LIC’s Arogya Rakshak

LIC’s AROGYA RAKSHAK (UIN: 512N318V01)
(A Non-linked, Non-Participating, Individual,
Health Insurance Plan)
Health is the greatest blessings for all human beings. Good health
is central to human happiness and well being that contributes
significantly to prosperity and wealth. Every aspect of life is dependent
on good health. Due to changing lifestyles, health issues have
escalated. Today, every individual is aware that the number of illnesses
is increasing day by day and so are the related costs for treatment.
Therefore, it is important to plan for your health emergencies before
it is too late.
LIC’s Arogya Rakshak, is a Non-Linked, Non-Participating, Regular
Premium, Individual, Health Insurance plan which provides fixed
benefit health insurance cover against certain specified health risks
and provides you with timely support in case of medical emergencies
and helps you and your family remain financially independent in
difficult times.
You (as Principal Insured (PI)), your spouse, all your children, and your
parents can all be insured under one policy. Quite a relief isn’t it, to
have all insured under one policy.
LIC’s Arogya Rakshak gives you following benefits under one
policy:
· Flexible benefit limit to choose from
· Flexible premium payment options
· Valuable financial protection in case of hospitalisation,
surgery etc
· Lump sum benefit irrespective of actual medical costs
· Increasing Health cover by way of Auto StepUp Benefit and
No Claim Benefit.
· If more than one members are covered under a policy,
Premium Waiver for other Insured(s) in case of unfortunate
death of the Original Principal Insured i.e. the Policyholder at
inception of policy.
· Premium Waiver Benefit for one year in the event of any
Insured undergoing surgery falling under Category I or
Category II as listed in Major Surgical Benefit Annexure.
· Ambulance Benefit
· Health Check-up Benefit
You can choose the amount of Initial Daily Benefit (i.e., the Hospital
Cash Benefit applicable in the first year of the policy) in respect of each
of the family members proposed to be covered under the same policy
from 2,500 per day to10,000 per day(in the multiples of 500) as per your needs. This is the amount that will be payable in the event of hospitalisation in the first three policy years on a per day basis. The amount of Hospital Cash Benefit will increase automatically by way of Auto Step Up Benefit and No Claim Benefit. The Major Surgical Benefit that you will be covered for will be 100 times the Hospital Cash Benefit. Thus, 3 the initial Major Surgical Benefit Sum Assured will range from2.5
lakh to 10 lakh in multiples of50,000. Other benefits such as Day
Care Procedure Benefit, Other Surgical Benefit, Medical Management
Benefit, Major Surgical Benefit Restoration,Extended Hospitalization
Benefit, Health Check-up benefit shall also depend upon the Hospital
Cash Benefit chosen.
Your premium as the Principal Insured will depend on your age,
gender, the level of Health cover i.e. the Initial Daily Benefit you have
chosen at outset and the mode of payment.
The Premium for other Insured members which includes your Spouse,
children and your parents will depend on their age, gender, the level
of Initial Daily Benefit chosen as well as on the age of PI.

1. Eligibility Conditions and other Restrictions :
   i. Minimum age at entry:
   Principal Insured: [18] years (last birthday)
   Insured Spouse/ Parents: [18] years (last birthday)
   Insured Children: [91] days (completed)
   ii. Maximum age at entry:
   Principal Insured: [65] years (last birthday)
   Insured Spouse/ Parents: [65] years (last birthday)
   Insured Children: [20] years (last birthday)
   iii. Cover Period:
   Principal Insured, Insured Spouse, Parents:

• [80 minus Age at entry]
• [70 minus Age at entry], if AHC benefit is triggered and the policy
  is not continued by payment of premium after expiry of AHC
  period.
  Insured Children: [25 minus Age at entry]
  iv. Initial Daily Benefit (i.e. the level of Hospital Cash Benefit (HCB) at
  inception):
  Initial Daily Benefit Principal
  Insured (PI)
  Insured Spouse
  (if any), Insured
  Parents (if any)
  Insured Children
  (if any)
  a) Minimum Initial
  Daily Benefit 2,500/- 2,500/- 2,500/- b) Maximum Initial Daily Benefit 10,000/-
  per life*
  Insured Spouse – Less
  than or equal to that
  of PI
  Insured Parents – Less
  than or equal to that of
  Insured Spouse
  (PI, if there is no
  Insured Spouse).
  Further, included
  parents shall be
  covered for equal
  benefits.
  Less than or equal
  to that of Insured
  Spouse (PI, if there is
  no Insured Spouse).
  Further, included
  children shall be
  covered for equal
  benefits.
  Initial Daily Benefit shall be in multiple of 500/- *The total Initial Daily Benefit under all policies issued to an individual under this plan shall not exceed 10,000/-
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  The benefits under this plan are payable in terms of Applicable
  Daily Benefit (ADB):
  Applicable Daily Benefit means the amount of Hospital Cash
  Benefit in a Policy Year reckoned as follows:
  a) During the first three years of cover starting from the Effective
  Date of Cover in respect of an Insured, the Applicable Daily
  Benefit shall be equal to the Initial Daily Benefit (i.e. the level
  of Hospital Cash Benefit) chosen by the Principal Insured.
  b) After the third year of cover, the Applicable Daily Benefit of
  the previous Policy Year shall be increased by way of ‘Auto
  Step Up Benefit’ (as specified under Para 3.I below) and ‘No
  Claim Benefit’ (as specified under Para 3.II. below). And the
  resulting amount shall be the Applicable Daily Benefit for
  that Policy Year.

1. Benefits payable on inpatient hospitalisation during the
   Cover Period:
   I. Hospital Cash Benefit (HCB):If any of the Insured(s) is hospitalised
   due to Accidental Body Injury or Sickness and the stay in hospital
   exceeds a continuous period of 24 hours, then for any continuous
   period of 24 hours or part thereof(after having completed the 24
   hours), provided any such part stay exceeds a continuous period
   of 4 hours in a non-ICU ward/room of a hospital, an amount equal
   to the Applicable Daily Benefit (ADB)available under the policy
   during that policy year shall be payable, regardless of actual costs
   of treatment, subject to Benefit Limits and Conditions mentioned
   in Para 14.I, Waiting Period mentioned in Para 17 and Exclusions
   mentioned in Para 18 below.
   If any of the Insured(s) is required to stay in an Intensive Care
   Unit of a hospital, two times the Applicable Daily Benefit will be
   payable subject to Benefit Limits and Conditions mentioned in
   Para 14.I., Waiting Period mentioned in Para 17 and Exclusions
   mentioned in Para 18 below.
   During a period of 24 continuous hours (i.e. one day) of
   Hospitalisation, if the said Hospitalisation included stay in an
   Intensive Care Unit as well as in any other inpatient (non-Intensive
   Care Unit) ward of the Hospital, the Corporation shall pay benefits
   as if the admission was to the Intensive Care Unit provided that
   the period of Hospitalisation in the Intensive Care Unit was at
   least 4 continuous hours.
   II. Major Surgical Benefit: In the event of an Insured, due to medical
   necessity, undergoing one of the surgeries listed in Major Surgical
   Benefit Annexure, in a hospital due to Accidental Bodily Injury or
   Sickness, the respective benefit percentage of the Major Surgical
   Benefit Sum Assured, as specified against each of the eligible
   surgeries mentioned in Major Surgical Benefit Annexure, shall
   be payable subject to Benefit Limits and Conditions mentioned
   in Para 14.II., Waiting Period mentioned in Para 17 and Exclusions
   mentioned in Para 18 below. The Major Surgical Benefit Sum
   Assured is equal to 100 (one hundred) times the Applicable Daily
   Benefit for that Policy Year in respect of each Insured.
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   Hospital Cash Benefit will be paid over and above the lump sum
   Major Surgical Benefit based on the length of stay in the hospital.
   In addition, the following benefits shall also be available under
   Major Surgical Benefit:
   a. Ambulance Benefit:
   In the event that a Major Surgical Benefit (as mentioned in the
   Major Surgical Benefit Annexure) is payable and emergency
   transportation costs by an ambulance have been incurred,
   an additional lump sum of `1,000 will be payable in lieu of
   ambulance expenses.
   b. Premium Waiver Benefit:
   In the event that a Major Surgical Benefit falling under
   Category 1 or Category 2 (as mentioned in the Major Surgical
   Benefit Annexure) is payable in respect of any Insured, the
   total one year premium in respect of the Policy including
   Rider Premium (if opted for), from the date of instalment
   premium due coinciding with or next following the date of
   the Surgery will be waived.
