Birla Sun Life Hospital Care Rider

We all hope to go through life without any health problems, but we all know the importance of planning for such eventualities. If and when that time comes, the high costs of hospitalization and surgeries should be the least of your concerns. BSLI Hospital Care Rider ensures the only thing your family has to think at that hour… is about you.

ELIGIBILITY CRITERIA

Entry Age	18 – 65 years Maximum age at the end of rider term is 70 years
Rider Term	Same as that of the base plan or till the attained age 70 of the life insured, whichever is earlier
Pay Term	Same as base plan
Pay Mode	Same as base plan
Sum Assured*	Minimum Rs. 1,50,000 Maximum Rs. 15,00,000 subject to maximum of 100% sum assured of the base plan

* subject to the total rider premiums on the base plan being no more than 30% of the base plan premium.

You may opt for this rider only at the time of policy issue.

RIDER BENEFITS

You can claim your daily cash benefit in case of hospitalization for medically necessary treatment of any Illness or Injury for a minimum period of 48 hours payable from the first day for the duration of hospitalization.

Hospital Cash Benefit

The minimum daily cash benefit amount is Rs. 600 per day and the maximum daily cash benefit amount is Rs. 6,000 per day. The rider sum assured will be 250 times this daily cash benefit amount.

ICU Benefit

An additional 100% of the chosen daily cash benefit amount per day is paid for each day of stay in the intensive care unit (ICU) subject to the daily cash benefit being payable at the time of hospitalization. This ICU benefit is payable for hospitalization up to 15 days per policy year. This benefit amount is fixed per day benefit and will be paid irrespective of actual hospitalization expenses.

Recuperating Benefit

A recuperating benefit which is a lump sum benefit and is equivalent to 3 times the chosen daily cash benefit will be payable for 7 or more days of continuous hospitalization for the same injury or disease, subject to the daily cash benefit being payable at the time of hospitalization. This benefit will be paid once in a policy year. This benefit is payable irrespective of whether the life insured is admitted to one or more hospitals during one and the same episode. This benefit is not payable if the life insured dies during hospitalization.

Policy Limits

You can claim 100 times the chosen daily cash benefit amount in one policy year and 250 times the chosen daily cash benefit amount in the entire policy term.

DEFINITIONS

Hospital

“Hospital” means any institution established for indoor or in‐patient care and day care treatment of sickness and/or injuries and which has been registered either as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner OR must comply with all minimum criteria as under:

- Has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places;
- Has fully qualified nursing staff under its employment round the clock;
- Has fully qualified doctor(s) in charge round the clock;
- Has a fully equipped operation theatre of its own where surgical procedures are carried out; and
- Maintains daily records of patients and will make these accessible to us Hospital does not include any institution which is operated primarily as a convalescent or rest home or a sanatorium, or a home for the aged, or a place for rehabilitation of alcoholics or drug addicts, or for any similar purpose.

Intensive Care Unit (ICU)

“Intensive Care Unit (ICU)” means a specially equipped and designated ward in any hospital that is used for the sole purpose of the treatment of patients with a critical or exigent condition, and where the patient is under 24 hour care and monitoring, by a physician and specially trained nursing staff.

Medically Necessary

“Medically Necessary” refers to a procedure, a treatment or a period of hospitalization which is ordered by a registered medical practitioner and
- Which is required for the treatment of a medical condition, and
- Appropriate and consistent with the symptoms and findings or diagnosis and treatment of the life insured medical condition, and
- Provided in accordance with generally accepted medical practice on a national basis, and
- Not of an experimental nature, not of an investigative nature and not in the nature of research

Hospitalization

If the life insured is hospitalized for medically necessary treatment of any illness or injury for a minimum period of 48 hours then the benefit will be payable from the first day for the duration of hospitalization.

Day

“Day” in hospital means a period of a full 24 hours during a period of confinement. The first day of confinement shall commence at the time of admission to the hospital and each subsequent Day shall commence 24 hours after the commencement of the previous day. In the event of the time of discharge of the life insured from the Hospital being more than 12 hours, but less than 24 hours from the end of the previous day, then the day of discharge shall also be regarded as a day.

