Checked-In Baggage are not lost;
If the lost/undelivered Checked-In Baggage is subsequently traced and offered for delivery to the Insured Person, the Insured Person shall refund the amount paid by the Company under this Benefit in full irrespective of whether delivery of the baggage is taken;
If a portion of the lost/undelivered Checked-In Baggage is subsequently traced and offered for delivery to the Insured Person, the Insured Person shall refund the amount paid by the Company under this Benefit which is attributable to the portion of Checked-In Baggage traced in full irrespective of whether delivery of the Baggage is taken;
The liability of the Company shall be determined based on the market value of the Contents of the Checked-In Baggage as on the scheduled/expected date of delivery at the destination port.

In case the market value of any single item of the Contents (excluding Valuables) of a Checked-In Baggage exceeds INR 2,000, the Company’s liability shall be limited to INR 2,000 only.

Exclusions applicable to loss of Checked-in Baggage:

Any partial loss or damage of any items contained in the Checked-In Baggage;
Any loss arising from any delay, detention, confiscation by customs officials or other public authorities;
Any loss due to damage to the Checked-In Baggage;
Valuables. Valuables shall mean and include photographic, audio, video, painting, computer and any other electronic equipment, telecommunications and electrical equipment, telescopes, binoculars, antiques, watches, jewellery and gems, furs and articles made of precious stones and metals
Any loss for which a claim has already been made under Delay of Checked-in Baggage;
Any loss of Checked-In Baggage sent in advance or shipped separately.

Documents to be submitted for Claim under this Benefit :

Property irregularity report issued by the appropriate authority;
Voucher of the Common Carrier for the compensation paid for the non-delivery / short delivery of the Checked-In Baggage;
Copies of correspondence exchanged, if any, with the Common Carrier in connection with the non-delivery / short delivery of the Checked-In Baggage.
Statement of claim furnishing the details of items contained in the Checked-In Baggage and the values thereof (excluding Valuables). Values of the items shall represent their market value after allowing for age and usage.
In case of items of individual value equal to or more than INR 2,000 contained within the Checked-In Baggage, proof of ownership in the form of purchase bill (or any other proof to the satisfaction of the insured / Assistance Service Provider).

DELAY OF CHECKED-IN BAGGAGE

The Company will pay the Sum Insured if the delivery of the Insured Person’s Checked-In Baggage which has been entrusted to the Common Carrier is delayed by more than the time as specified in the Certificate of Insurance from the Insured Person’s arrival at the Place of Destination specified on his valid ticket during the Period of Insurance.

Exclusions applicable to delay of Checked-in Baggage:

Any delay which does not exceed the time period specified in this Benefit.
Any loss for which a claim has already been made under Loss of Checked-in Baggage;
Any delay in delivery of the Checked-In Baggage arising out of or resulting from detention or confiscation of the baggage by the Common Carrier or customs or any government or other agencies;
Any delay is attributable to damage to the Checked-In Baggage warranting an examined delivery by the Common Carrier.

Documents to be submitted for any Claim under this Benefit:

Property irregularity report issued by the appropriate authority stating the scheduled time of delivery and the actual time of delivery of the Checked-In Baggage;
Voucher of the Common Carrier for the delay in delivery of the Checked-In Baggage;
Copies of correspondence exchanged, if any, with the Common Carrier in connection with the delay in delivery of the Checked-In Baggage.

MISSED CONNECTION

If the Insured Person misses the flight( or connecting flight) solely and directly due to the delayed arrival of the Carrier in which the Insured Person was travelling on a valid ticket/booking, the Company will indemnify the Insured Person for the cost of direct route economy class airfare actually incurred by the Insured Person to continue the journey to the scheduled Place of Destination provided that:

The Company shall not be liable to make any payment under this Benefit if the delay could reasonably have been foreseen by the Insured Person or if the Insured Person could reasonably have become aware of such delay in advance;
The Company shall be liable under this Benefit only if the time gap between the scheduled arrival of the Common Carrier and the connecting flight is more than 6 consecutive hours as specified in the Certificate of Insurance;
The Company’s liability to make payment under this Benefit shall be in excess of the total amount refunded or returned to the Insured Person by the flight service provider.