   In case of multiple MSB claims (in respect of multiple/same
   Insured) falling under Category 1 or Category 2(as mentioned
   in the Major Surgical Benefit Annexure) in the same Policy
   year, premium waiver benefit will be available only once
   during the policy year.
   c. Major Surgical Benefit Restoration:
   In the event that 100% of Major Surgical Benefit Sum Assured
   is exhausted in a policy year in respect of an Insured due to
   the previous Major Surgical Benefit claims in that policy
   year, the next Major Surgical Benefit claim (i.e. in case of
   any specified surgeries as mentioned in the Major Surgical
   Benefit Annexure) in that policy year, post exhaustion of Sum
   Assured, will be covered, subject to:
   i. The subsequent Major Surgical Benefit claim should not
   be arising from or due to the previous Major Surgical
   Benefit claims in that policy year.
   ii. The subsequent Major Surgical Benefit claim should be
   for a different category/bucket (For e.g. Cardiovascular
   System, Digestive System etc.) than any of the previous
   Major Surgical Benefit claims in that policy year.
   iii. The subsequent Major Surgical Benefit claim
   should be for a different procedure (For e.g. CABG,
   Pancreatolithotomy etc.) than any of the previous Major
   Surgical Benefit claims in that policy year.
   III. Day Care Procedure Benefit: In the event of an Insured, due to
   medical necessity undergoing any specified Day Care Procedure
   mentioned in the Day Care Procedure Benefit Annexure, in a
   Hospital or Day Care Centre due to Accidental Bodily Injury or
   Sickness, a lump sum amount equal to 5 (five) times the Applicable
   Daily Benefit shall be payable, regardless of the actual costs
   incurred subject to Benefit Limits and Conditions mentioned in
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   Para 14.III., Waiting Period mentioned in Para 17 and Exclusions
   mentioned in Para 18 below.
   IV. Other Surgical Benefit: In the event of an Insured, due to
   medical necessity, undergoing any Surgery not listed under
   Major Surgical Benefit or Day Care Procedure Benefit causing
   the Insured’s Hospitalization to exceed continuous period of
   24 hours then, a daily benefit equal to 2.5 (two and half) times
   the Applicable Daily Benefit shall be payable regardless of the
   actual costs incurred for each continuous period of 24 hours or
   part thereof provided any such part stay exceeds a continuous
   period of 4 hours of Hospitalization, subject to Benefit Limits and
   Conditions mentioned in Para 14.IV., Waiting Period mentioned in
   Para 17 and Exclusions mentioned in Para 18 below.
   Hospital Cash Benefit will be paid over and above the Other
   Surgical Benefit based on the length of stay in the hospital.
   V. Medical Management Benefit: In the event of an Insured
   undergoing inpatient hospitalization, due to the following major
   medical conditions, a lump-sum of 2.5 times of Applicable Daily
   Benefit shall be payable regardless of the actual cost incurred,
   subject to Benefit Limits and Conditions mentioned in Para 14.V.,
   Waiting Period mentioned in Para 17 and Exclusions mentioned
   in Para 18 below.
   a. Dengue
   b. Malaria
   c. Pneumonia
   d. Pulmonary Tuberculosis
   e. Viral Hepatitis A
   Hospital Cash Benefit will be paid over and above the Medical
   Management Benefit based on the length of stay in the hospital.

VI. Extended Hospitalization Benefit :In the event of an
Insured undergoing a single period of continuous inpatient
hospitalization in excess of 30 days due to Accidental Body Injury
or Sickness, a lumpsum of 10 times of Applicable Daily Benefit
shall be payable regardless of the actual cost incurred, subject to
Benefit Limits and Conditions mentioned in Para 14.VI., Waiting
Period mentioned in Para 17 and Exclusions mentioned in Para
18 below.
Extended Hospitalization benefit would be payable in addition
to any applicable Hospital Cash Benefit, Major Surgical Benefit,
Other Surgical Benefit or Day Care Benefit payable for the same
event of inpatient hospitalization.

3. Other Benefits:
   I. Auto Step Up Benefit: Under this benefit, an amount equal to
   15% of Initial Daily Benefit shall be added to the Applicable Daily
   Benefit of the previous policy year. Such increase in the Applicable
   Daily Benefit shall be effected at the end of every third policy
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   anniversary during the Cover Period and shall continue to be
   added until Applicable Daily Benefit attains a maximum amount
   of 1.5 times the Initial Daily Benefit. Thereafter this amount in each
   Policy year in future shall remain at that maximum level attained
   i.e. no addition shall be made under this benefit.
   In case of all the Insured(s) covered at inception, the date on
   which Auto Step up Benefit is effected may be same. However,
   in respect of any Insured(s) joining subsequently, the date on
   which Auto Step up Benefit is effected may be different as the
   third policy anniversary shall be construed from ‘Effective Date of
   Cover’ of the respective Insured.
   In case the Auto Health Cover Benefit is triggered in respect of
   an Insured as detailed in Para 3.IV. below, Auto Step Up Benefit
   shall not be applicable. On expiry of Auto Health Cover Period,
   the conditions applicable for Auto Step Up Benefit shall be as
   specified in Para 3.IV.ii (Auto Health Cover Benefit).
   II. No Claim Benefit: In the event of every three claim free policy
   years, an amount equal to 5% (five percent) of the Initial Daily
   Benefit shall be added to the Applicable Daily Benefit at the end
   of the third claim free year; where, ‘Claim free policy years’ shall
   be construed in respect of the policy as a whole, that is, there are
   no claims in respect of any of the Insured(s) covered under the
   policy during the immediate previous three years. There shall be
   no maximum limit for this benefit throughout the cover period.
   Hence, even if any additional member is included after the Date of
   Commencement of Policy, the date of accrual of No Claim Benefit
   in respect of such additional member shall coincide with that of
   PI (i.e. No Claim Benefit shall be added for that additional Insured
   member from the policy anniversary on which ‘No Claim Benefit’
   is added in respect of Principal Insured). Hence, No Claim Benefit
   in respect of any such additional member may accrue even after
   a minimum period of one year from Effective Date of Cover and
   before completion of three policy years from his/her joining the
   policy. Therefore, the No Claim Benefit for Principal Insured and
   additional members will accrue concurrently irrespective of their
   date of joining the policy.
   On death of original PI, in case the Auto Health Cover Benefit
   is triggered/not triggered in respect of any of the Insured (as
   detailed in Para 3.IV.ii. below), No Claim Benefit (i.e. in respect
   of all the Insured members) shall be added in the event of three
   claim free policy years from the Date of Expiry of AHC period in
   respect of the Insured member for which AHC period expires in
   the last.
   III. Health Check-up Benefit:
   In addition to various benefits payable on hospitalization
   mentioned in Para 1. above, Health Check-up Benefit is also
   payable in respect of each of the Insured. Under this benefit, an
   amount equal to the actual expenses incurred but not exceeding
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   One half of Applicable Daily Benefit shall be payable in respect
   of each Insured towards Health Check-up expenses once in every
   3 policy years provided he/she undergoes Health Check-up and
   shares a copy of the medical report and the medical bills.
   IV. Death Benefit:
   i. On death of an Insured person other than the Principal
   Insured: The policy will continue in respect of other Insured(s)
   and premium payable in respect of the deceased Insured
   shall cease from the instalment premium due date coinciding
   with or next following the date of death of the Insured.
   ii. On death of Original Principal Insured: Auto Health Cover
   (AHC) Benefit (wherein the premiums payable under the
   Base Policy shall be waived for Auto Health Cover Period)
   as detailed below shall be available to the other Insured(s)
   covered under this policy and the policy shall continue. Auto
   Health Cover (AHC) Benefit shall be available to each of the
   eligible Insureds, as per terms and conditions mentioned in
   Para A below. If any of the Insured(s) do(es) not satisfy trigger
   condition for AHC Benefit, then the condition as specified in
   Para B below shall apply.
   In such an event, the new PI shall be as specified in Para 4
   below.
   Auto Health Cover (AHC) Benefit:
   In case of death of original Principal Insured, the policy shall
   continue with new PI along with other eligible surviving
   Insured(s) without any payment of premiums from the policy
   anniversary coinciding with or next following the date of
   death of the Principal Insured, for a further period of 15 years
   or up to specified age in respect of each of the Insureds,
   whichever is earlier, provided they are eligible for this AHC
   Benefit.
   The period for which AHC Benefit shall be applicable in
   respect of each of the eligible Insureds shall be denoted as
   “Auto Health Cover (AHC) Period”. The applicable Auto
   Health Cover Period for each eligible Insured shall be as
   detailed below:
   • For Insured Child(ren): AHC Period shall be a period of 15
   years or till the policy anniversary on which the Insured Child
   is 25 years, whichever is earlier.