Pre-existing condition

“Pre-existing condition” means a condition (illness or bodily injury) for which, prior to the issue date of the policy:
- the life insured had signs or symptoms, or
- medical advice or treatment was recommended by or received from a physician, or
- the life insured had undergone medical tests or investigations
Any congenital disorder, or related illness or complication arising out of or in connection with a preexisting medical condition, shall be considered part of that pre-existing medical condition.

EXCLUSIONS

The life assured will not be entitled to any benefits if a covered illness results either directly or indirectly from any one of the following causes:

Any condition manifesting itself within 90 days from the policy issue date or revival thereof, whichever is later
Any pre-existing disease and its complications
AIDS, HIV related complications or any Sexually Transmitted Diseases
Attempted suicide or self inflicted injury, irrespective of the mental condition
Hazardous sports or activities included but not limited to bungee jumping, mountaineering etc.
Any flying activity other than as a bonafide passenger
Under the influence of alcohol, drugs or any substance not prescribed by a Registered Medical Practitioner or as a result of abuse from any of these substances
War, terrorism, riots, civil commotion, strikes, civil war or service in the military or paramilitary forces
of a country at war
Criminal, unlawful or illegal activity participation
Exposure to radioactive or nuclear fuel
Treatment taken outside India
Psychiatric or mental illness
Circumcision, any cosmetic procedures or plastic surgery
Pregnancy, childbirth or their complications, abortion, medical termination of pregnancy, infertility or sex change operation
Organ donation (as a donor)
Rehabilitation or convalescent care or length beyond customary length of stay
Dental Treatment except if arising from an accident
Non-Allopathic treatment
Purely investigative procedure not resulting in any treatment or elective procedures or unreasonable failure to seek medical advice
Study and treatment of sleep apnoea
Deliberate exposure to exceptional danger (except in an attempt to save human life)

Excluded for first two policy years

Specific waiting period of 2 years from policy issue date or revival date for conditions/procedures mentioned below will apply for all benefits.

Hernia Repair
Corrective procedure for gall stones
Corrective procedure for kidney or urinary tract stones
Discectomy, Laminectomy
Hemi / Partial Thyroidectomy
Corrective procedure for anal fistula or anal fissure
Removal of uterus, fallopian tubes and/or ovaries, except for malignancy
Corrective procedure for fibroids, uterine prolapse, or dysfunctional uterine bleeding
Corrective procedures for Haemorrhoids
Cataract & joint replacement surgeries

TERMS AND CONDITIONS

Termination of rider

You are not allowed to opt out of the rider once availed. However, the rider benefit will cease immediately if the base plan is terminated, discontinued or made paid-up. The rider benefit will also cease when the total claims paid equals 100% of the sum assured.

Current Tax Benefits

As per extant tax laws, under Section 80D of the Income Tax Act,1961, premiums up to Rs.15,000 (Rs.20,000 for senior citizens) are allowed as a deduction from your taxable income each year.

Service Tax

Service Tax and other levies, as applicable, will be extra and levied as per the extant tax laws.

Prohibition of Rebates – Section 41 of the Insurance Act, 1938

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer.

Non-Disclosure – Section 45 of the Insurance Act, 1938

No policy of life insurance effected after the coming into force of this act shall, after the expiry of two years from the date on which it was effected be called in question by an insurer on the ground that statement made in the proposal or in any report of a medical officer, or referee, or friend of the life insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policyholder and that the policyholder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose.

Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the
application.

DISCLAIMERS

This rider is underwritten by Birla Sun Life Insurance Company Limited (BSLI). This brochure contains only the salient features of the rider. Tax benefits are subject to changes in the tax laws. Insurance is the subject matter of the solicitation. For further details please refer to the policy contract or call your BSLI Insurance Advisor or visit our website and see how we can help in making your dreams come true.

Regd. Office: One Indiabulls Centre, Tower 1, 15th & 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai 400013. Reg. No. 109

UIN: 109C016V01 ADV/8/10‐11/4144 VER 1 /Aug/2010