Exclusions applicable to Missed Connection

A Claim has already been made under Trip Delay.
Missing of the flight is the result of Any deviation from the originally scheduled route at the instance of the Insured Person for any reason whatsoever;
Any advance intimation given to the Insured Person of a possible delay of the Carrier that might lead to missing of connecting flight;
Any circumstances other than those directly attributable to the delay of the earlier Common Carrier.

Documents to be submitted in support of the Claim:

Confirmation from the Carrier of the delay as to the expected time of arrival and the actual time of arrival at Place of Destination together;
Copy of unused ticket for the missed flight;
Certificate from the Carrier of the missed flight that the fare for the part of the journey covered by the missed flight is forfeited in full or in part together with the amount of forfeiture;
Original used ticket obtained afresh towards the alternative flight for the part of the journey covered by the missed flight indicating the amount paid as fare.

Trip Cancellation:

If the Insured Person’s outward journey as a fare-paying passenger from the City of Residence to a Place of Destination on a Common Carrier is unavoidably cancelled before the commencement of the Period of Insurance solely and directly due to one of the reasons below, then the Company will indemnify for those travel expenses that the Insured Person paid and cannot recover and for which no value can be derived:

Earthquake, storm, flood, inundation, cyclone or tempest provided that the peril takes place prior to the commencement of the Period of Insurance at or in the vicinity of the Place of origin of the journey, the ultimate scheduled Place of Destination or any intermediate place which is involved in or related to the proposed journey.
Terrorism provided that the peril takes place prior to the commencement of the Period of Insurance at or in the vicinity of the Place of origin of the journey, the ultimate scheduled Place of Destination or any intermediate place which is involved in or related to the proposed journey;
The Insured Person’s Immediate Family Member dies or is Hospitalized in an Emergency due to an unforeseen Illness or Injury for at least 2 consecutive days provided that such Illness or Injury shall occur not earlier than 10 days consecutive days from the scheduled commencement of the Period of Insurance;
The Insured Person is Hospitalized in an Emergency due to an unforeseen Illness or Injury and such Hospitalization commences within 10 days from the scheduled commencement of the Period of Insurance and continues for at least 2 consecutive days and the treating Medical Practitioner certifies in writing that the Insured Person is not fit to undertake travel.

If a Claim is admitted under this Benefit, the Policy shall be immediately and automatically cancelled on the Company’s admission of the Claim.
Any amount refunded to the Insured Person by the Common Carrier in relation to the cancellation shall be deducted from the amount payable to the Insured Person under this Benefit.

Exclusions applicable to Trip Cancellation

strikes or labour disputes or slowdown;
Interruption or cancellation of the journey either wholly or in part at the instance of the Common Carrier (apart from the reasons listed above) or by the travel agent;
Interruption or cancellation of the journey either wholly or in part at the instance of the authority governing the Common Carrier or the government;

Documents to be submitted in support of the Claim:

It is a condition precedent to the Company’s liability under this Benefit that the following information and documentation (as applicable) shall be submitted to the Company or the Assistance Service Provider immediately and in any event within 30 days of the event giving rise to the Claim under this Benefit:

Confirmation in writing of the cancellation of the journey from the Common Carrier detailing the circumstances of cancellation;
Ticket/boarding pass issued by the Common Carrier indicating the cost of ticket and receipt for the refund of the fare of the Common Carrier towards the cancelled portion of the journey indicating cancellation charges retained by the Common Carrier.
Boarding pass in original for the return journey from the place of cancellation to the Country of Residence / City of Residence which indicates the cost of the tickets together with the receipts for the refunds obtained towards the unfulfilled portion of the journey.
A declaration from the Insured Person furnishing the circumstances that compelled him/her to cancel the journey;
Medical evidence as may be required in case of the cancellation of the journey arising out of personal contingencies of the Insured Person or his / her Immediate Family Member;
Receipt for the refund of the fare of the Common Carrier towards the cancelled portion of the journey indicating the cancellation charges retained;
Boarding pass in original for the return journey from the place of cancellation to the Country of Residence / City of Residence of the Insured Person together with the receipts for the refunds obtained towards the unfulfilled portion of the journey.