   • For Insured Spouse/Insured Parent(s): AHC Period shall be
   a period of 15 years or till the policy anniversary on which
   the age of Insured Spouse/Parents is 70 years, whichever is
   earlier.
   (Note: The AHC Period mentioned above shall commence
   from the policy anniversary coinciding with or next following
   the date of death of the Principal Insured. On completion of
   AHC Period, as applicable to each Insured member, the cover
   in respect of remaining eligible Insured(s) can continue by
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   payment of premiums for, the outstanding term, if any. The
   premium payment, in such a case, shall commence from
   the policy anniversary date coinciding with the date of
   completion of the AHC Period).
   Hence, the Auto Health Cover Benefit will be triggered only
   if the age of Insured spouse / Insured Parent(s) as on the
   policy anniversary coinciding with or next following the date
   of death of PI is below 70 years and/or any of the Insured
   Child(ren) is below 25 years. In case any of the surviving
   Insured does not satisfy the criteria, the Auto Health Cover
   benefit will not be applicable for such Insured life and the
   condition as specified in B) below shall apply.
   A) Conditions applicable for Auto Health Cover Benefit:
   i. The policy should be in force, by payment of all due
   premiums, on the date of death of the PI and also till the start
   date of AHC Period.
   ii. AHC Benefit shall not be applicable if Principal Insured
   (whether sane or insane) commits suicide at any time within
   12 months from the Effective Date of Cover or within 12
   months from the date of revival,
   iii. The benefit of “Auto Health Cover” as mentioned above shall
   trigger in respect of each of the Insureds from the policy
   anniversary coinciding with or next following the date of
   death of the Principal Insured, provided such surviving
   Insured(s) satisfy the trigger condition.
   iv. During the AHC Period, the premiums under the Base Policy
   in respect of eligible Insured(s) shall be waived. However,
   premiums in respect of any riders, if opted for, shall not be
   waived and shall continue to be paid as per respective rider
   conditions. In case the rider premiums are not paid within
   the grace period, the rider benefits shall cease. Once the rider
   is ceased, it cannot be re-opted during the cover period.
   v. The benefit payable under the Base Policy during the AHC
   Period shall be based on the Applicable Daily Benefit as
   applicable in respect of each Insured as on the date of death
   of PI i.e. Applicable Daily Benefit shall remain at the same level
   during the AHC Period and no further increase in Applicable
   Daily Benefit by way of ‘Auto Step Up’ or ‘No Claims Benefit’
   shall apply during this period.
   vi. AHC Benefit shall be available in case of death of Original
   Principal Insured only. On the Insured Spouse/Parent
   becoming the new PI (as mentioned under Para 4 below),
   AHC benefit shall not be available on death of new Principal
   Insured.
   vii. If the AHC Benefit is triggered for any eligible Insured(s),
   the cover in respect of such member(s) shall continue till
   10
   the expiry of their respective AHC period. On expiry of the
   AHC period, the cover in respect of eligible Insured(s) can
   continue till their Date of Cover Expiry provided premiums in
   respect of such Insured member(s) are paid by the PI.
   If the premium in respect of any such Insured member(s)is not
   paid within the grace period; then his/her cover shall cease on
   the expiry of the grace period. The cover may be revived on the
   request of PI as specified under Para 10. B) below. The revival
   period of 5 years for each Insured post AHC shall be reckoned
   from the respective First Unpaid Premium for each such
   member.
   The Applicable Daily Benefit after the expiry of Auto Health
   Cover Period, under such cases shall be as specified in (viii)
   below.
   viii. Calculation of Applicable Daily Benefit on expiry of AHC
   Period in respect of each Insured:
   On expiry of AHC period in respect of an Insured, the
   Applicable Daily Benefit payable for such a member, for a
   period of three completed policy years, shall be based on
   the Applicable Daily Benefit as on the date of death of PI and
   thereafter the Auto Step Up Benefit shall be resumed.
   ‘No Claim Benefit’ (i.e. in respect of all the Insured members)
   shall be added to Applicable Daily Benefit only after
   completion of three claim free policy years from date of
   expiry of AHC period in respect of all the Insured(s) covered.
   If the date of expiry of AHC period is not same for all the
   insured(s), the No Claim Benefit shall be added to Applicable
   Daily Benefit in the event of three claim free policy years from
   the Date of Expiry of AHC period in respect of the insured
   member for which AHC period expires in the last.
   B) Conditions applicable if AHC Benefit is not triggered in respect
   of any of the Insureds i.e. the age of the Insured Spouse and/
   or age of the Insured Parent(s) is 70 years or above on the
   policy anniversary coinciding with or next following the date
   of death of PI:
   The cover in respect of such member(s) shall continue till their
   respective Date of Cover Expiry provided the premiums in
   respect of such Insured member(s) are paid. In such an event, the
   Applicable Daily Benefit for such member shall continue to be
   increased only by way of Auto Step-up Benefit, if any. However,
   No Claim Benefit for such members shall only be added in the
   event of three claim free policy years from the Date of Expiry of
   AHC period in respect of the Insured member for which AHC
   period expires in the last.
   If the premium in respect of such Insured member(s)is not paid
   within the grace period; then his/her cover shall cease on the
   expiry of the grace period. The cover may be revived on the
   request of PI as specified under Para 10(B) below.
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   V. Maturity Benefit: No benefits are payable at the end of the Cover
   Period and the Policy shall stand terminated.
4. Default provision for Insured Spouse/Parent to become
   Principal Insured on exit of original PI from the policy:
   On the exit of original PI in the event of death or expiry of his/
   her cover (where expiry of cover shall be on the Date of Cover
   Expiry of PI or on PI exhausting all the lifetime maximum Benefit
   Limits), the policy shall continue with the surviving Insured
   Spouse as new PI along with other eligible surviving Insured(s). If
   there is no Insured Spouse under the Policy; or if Insured Spouse
   has predeceased the PI; or if the Insured Spouse has exited from
   the policy, the policy shall continue with elder of the surviving
   Insured Parents as new PI along with other eligible surviving
   Insured(s).
   The premium for such new successive PI would be based on the
   then applicable tabular premium rates for Principal Insured and
   the age for calculation of revised premium rate will be his/her age
   at entry. However, the existing level of cover in respect of the new
   PI shall remain unaltered as applicable to him /her.
   In the event of the expiry of cover of PI or on death of PI (wherein
   AHC benefit is not triggered), the premium in respect of the
   new PI (Insured Spouse/Parent) will change with effect from the
   coinciding or following instalment premium due date.In case
   AHC benefit is triggered the premium in respect of the new PI
   will change with effect from the instalment premium due date
   coinciding with the date of expiry of his/her AHC Period.
   Further, Auto Health Cover Benefit (as mentioned in Para 3.IV.ii
   above) will not be available on death of the new PI.
5. Payment of Premiums:
   You may pay premiums regularly at yearly or half-yearly intervals
   over the Cover period.
   The premium in respect of each individual will be payable from
   the date of entry into the policy till the date of cover expiry under
   the policy and will depend on the age, gender of the insured
   member, the level of Hospital Cash Benefit (HCB) chosen whether
   the insured member is Principal Insured or any other Insured life
   (in case of cover for more than one member in a policy).
   The level of premium for Principal Insured and the other insured
   members shall be different for the same age and same level of
   cover.
   The total premium to be charged for a policy will be the sum of
   premiums in respect of each member to be covered in that
   policy.
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6. Premium Review:
   The premiums are guaranteed for 3 years from the date of
   commencement of policy in respect of each Insured covered at
   inception. Based on the experience of the portfolio under this
   Plan, the Corporation reserves the right to revise the premium
   rates any time after the completion of 3 policy years starting
   from the Date of Commencement of Policy, the premium rates
   for future years will be subject to revision in compliance with
   applicable Regulations from time to time. However, such revised
   rates shall be guaranteed for a further period of at least 3 years.
   The instalment premium on each review will be based on age at
   entry i.e. age as on the Date of Commencement of Policy/ age at
   the time of inclusion into the policy, as the case may be and the
   Corporation’s premium rates then prevailing for this product.
   If any additional member is included in the policy after the Date
   of Commencement of Policy, the premium charged in respect
   of that member will be guaranteed till the policy anniversary
   on which the premium rates are revised in respect of Principal
   Insured and hence may change even before completion of 3
   years from his/her joining the policy. Thereafter the premium
   rates for Principal Insured and additional members will be revised
   concurrently (i.e. the period of three years shall reckoned from the
   Date of Commencement of Policy/date from which the premiums
   are reviewed).