BOUNCE BOOKING

The Company will indemnify the Insured Person the actual additional expenses/cost incurred by the Insured for alternative flight arrangements in the event of the confirmed flight reservation for any part of the Trip within the Period of Insurance bouncing at the sole instance of the Common Carrier or bouncing of the confirmed accommodation booking at the place of stay being part of the Trip solely at the instance of the accommodation provider.

Provided that the Company’s liability shall be in relation to the travel covered by such confirmed booking and in relation to accommodation in the same place of stay and also provided that the Company’s liability to such additional expenses shall be in relation to the same class of travel and the same category of accommodation as the case may be covered by the originally confirmed bookings.
It is a condition precedent to admission of liability by the Company under this Benefit that the Insured shall take all steps to fix the primary responsibility for the bouncing of bookings both with the Common Carrier and/or with the accommodation provider and try to recover from them the consequential loss incurred by the Insured by way of additional expenses for alternative travel arrangement or alternative accommodation arrangement. Details of the steps taken by the Insured shall be furnished to the Company.
Any recovery towards additional expenses incurred for alternative travel or accommodation arrangement effected from the Common Carrier or accommodation provider as the case may be, if any, effected from the concerned agencies after settlement of the claim under the policy, shall be remitted to the Company to the extent of the amount of claim admitted and paid by the Company to the Insured.

Exclusions applicable to Bounce Booking:

If the Insured shall fail to adhere to the rules of the Common Carrier or the accommodation provider in connection with reconfirmation of the booking before the date of travel or date of accommodation as the case may be;
In connection with any waitlisted travel booking or accommodation booking irrespective of whether such bookings have been promised to be confirmed later;
If the confirmed accommodation is a personal arrangement or is free of charge;
Where the alternative arrangements for either the travel or the accommodation is provided by the Common Carrier or the accommodation provider as the case may be within 6 hours from the time of departure of the travel covered by the bounced booking or the time of commencement of stay covered by the earlier confirmed

Documents to be submitted for any Claim under this Benefit :

A declaration from the Insured that he/she has strictly complied with the rules laid down by the Common Carrier or accommodation provider as the case may be relating to the reconfirmation of the booking prior to the date of departure of the flight or occupation of the accommodation.
A confirmation from the Common Carrier of the bounced booking solely at their instance and responsibility.
A confirmation from the accommodation provider of the bounced booking solely at their instance and responsibility.
The Insured shall lodge his / her claim on the Common Carrier and/or the accommodation provider in writing
Statement of Claim for the expenses incurred;
Original receipt for payment of charges to the other Common Carrier and/or other the accommodation provider

GENERAL EXCLUSIONS (applicable to Benefit – ‘Medical Cover’),

Any Claim in respect of any Insured Person for, arising out of or directly or indirectly due to any of the following shall not be admissible unless expressly stated to the contrary elsewhere in the Policy terms and conditions:

Any condition or treatment as specified in Annexure-II.
The Company shall not admit any Claim in respect of an Insured Person which involves treatment/consultation in any of the hospitals as listed in Black Listed Hospital.
Any events occurring outside the Period of Insurance except for a Claim for Trip Cancellation.
The Insured Person:
1. travelling against the advice of a Medical Practitioner; or
2. receiving, or is supposed to receive, medical treatment; or
3. having received terminal prognosis for a medical condition; or
4. travelling for the purpose of obtaining medical treatment; or
5. Taking part or is supposed to participate in a naval, military or air force operation or warlike or peacekeeping operation; or
6. Is not a domestic fare paying passenger