   Any such revision in premium rates under a policy, after the
   approval from the Authority, shall be notified to each policy
   holder at least ninety days prior to the date when such review
   or modification comes into effect. However, the policyholder has
   the option to cancel the policy, if not agreed with the revised
   instalment premium for this plan.
   The instalment premium for both the optional riders is however
   guaranteed throughout the term for which cover is provided.
7. Sample Illustrative Premium:
   Tables below give an indicative annual premium, for all health
   benefits corresponding to an Initial Daily Benefit of 5000 per day, for some of the ages in respect of various lives that can be covered under a single policy: PRINCIPAL INSURED (Male) Age at entry Premium ()
   20 7,884
   30 9,543
   40 12,381
   50 17,254
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   SPOUSE (Female)
   Age of PI at the
   time of inclusion
   of Spouse
   Age at entry of
   Spouse
   Premium () 30 25 7,121 35 30 8,130 50 45 12,503 55 50 14,312 CHILD Age of PI at the time of inclusion of Child Age at entry - Child Premium ()
   25 0 3,331
   30 5 3,358
   40 10 3,481
   50 15 3,830
   PARENT (Male)
   Age of PI at the
   time of inclusion of
   other member
   Age at entry –
   Parent Premium (`)
   25 50 16,727
   30 55 19,799
   35 60 22,961
   40 65 26,105
   The above premiums are exclusive of Taxes.
8. Modal loading and HCB Rebates:
   i. Modal Loading:
   Mode Loading (as a % of Tabular
   Premium)
   Yearly Nil
   Half-yearly 1.50%
   ii. HCB Rebates:
   In respect of a member covered under a policy, if HCB is 4000 or above, then the premium arrived at in respect of that member shall be reduced by an amount () given below:
   HCB () For PI () For each Insured
   member other than PI (`)
   4000 & 4500 400 200
   5000 & 5500 700 350
   6000 & 6500 1000 500
   7000 & 7500 1400 700
   8000 & 8500 1800 900
   9000 & 9500 2300 1150
   10000 2800 1400
   14
9. Options:
   I) Cover to new additional members:
   If the Principal Insured gets married/ remarried during the Cover
   Period, the spouse can be included in the Policy within Twelve
   months from the date of marriage/remarriage, but the Cover
   shall start from the policy anniversary coinciding with or next
   following the date of inclusion. Enhanced premiums shall be due
   from such policy anniversary.
   Any child born/legally adopted after taking the Policy can
   be covered from the next immediate policy anniversary date
   following the date on which the child completes the age of
   91 days. If the age of the legally adopted child on the date of
   adoption is more than 91 days, the child can be covered from
   the policy anniversary coinciding with or next following the date
   of adoption. Enhanced premiums shall be due from such policy
   anniversary.
   Such changes will be carried out subject to receipt of the proof of
   the event by the Corporation and will also be subject to fulfillment
   of underwriting conditions of the Corporation. Waiting periods
   and Exclusions will apply for the new Insured.
   Addition in any other case will not be allowed. The existing
   spouse, parents, and children, if not covered at the time of taking
   policy, shall not be covered under the policy.
   If both of the parents (father and mother) are alive and are eligible
   for cover, then either both of them will have to be covered or
   none of them will be covered. The PI will not have any option to
   choose one of them.
   Any addition of new lives shall be allowed by the original Principal
   Insured only. After the death of original Principal Insured, no
   addition will be allowed.
   II) Removal of existing members:
   In the event of death or divorce, an Insured may be removed
   from coverage upon request by the Principal Insured in writing.
   This will be effective from the instalment premium due date
   coinciding with or next following the date of such a request. No
   further premiums are due in respect of that Insured from such
   instalment premium due date.
   In any other circumstances, removal of an existing Insured will be
   permitted at the sole discretion of the Corporation.
   III) Option to migrate:
   Children covered under this Plan shall have the option to take a
   suitable new health insurance policy (subject to underwriting) on
   the policy anniversary coinciding with or immediately following
   the completion of 25 years of age.
   15
   i) The new policy should be purchased within 90 days of the
   termination of child’s cover from the existing policy.
   ii) The Insured member shall be eligible for suitable credits
   gained for pre-existing conditions and time bound exclusions
   for all the previous years, provided the policy is in-force. The
   outstanding Waiting periods and outstanding period of any
   Exclusion will however apply under the new policy.
   iii) These credits shall be available up to a maximum of the
   current SA level under the existing policy.
   iv) Other terms and conditions including premium rates will be
   as applicable for the new policy.
   IV) Quick Cash facility:
   If any of the insured lives undergoes any eligible surgery falling
   under Category 1 or Category 2 (as mentioned in the Major
   Surgical Benefit Annexure) of Major Surgical Benefit, in any of the
   listed network hospitals, the PI will have an option to avail Quick
   Cash facility. Under this facility, 50% of eligible Major Surgical
   Benefit amount would be made available even during the period
   of hospitalization of any of the insured lives covered (the surgery
   may be either planned or emergency due to accident) instead
   of waiting for making a claim for the benefit after discharge. It
   will be only an advance payment to the Principal Insured in the
   event of hospitalization for any Major Surgical Benefit defined
   in the surgeries listed under categories 1 or 2 (as mentioned in
   the Major Surgical Benefit Annexure) and permissible under the
   policy conditions of the Plan. This will be, however, subject to
   approval from the Corporation, and the advance amount will be
   adjusted from the final settlement of Major Surgical Benefit claim
   amount.
   This facility of advance payment could be availed by submitting
   the Bank Account details of the Principal Insured in the prescribed
   format. The amount of advance shall be credited in the Principal
   Insured’s bank account directly.
   V) LIC’s New Term Assurance Rider (512B210V01):
   Original PI and/ or Insured Spouse may opt for Term Assurance
   as optional rider up to the MSB SA. This rider is available at the
   time of inception/inclusion into the policy. This benefit shall be
   available only till the policy anniversary on which the age nearer
   birthday of the Insured is 75 years or for a term of 35 years starting
   from the date of cover commencement, whichever is earlier. In
   case of unfortunate death, an amount equal to Term Assurance
   Sum Assured will be payable on death during the term for which
   Term Assurance Rider is opted for. For more details on the above
   riders, refer to the rider brochure or contact LIC’s nearest Branch
   Office.
   VI) LIC’s Accident Benefit Rider (512B203V03):
   Original PI and/ or Insured Spouse may also opt for Accident
   Benefit Rider if Term Assurance Rider has been opted for.
   Maximum Accident Benefit Sum Assured shall be equal to the
   Term Assurance Rider SA. LIC’s Accidental Benefit Rider can be
   16
   opted for at any time provided the outstanding premium paying
   term of the LIC’s New Term Assurance Rider is atleast five years but
   before the policy anniversary on which the age nearer birthday of
   life assured is 65 years. In case of unfortunate death due to an
   accident, a sum equal to the Accident Benefit Sum Assured shall
   be payable.
   Accident Benefit Rider will be available under the Plan by
   payment of additional premium of 0.50 (exclusive of taxes) for every 1,000/- of the Accident Benefit Sum Assured per policy
   year in respect of each life to be covered.
   The additional premium for this benefit will not be required to be
   paid on and after the Policy anniversary on the expiry of LIC’s New
   Term Assurance Rider or LIC’s Accident Benefit Rider, whichever
   is earlier. For more details on the above riders, refer to the rider
   brochure or contact LIC’s nearest Branch Office.
10. Other Features:
    A) Grace Period: A grace period of 30 days will be allowed for
    payment of yearly or half yearly premiums.
    If premium is not paid before the expiry of the days of grace, the
    Policy lapses and all the benefits payable under this Plan will
    cease.
    B) Revival: A policy lapsed due to non-payment of premiums may be
    revived by the PI within a period of 5 consecutive years from the
    due date of first unpaid premium but before the expiry of cover
    in respect of PI.
    There may be a possibility that while premiums are not required to
    be paid in respect of one or more Insured(s) due to continuation of
    AHC period, premiums in respect of one or more other Insured(s)
    become payable, either because AHC benefit is not triggered or
    AHC period is completed in respect of such Insured(s). Under
    such circumstances, the revival shall be applicable in respect
    of all those Insured(s) for whom the premiums are due but not
    paid within the grace period. The cover in respect of such Insured
    member(s) may be revived on the request of the PI within a period
    of 5 consecutive years from the due date of their respective first
    unpaid premium but before the expiry of cover in respect of PI
    as well as that of such Insured(s). The Insured member shall be
    exited from the policy if the cover is not revived within 5 years of
    the First Unpaid Premium for such a member.
    The revival shall be effected on payment of all the arrears of
    premium(s) as applicable together with interest (compounding
    half-yearly) at such rate as may be fixed by the Corporation from
    time to time and on satisfaction of Continued Insurability of
    each such Insured whose cover is to be revived on the basis of
    information, documents and reports that are already available
    and any additional information in this regard if and as may be
    required in accordance with the Underwriting Policy of the
    17
    Corporation at the time of revival, being furnished by the Principal
    Insured/Insured.
    Waiting periods and Exclusions, as described in Para 17 and 18
    respectively, will apply on revival.
    The Corporation reserves the right to accept at original
    terms, accept with modified terms or decline the revival of a
    discontinued policy/revival of cover of Insured member(s). The
    revival of the discontinued policy shall take effect only after the
    same is approved, accepted and revival receipt is issued by the
    Corporation.
    The rate of interest applicable for revival under this Plan for every
    12 months’ period from 1st May to 30th April shall not exceed
    10-year G-Sec Rate as p.a. compounding half-yearly as at the last
    trading day of previous financial year plus 300 basis points. For the
    12 months’ period commencing from 1st May, 2020 to 30th April,
    2021 the applicable interest rate shall be 9.5% p.a. compounding
    half-yearly.
    Revival of Rider(s), if opted for, will only be considered along with
    the revival of the Base Policy and not in isolation.
    No benefit will be paid for an event that occurred during the
    lapse period till the Date of Revival when the Policy/cover was in
    a discontinued state.
    Further, if the premium review date(s) falls between the revival
    period and revival is done after the Premium Review Date, the
    premium before and after the Premium Review Date may be
    different on account of revision in rates. In such case, premium
    rate as applicable on respective due dates shall apply. However,
    there shall be no change in premium rates if the revival is effected
    before the premium review date.
    The policy will terminate at the end of revival period if the same
    is not revived. No revival of policy/cover will be allowed after the
    expiry of revival period.
    C) Surrender:
    No surrender value will be available under the Plan.
11. Free Look period:
    If you are not satisfied with the “Terms and Conditions” of the
    policy, you may return the policy to us within 15 days from the
    date of receipt of the policy bond stating the reasons of objection.
    The Corporation will cancel the policy and return the premium
    paid subject to the following deductions: 1) Stamp duty on the
    policy 2) Proportionate Risk Premium (for Base Policy (shall not
    be applicable during the waiting period) and Rider(s), if opted for)
    for the period of cover 3) Any expense borne by the Corporation
    on medical examination and special reports, if any of the Insured
    persons.
    18
12. Loan:
    No loan will be available under this Plan.
13. Assignment:
    No Assignment will be allowed under this Plan.
14. Benefit Limits and Conditions:
    I. Hospital Cash Benefit Limits and Conditions:
    i. The Hospital Cash Benefit shall be payable only if
    Hospitalisation has occurred within India.
    ii. The total number of days for which hospital cash benefit
    would be payable, in respect of each Insured, in a Policy Year
    would be restricted to –
    a. A maximum of 30 (thirty) days of Hospitalization
    (inclusive of stay in Intensive Care Unit) in the first Policy
    Year following the Effective Date of Cover in respect of
    that Insured.
    b. A maximum of 90 (ninety) days of Hospitalization
    (inclusive of stay in Intensive Care Unit) in the second
    and subsequent Policy Years following the Effective Date
    of Cover in respect of that Insured.
    Hospital Cash Benefit paid for hemodialysis and radiotherapy
    will also be included under this maximum limit.
    iii. The total number of days of Hospitalization for which
    Hospital Cash Benefit is payable during the Cover Period, in
    respect of each and every Insured covered under the policy,
    shall be limited to a maximum of 900 (nine hundred) days
    (inclusive of stay in Intensive Care Unit). Upon attainment of
    this limit by an Insured, the Hospital Cash Benefit in respect
    of that Insured shall cease immediately.
    iv. The Benefit Limits specified in the above clauses in respect of
    an Insured under the Policy, shall solely and exclusively apply
    to that Insured. Any unclaimed Hospital Cash Benefit of any
    one Insured is not transferable to any other Insured.
    v. The Hospital Cash Benefit shall not be payable in the event
    of an Insured undergoing any specified Day Care Procedure
    (as mentioned in the Day Care Procedure Benefit Annexure)
    except for maintenance hemodialysis and radiotherapy.
    vi. Though hemodialysis and radiotherapy are Day Care
    Procedure, the Hospital Cash Benefit shall also be payable for
    these two procedures even if stay in hospital/day care centre
    is less than 24 hrs.
    II. Major Surgical Benefit Limits and Conditions:
    i. If more than one Surgery is performed on the Insured, during
    the same surgical session, the Corporation shall pay 100%
    as per the category in respect of the most severe Surgery
    performed and for other surgeries 25% of the eligible
    amount shall be paid. This benefit shall be paid for each
    of the additional surgery done in the single session and is
    subject to the overall annual and lifetime limits.
    ii. The Major Surgical Benefit shall be paid as a lump sum as
    19
    specified for the benefit concerned and is subject to providing
    proof of Surgery to the satisfaction of the Corporation.
    iii. All Surgical Procedures claimed should be confirmed as
    essential and required, by a qualified Physician or Surgeon,
    to the satisfaction of the Corporation.
    iv. The Major Surgical Benefit will be payable only after the
    Corporation is satisfied on the basis of medical evidence
    that the specified Surgery covered under the Plan has been
    performed.
    v. The Major Surgical Benefit shall be payable only if the Surgery
    has been performed within India.
    vi. The total amount payable in respect of each Insured under
    the Major Surgical Benefit in any Policy Year during the Cover
    Period shall not exceed 100% of the Major Surgical Benefit
    Sum Assured in that Policy year. In the event that the Major
    Surgical Benefit Sum Assured is exhausted in a policy year the
    next Major Surgical Benefit claim shall be subject to Major
    Surgical Benefit Restoration as specified in Para 1.II.c above.
    vii. The total amount payable in respect of each Insured during
    the Cover Period under the Major Surgical Benefit shall not
    exceed a maximum limit of 1000% of the Major Surgical
    Benefit Sum Assured i.e. 1000 times the ADB applicable for
    the policy year in which the claim arises. If the total amount
    paid in respect of an Insured equals this lifetime maximum
    limit, the Major Surgical Benefit in respect of that Insured will
    cease immediately.
    viii. The Benefit Limits specified in the above clauses in respect of
    an Insured under this Policy, shall solely and exclusively apply
    to that Insured. Any unclaimed Major Surgical Benefit of any
    one Insured is not transferable to any other Insured.
    ix. The Major Surgical benefit for any surgery cannot be claimed
    and shall not be payable more than once for the same
    surgery during the Cover Period. Also, PTCA (Percutaneous
    Transluminal Coronary Angioplasty) conducted under
    multiple sittings cannot be claimed and shall not be payable
    more than once.
    x. If Major Surgical Benefit is payable, Medical Management
    Benefit would not be payable for the same event of
    hospitalization.
    In addition, the following benefits and limits are applicable:
    a) Ambulance Benefit Limits and Conditions:
    The lumpsum payable in case of Ambulance transportation
    expenses shall be payable for covered Major Surgical
    Benefit in respect of each Insured, provided the ambulance
    transportation is medically necessary and is subject to
    providing satisfactory evidence to the Corporation.
    b) Major Surgical Benefit Restoration Benefit Limits and
    Conditions:
    i. In any Policy Year during the Cover Period in respect of
    each Insured, only the first Major Surgical Benefit claim post
    exhaustion of 100% of Major Surgical Benefit Sum Assured,
    20
    would be payable in line with the applicable benefit payout
    level (as mentioned in the Major Surgical Benefit Annexure)
    for the covered procedure.
    ii. The Major Surgical Benefit Restoration claim shall be paid
    as a lump sum as specified for the benefit concerned and is
    subject to providing proof of Surgery to the satisfaction of
    the Corporation.
    iii. All Surgical Procedures claimed should be confirmed as
    essential and required, by a qualified Physician or Surgeon,
    to the satisfaction of the Corporation.
    iv. The Major Surgical Benefit Restoration claim will be payable
    only after the Corporation is satisfied on the basis of medical
    evidence that the specified Surgery covered under the Plan
    has been performed.
    v. The Major Surgical Benefit Restoration claim shall be payable
    only if the Surgery has been performed within India.
    vi. The Major Surgical Benefit Restoration claim shall be payable
    only once in any Policy year in respect of each Insured i.e., the
    total amount payable in respect of each Insured under such
    Major Surgical Benefit Restoration claim in any Policy Year
    during the Cover Period shall not exceed 100% of the Major
    Surgical Benefit Sum Assured in that Policy year.
    vii. The Major Surgical Benefit Restoration claim shall be payable
    only up to a maximum of 10 (ten) times during the Cover
    Period in respect of each Insured.
    viii. The Benefit Limits specified in the above clauses in respect of
    an Insured, shall solely and exclusively apply to that Insured.