An act of self-destruction or self-inflicted injury, attempted suicide or suicide while sane or insane or Illness.
Any Illness or Injury directly or indirectly resulting from or arising from or occurring during the commission of any breach of any law by the Insured Person with any criminal intent.
Any condition directly or indirectly caused by or associated with any sexually transmitted disease, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III) or Lymphadenopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
Any treatment arising from or traceable to pregnancy (including voluntary termination), miscarriage (unless due to an Accident), childbirth, maternity (including caesarian section), abortion or complications of any of these. This exclusion will not apply to ectopic pregnancy, which is proved by diagnostic means and certification by a gynaecologist that it is life-threatening.
Any treatment arising from or traceable to any fertility, infertility, subfertility or assisted conception procedure or sterilization or procedure, birth control procedures, hormone replacement therapy, contraceptive supplies or services including complications arising due to supplying services or Assisted Reproductive Technology.
Any treatment or surgery for any dental illness or injury.
Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practising outside the discipline for which he is licensed or any kind of self-medication.
Charges incurred in connection with cost of spectacles (unless to the extent covered under Benefit 15) and contact lenses, hearing aids, routine eye and ear examinations, laser surgery for correction of refractory errors, dentures, artificial teeth and all other similar external appliances and/or devices whether for diagnosis or treatment.
Experimental, investigational or unproven treatments which are not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness for which confinement is required at a Hospital. Any Illness or treatment which is a result or a consequence of undergoing such experimental or unproven treatment. Any diagnosis or treatment of an Illness / Injury which does not require Hospitalization.
Any expenses incurred on the prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, walker, belts, collar, caps, splints, braces, stockings of any kind, diabetic footwear, glucometer or thermometer, crutches, ambulatory devices, instruments used in the treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition, cost of cochlear implants.
Weight management services and treatment, vitamins and tonics related to weight control programmers, services and supplies including treatment of obesity (including morbid obesity).
Any treatment related to sleep disorder or sleep apnea syndrome, general debility convalescence, cure, rest cure, health hydros, nature cure clinics, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care, custodial care or any treatment in an establishment that is not a Hospital.
Treatment of all external Congenital Anomalies or Illness or defects or anomalies or treatment relating to external birth defects.
Treatment of mental illness, stress, psychiatric or psychological disorders.
Aesthetic treatment, cosmetic surgery and plastic surgery or related treatment of any description, including any complication arising from these treatments, other than as may be necessitated due to an Injury.
Any treatment or surgery for change of sex or gender reassignments including any complication arising from these treatments.
Circumcision unless necessary for the treatment of an Illness or as may be necessitated due to an Accident.
All preventive care, vaccination, including inoculation and immunizations (except in case of post-bite treatment), vitamins and tonics.
Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.
All expenses related to donor screening, treatment, including surgery to remove organs from the donor, in case of transplant surgery.
Non-allopathic treatment.
Illness or Injury attributable to the consumption, use, misuse or abuse of tobacco, intoxicating drugs or alcohol.
Charges incurred at a Hospital primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury, for which in-patient care or a daycare procedure is required.
War (whether declared or not) and warlike occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
Stem cell implantation, harvesting, storage or any kind of treatment using stem cells.
Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, Claim or expense. For the purpose of this exclusion:
Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile or fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating disablement or death.
Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.
Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease-producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.
In addition to the foregoing, any loss, claim or expense of whatsoever nature directly or indirectly arising out of, contributed to, caused by, resulting from, or in connection with any action taken in controlling, preventing, suppressing, minimizing or in any way relating to the above is also excluded.
Impairment of an Insured Person’s intellectual faculties by abuse of stimulants or depressants.
Any sporting activities in so far as they involve the training or participation in competitions of professional or semi-professional sports persons, unless declared beforehand and agreed by the Company subject to additional premium being paid and incorporated accordingly in the Policy.
Any Claim relating to Hazardous Activities.

Claims:

To intimate a claim email at customerfirst@careinsurance.com or call at 1800-102-4488 / 1860-500-4488.

For any queries please emails us at insurance_care@olamoney.com