    Any unclaimed Major Surgical Benefit Restoration claim on
    any one Insured is not transferable to any other Insured.
    III. Day Care Procedure Benefit Limits and Conditions:
    i. If more than one Day Care Procedure is performed on the
    Insured, through the same incision or by making different
    incisions, during the same surgical session, the Corporation
    shall only pay for one Day Care Procedure performed.
    ii. The Day Care Procedure Benefit shall be paid as a lump sum
    and is subject to providing proof of Surgery/Procedure to the
    satisfaction of the Corporation.
    iii. All Day Care Procedures claimed should be confirmed as
    essential and required, by a qualified Physician or Surgeon,
    to the satisfaction of the Corporation.
    iv. The Day Care Procedure Benefit will be payable only after the
    Corporation is satisfied on the basis of medical evidence that
    the specified Day Care Procedure covered under the Plan has
    been performed.
    v. The Day Care Procedure Benefit shall be payable only if the
    Day Care Procedure has been performed within India.
    vi. In respect of each Insured, the Day Care Procedure Benefit
    will be payable only up to a maximum of 3 (three) Day Care
    Procedures in any Policy Year during the Cover Period.
    21
    vii. In respect of each Insured during the Cover Period, the Day
    Care Procedure Benefit will be payable only up to a lifetime
    maximum of 30 (thirty) Day Care Procedures. If the number
    of Day Care Procedures eligible for the Day Care Procedure
    Benefit in respect of an Insured equals this lifetime maximum
    limit, the Day Care Procedure Benefit in respect of that
    Insured will cease immediately.
    viii. The Benefit Limits specified in the above clauses in respect of
    an Insured under the Policy, shall solely and exclusively apply
    to that Insured. Any unclaimed Day Care Procedure Benefit
    of any one Insured is not transferable to any other Insured.
    ix. If a Day Care Procedure is performed no Hospital Cash
    Benefit shall be paid (except for maintenance hemo dialysis
    and radiotherapy) even if the hospitalization for a day care
    procedure exceeds 24 hours.
    x. If Day Care Benefit is payable, Medical Management Benefit
    would not be payable for the same event of hospitalization.
    IV. Other Surgical Benefit Limits and Conditions:
    i. If more than one Surgical Procedure is performed on the
    Insured, through the same incision or by making different
    incisions, during the same surgical session, the Corporation
    shall only pay for one Surgical Procedure.
    ii. The Other Surgical Benefit shall be paid as a Daily Benefit and
    is subject to providing proof of Surgery to the satisfaction of
    the Corporation.
    iii. All Surgical Procedures claimed should be confirmed as
    essential and required, by a qualified Physician or Surgeon,
    to the satisfaction of the Corporation.
    iv. The Other Surgical Benefit will be payable only after the
    Corporation is satisfied on the basis of medical evidence that
    the specified Surgical Procedure has been performed.
    v. The Other Surgical Benefit shall be payable only if the Surgical
    Procedure has been performed within India.
    vi. The total number of days of Hospitalization for which the
    Other Surgical Benefit is payable during a Policy Year in
    respect of each and every Insured covered under the Policy
    shall not exceed 15 (fifteen) days in the first Policy Year from
    the Effective Date of Cover in respect of that Insured and 45
    (forty five) days for the second and subsequent Policy Years
    from the Effective Date of Cover in respect of that Insured.
    vii. The total number of days of Hospitalization for which the
    Other Surgical Benefit is payable during the Cover Period,
    in respect of each and every Insured covered under the
    Policy shall not exceed a lifetime maximum limit of 450 (four
    hundred and fifty) days. Upon attainment of this lifetime
    maximum limit, the Other Surgical Benefit in respect of that
    Insured will cease immediately.
    viii. The Benefit Limits specified in the above clauses in respect of
    an Insured under this Policy, shall solely and exclusively apply
    to that Insured. Any unclaimed Other Surgical Benefit on any
    one Insured is not transferable to any other Insured.
    ix. If Other Surgical Benefit is payable, Medical Management
    Benefit would not be payable for the same event of
    hospitalization.
    22
    V. Medical Management Benefit Limits and Conditions:
    i. The Medical Management Benefit shall be paid as a lump sum,
    subject to providing proof of hospitalization for the specified
    medical condition, to the satisfaction of the Corporation.
    ii. The Medical Management benefit shall be payable only if
    Hospitalisation and treatment has occurred within India.
    iii. In respect of each Insured, the Medical Management Benefit
    would be payable maximum of 2 (two) times in each Policy
    Year during the Cover Period
    iv. In respect of each Insured during the Cover Period, the
    Medical Management Benefit will be payable only up to a
    lifetime maximum limit of 20 (twenty) times. If the Medical
    Management Benefit in respect of an Insured equals this
    lifetime maximum limit, the Medical Management Benefit in
    respect of that Insured will cease immediately.
    v. The Benefit Limits specified in the above clauses in respect of
    an Insured, shall solely and exclusively apply to that Insured.
    Any unclaimed Medical Management Benefit on any one
    Insured is not transferable to any other Insured.
    vi. Medical Management Benefit would not be payable if Major
    Surgical Benefit, Other Surgical Benefit or Day Care benefits
    are payable for the same event of inpatient hospitalization.
    VI. Extended Hospitalization Benefit Limits and Conditions:
    i. Extended Hospitalization Benefit shall be paid as a lump
    sum, subject to providing proof of inpatient hospitalization
    to the satisfaction of the Corporation.
    ii. Extended Hospitalization Benefit shall be payable only if
    Hospitalization has occurred within India.
    iii. In respect of each Insured, the Extended Hospitalization
    Benefit would be payable maximum of 1 (one) time in each
    Policy Year during the Cover Period
    iv. In respect of each Insured during the Cover Period, the
    Extended Hospitalization Benefit will be payable only up to
    a lifetime maximum limit of 10 (ten) times. If the Extended
    Hospitalization Benefit in respect of an Insured equals this
    lifetime maximum limit, the Extended Hospitalization Benefit
    in respect of that Insured will cease immediately.
    v. The Benefit Limits specified in the above clauses in respect of
    an Insured under the Policy, shall solely and exclusively apply
    to that Insured. Any unclaimed Hospital Cash Benefit of any
    one Insured is not transferable to any other Insured.
    VII. Health Check-up Benefit Limits and Conditions:
    i. In respect of each Insured, the Health Check-up Benefit would
    be payable only once every 3 (three) Policy Year during the
    Cover Period.
    ii. The Benefit Limits specified in the above clauses in respect of
    an Insured, shall solely and exclusively apply to that Insured.
    Any unclaimed Health Check-up Benefit on any one Insured
    is not transferable to any other Insured.
    iii. Health Check-up Benefit shall be payable only if the Health

Check-up is done within India.

23
A short summary of Benefits and their Limits, subject to terms and
conditions mentioned in this document, are as under:
S.
No. Benefits Event Amount of
Benefit
Annual
Benefit
Limit
Lifetime
Maximum
Benefit
Limit
Additional Benefit(s) payable
1
Hospitalisation
Cash Benefit
(HCB)
Hospitalisation
(Non ICU ward)
Applicable Daily
Benefit (ADB)
for each day of
hospitalisation
Year 1:
30 days
Year 2
onwards:
90 days
900 Days
i. Extended Hospitalisation
Benefit as mentioned under
S. No. 6 below, if applicable.
Hospitalisation
(ICU ward)
Two times of
ADB for each day
of hospitalisation
2 Major Surgical
Benefit (MSB)
Undergoing
a Surgical
Procedure (as
mentioned in
MSB Annexure)
in a Hospital
Lump Sum
Benefit equal
to percentage
of MSB Sum
Assured based
on the surgery
performed;
where MSB Sum
Assured is 100
times of ADB
100% of
MSB Sum
Assured.
10 times the
MSB Sum
Assured.
i. HCB based on the length of
stay in the hospital.
ii. Ambulance Benefit: Lump
sum of Rs 1,000 payable if
ambulance service is availed.
iii. Premium Waiver Benefit:
Total one year premium
will be waived if MSB
falling under Category 1 or
Category 2 is performed.
iv. MSB Restoration: On
exhaustion of annual limit of
100% of MSB Sum Assured,
next MSB claim in that policy
year shall also be covered
(subject to maximum of
10 times during the Cover
period).
v. Extended Hospitalisation
Benefit as mentioned under
S. No. 6 below, if applicable.
3
Day Care
Procedure
Benefit
(DCPB)
Undergoing
a Day Care
Procedure (as
mentioned in
DCPB Annexure)
in a Hospital or
Day Care centre
Lump Sum
Benefit equal to
5 times of ADB
3-day care
procedures
30-day care
procedures
i. HCB shall be payable only
if DCPB is hemodialysis or
radiotherapy.
ii. Extended Hospitalisation
Benefit as mentioned under
S. No. 6 below, if applicable.
4 Other Surgical
Benefit (OSB)
Undergoing
any Surgical
Procedure other
than those
mentioned
under MSB
and DCPB in a
Hospital
2.5 times of ADB
for each day of
hospitalisation
Year 1:
15 days
Year 2
onwards: 45
days
450 Days
i. HCB based on the length of
stay in the hospital.
ii. Extended Hospitalisation
Benefit as mentioned under
S. No. 6 below, if applicable.
5
Medical
Management
Benefit (MMB)
Inpatient
Hospitalisation
due to Dengue/
Malaria/
Pnuemonia/
Pulmonary
Tuberculosis /
Viral Hepatitis A
Lump Sum
Benefit equal to
2.5 times of ADB
2 times 20 times
HCB based on the length of stay
in the hospital.
6
Extended
Hospitalisation
Benefit (EHB)
Single period
hospitalisation
in excess of 30
days (Payable
in addition to
HCB,MSB,OSB
and DCPB)
Lump Sum
Benefit equal to
10 times of ADB
1 time 10 times –
7 Health Check
Up Benefit

Actual costs subject to a maximum of one-half of ADB once in every 3 years

24

15. Commencement and Termination of Benefit Covers:
    The Hospital Cash Benefit, Major Surgical Benefit, Day Care
    Benefit, Other Surgical Benefit, Medical Management Benefit and
    Extended Hospitalization Benefit cover in respect of each Insured
    covered under your policy shall commence on their respective
    Effective Date of Cover.
    The Hospital Cash Benefit, Major Surgical Benefit, Day Care
    Procedure Benefit, Other Surgical Benefit, Medical Management
    Benefit and Extended Hospitalization Benefit cover in respect of
    each Insured shall terminate at the earliest of the following:
    i. The Date of Cover Expiry;
    ii. On death of the Insured;
    iii. On attaining the lifetime maximum Benefit Limits as specified
    in Para 14. above;
    iv. In respect of the Insured Spouse, on divorce or legal
    separation from the Principal Insured;
    v. On non-payment of premium within the revival period in
    respect of such Insured;
    vi. On termination of the Policy due to non-payment of
    premium/absence of any eligible PI under the Policy/ any
    other reason.
16. Termination of Policy:
    A) If policy is issued on single life:
    The policy shall terminate at the earliest of the following:
    i. Non-payment of premiums within the revival period;
    ii. On death;
    iii. On the Date of Cover Expiry;
    iv. On exhausting all the lifetime maximum Benefit Limits as
    specified in Para 14 above;
    v. On payment of free look cancellation amount;
    vi. If the Policyholder cancels the Policy after premium review,
    if any;
    vii. On grounds of misrepresentation, fraud, non-disclosure, or
    non-cooperation of the insured.
    B) If policy is issued on more than one life:
    The policy shall terminate at the earliest of the following:
    i. Non-payment of premiums in respect of each Insured
    member within the revival period;
    ii. If AHC is not being available to any of the Insured, on exit of
    last successive PI;
    iii. If AHC is being available in respect of any of the Insured, on
    exit of last successive PI and thereafter on the earliest of the
    following in respect of the last eligible Insured member:
    a. expiry of AHC period;
    b. on death;
    c. on exhaustion of all the lifetime maximum Benefit Limits
    as specified in Para 14 above;
    iv. On payment of free look cancellation amount;
    v. If the Policyholder cancels the policy after premium review, if
    any;
    25
    vi. On grounds of misrepresentation, fraud, non-disclosure or
    non-cooperation of any of the insured.
17. Waiting Period:
    General waiting period:
    There shall be no general waiting period in case Hospitalization
    or Surgery is due to Accidental Bodily Injury occurring on or after
    the Effective Date of Cover of the policy. There shall be a general
    waiting period during which no benefits shall be payable in the
    event of Hospitalization or Surgery, if the said Hospitalization or
    Surgery occurred due to Sickness.
    i. The general waiting period shall be 90 (ninety) days from the
    Effective Date of Cover in respect of each Insured.
    ii. If the policy/cover in respect of Insured member(s) is revived
    after discontinuance of the Cover then the following shall
    apply in respect of each Insured:
    a. If the request for revival is received by the Corporation
    within 90 (ninety) days from the due date of the first
    unpaid premium, then there shall be a general waiting
    period of 45 (forty-five) days from the Date of Revival in
    respect of each Insured.
    b. If the request for revival is received by the Corporation
    beyond 90 (ninety) days from the due date of the first
    unpaid premium, then there shall be a general waiting
    period of 90 (ninety) days from the Date of Revival in
    respect of each Insured.
    Specific waiting period:
    In addition, in respect of each Insured, no benefits are available
    hereunder and no payment will be made by the Corporation
    for any claim under the Policy on account of Hospitalization or
    Surgery directly or indirectly caused by, based on, arising out of or
    howsoever attributable to any of the following during the specific
    waiting period:
    i. Treatment for adenoid or tonsillar disorders
    ii. Treatment for anal fistula or anal fissure
    iii. Treatment for benign enlargement of prostate gland
    iv. Treatment for benign uterine disorders like fibroids, uterine
    prolapse, dysfunctional uterine bleeding etc
    v. Treatment for Cataract
    vi. Treatment for Gall stones
    vii. Treatment for slip disc
    viii. Treatment for Piles
    ix. Treatment for Benign Thyroid Disorders
    x. Treatment for Hernia
    xi. Treatment for Hydrocele
    xii. Treatment for Degenerative Joint Conditions
    xiii. Treatment for Sinus Disorders
    xiv. Treatment for Kidney or Urinary Tract Stones
    xv. Treatment for Varicose Veins
    xvi. Treatment for Carpal Tunnel Syndrome
    xvii. Treatment for Benign Breast Disorders e.g. Fibroadenoma,
    Fibrocystic disease etc
    26
    xviii. Treatment for Benign Ovarian disorders
    xix. Treatment for Gastric/Duodenal Ulcer
    xx. Treatment for Retinal disorders
    xxi. Treatment for Knee/Joint Replacement Surgery (other than
    caused by an accident)
    xxii. Treatment for Osteoporosis or Osteoarthritis
    xxiii. Treatment for Chronic renal failure or end stage renal failure
    xxiv. Treatment for Internal Congenital disease or defects or
    anomalies
    The specific waiting period in respect of the treatments specified
    in the list above shall be as follows:
    i. The specific waiting period shall be 2 (two) years from the
    Effective Date of Cover in respect of each Insured.
    ii. If the policy/cover in respect of Insured member(s) is revived
    after discontinuance of the Cover then the following shall
    apply in respect of each Insured:
    a. If the request for revival is received by the Corporation
    within 90 (ninety) days from the due date of the first
    unpaid premium, then the specific waiting period shall
    continue to be till 2 (two) years from the Effective Date
    of Cover in respect of each Insured.
    b. If the request for revival is received by the Corporation
    beyond 90 (ninety) days from the due date of the first
    unpaid premium, then there shall be a specific waiting
    period of 2 (two) years from the Date of Revival in
    respect of each Insured.
18. Exclusions:
    No benefits are available hereunder and no payment will be
    made by the Corporation for any claim under this policy on
    account of hospitalization or surgery directly or indirectly caused
    by, based on, arising out of or howsoever attributable to any of
    the following:
19. Any Pre-existing Condition unless disclosed to and accepted
    by the Corporation prior to the Effective Date of Cover or
    the Date of Revival (if the Policy/cover in respect of Insured
    member(s) is revived after discontinuance of the Cover).
20. Any treatment or Surgery not performed by a Physician/
    Surgeon or any treatment or Surgery of a purely experimental
    nature.
21. Any experimental or unproven pharmacological regimens
    or usage of any unproven treatment devices; any conditions
    (injuries or illnesses) arising due to advocation of any
    experimental or unproven pharmacological regimens or
    treatment devices or diagnostic tests.
22. Admission, diagnosis, or treatment in a Hospital outside
    India. Admission into a Hospital for routine examination,
    preventive medical check-up, vaccinations or any medical
    examination that are customarily carried out on an Out
    Patient Basis.
23. Any Surgery/ Surgical Procedure carried out purely for the
    purposes of diagnosis, screening and investigation, e.g.
    27
    lower/upper GI Endoscopy or true- cut needle biopsy unless
    otherwise specified.
24. Admission into a hospital for any cosmetic, plastic surgery,
    aesthetic, or related treatment of any type, also including any
    complications attributable to such treatments, irrespective
    of the reason behind such treatment, unless medically
    necessary for the treatment of illness or as a result of an injury
    or accident and performed within 6 months of the same.
25. Hospitalisation Surgery for donation of an organ by donor.
26. Any dental examination, surgery, or treatment except as
    necessitated due to any accident.
27. Convalescence, general debility, rest cure, external
    congenital disease or defect or anomaly, sterilization or
    infertility (diagnosis and treatment), any sanatoriums, spa or
    rest cures or long-term care or hospitalization undertaken as
    a preventive or recuperative measure or for sole purpose of
    physiotherapy.
28. Any claim arising out of any condition directly or indirectly
    due to attempted suicide or intentional self-inflicted injury,
    by the life insured, whether sane or not at the time.
29. Life insured being under the influence of drugs, alcohol,
    narcotics, or psychotropic substance, not prescribed by a
    Registered Medical Practitioner.
30. Removal or correction or replacement of any material/
    prosthesis/medical devices that was implanted in a former
    surgery before Effective Date of Cover or Date of Revival (if
    the Policy/cover in respect of Insured member(s) is revived
    after discontinuance of the Cover).
31. Any diagnosis or treatment arising from or traceable to
    pregnancy (This exclusion does not apply in case of ectopic
    pregnancy), childbirth including caesarean section, medical
    termination of pregnancy and/or any treatment related to
    pre and post-natal care of the mother or the new born.
32. Any treatment directly or indirectly arising from or
    consequent to War (declared or undeclared), invasion, act of
    foreign enemy, hostilities (declared or undeclared), civil war,
    riots, civil commotion, rebellion, revolution, or any warlike
    operations / terrorism / acts of terrorism.
33. Any claim occurring as a direct or indirect result of Service
    in the military/ para- military, naval, air forces or police
    organizations and participation in operations requiring the
    use of arms or which are ordered by such authorities for
    combating terrorists, rebels, and the like.
34. Any natural peril (including but not limited to avalanche,
    earthquake, volcanic eruptions, or any kind of natural hazard).
35. Any claim in respect of treatment due to conditions arising
    out of Life Insured engaging in or taking part in professional
    sport(s) or competitive sports or any hazardous pursuits,
    including but not limited to, diving or riding or any kind of
    race; underwater activities involving the use of breathing
    apparatus or not; martial arts; hunting; mountaineering;
    parachuting; bungee-jumping, racing, scuba diving, aerial
    sports.
36. Any treatment directly or indirectly arising from Exposure of
    28
    life assured to Radioactive, explosive, or hazardous nature of
    nuclear fuel materials or property contaminated by nuclear
    fuel materials or Accident arising from such nature.
37. Any treatment directly or indirectly arising from or
    consequent to Participation by the life insured in a criminal
    or unlawful act.
38. Any conditions resulting from failure to seek or follow
    reasonable medical advice. “Reasonable Medical Advice”
    refers to tests or treatments as recommended by a Medical
    Practitioner that a prudent person would normally undergo.
39. Any claim arising as a direct or indirect consequence of
    Participation by the life insured in any flying activity other
    than as a bona fide passenger (whether paying or not), in a
    licensed aircraft provided that the life insured does not, at
    that time, have any duty on board such aircraft.
40. Admission into a Hospital for supply or fitting of eyeglasses
    or hearing aids. LASIK / PRK / Phakik IOL implants or any other
    procedures carried out for purpose of correcting refractive
    errors like Myopia.
41. Admission into a Hospital for diagnosis and Treatment of
    sterility, any fertility, sub-fertility or assisted conception
    procedure or birth control/contraceptive measures or of a
    sexually transmitted / veneral disease.
42. Admission into a Hospital for a sex change operation.
43. Any stem cell therapies.
44. Hormone replacement therapy.
45. Any treatment related to sleep disorder or Sleep Apnoea
    Syndrome, obesity and any other weight control
    programmed.
46. Pre and Post Hospitalization treatment will not be payable.
47. Treatment for any illness or injury where the period of
    confinement in a hospital is less than twenty-four hours
    (excludes day care procedures and HCB paid out to
    hemodialysis/ radiotherapy.)
48. General Waiting Period of 90 days/45 days as specified in Para
    17 shall be applicable for all the benefits covered under the
    Plan except in case of Hospitalisation due to an accident or
    a trauma which occurred after the inception of the policy
    where this waiting period will not apply.
49. Specific Waiting Period of 24 months as specified in Para 17
    for certain conditions and procedures and any complications
    arising out of them will apply to all benefits covered under
    the Plan.
50. Taxes:
    Statutory Taxes, if any, imposed on such insurance plans by the
    Government of India or any other constitutional Tax Authority of
    India shall be as per the Tax laws and the rate of tax shall be as
    applicable from time to time.
    The amount of applicable taxes as per the prevailing rates, shall
    be payable by the Policyholder on premiums including extra
    29
    premiums, if any, and shall be collected separately over and
    above in addition to the premiums payable by the policyholder.
    The amount of tax paid shall not be considered for the calculation
    of benefits payable under the Plan.
    Regarding Income tax benefits/implications on premium(s) paid
    and benefits payable under this Plan, please consult your tax
    advisor for details.
    SECTION 45 OF THE INSURANCE ACT, 1938:
    The provision of Section 45 of the Insurance Act, 1938 shall be
    applicable as amended from time to time. The simplified version of
    this provision is as under:
    Provisions regarding policy not being called into question in terms of
    Section 45 of the Insurance Act, 1938 are as follows:
51. No Policy of Life Insurance shall be called in question on any
    ground whatsoever after expiry of 3 years from
    a. the date of issuance of policy or
    b. the date of commencement of risk or
    c. the date of revival of policy or
    d. the date of rider to the policy
    whichever is later.
52. On the ground of fraud, a policy of Life Insurance may be called
    in question within 3 years from
    a. the date of issuance of policy or
    b. the date of commencement of risk or
    c. the date of revival of policy or
    d. the date of rider to the policy
    whichever is later.
    For this, the insurer should communicate in writing to the insured
    or legal representative or nominee or assignees of insured, as
    applicable, mentioning the ground and materials on which such
    decision is based.
53. Fraud means any of the following acts committed by insured or
    by his agent, with the intent to deceive the insurer or to induce
    the insurer to issue a life insurance policy:
    a. The suggestion, as a fact of that which is not true and which
    the insured does not believe to be true;
    b. The active concealment of a fact by the insured having
    knowledge or belief of the fact;
    c. Any other act fitted to deceive; and
    d. Any such act or omission as the law specifically declares to be
    fraudulent.
54. Mere silence is not fraud unless, depending on circumstances of
    the case, it is the duty of the insured or his agent keeping silence
    to speak, or silence is in itself equivalent to speak.
55. No Insurer shall repudiate a life insurance Policy on the ground of
    Fraud, if the Insured / beneficiary can prove that the misstatement
    30
    was true to the best of his knowledge and there was no deliberate
    intention to suppress the fact or that such mis-statement of or
    suppression of material fact are within the knowledge of the
    insurer. Onus of disproving is upon the policyholder, if alive, or
    beneficiaries.
56. Life insurance Policy can be called in question within 3 years on
    the ground that any statement of or suppression of a fact material
    to expectancy of life of the insured was incorrectly made in the
    proposal or other document basis which policy was issued or
    revived or rider issued. For this, the insurer should communicate
    in writing to the insured or legal representative or nominee
    or assignees of insured, as applicable, mentioning the ground
    and materials on which decision to repudiate the policy of life
    insurance is based.
57. In case repudiation is on ground of mis-statement and not on
    fraud, the premium collected on policy till the date of repudiation
    shall be paid to the insured or legal representative or nominee or
    assignees of insured, within a period of 90 days from the date of
    repudiation.
58. Fact shall not be considered material unless it has a direct bearing
    on the risk undertaken by the insurer. The onus is on insurer to
    show that if the insurer had been aware of the said fact, no life
    insurance policy would have been issued to the insured.
59. The insurer can call 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
    of age of life insured. So, this Section will not be applicable for
    questioning age or adjustment based on proof of age submitted
    subsequently.
    [Disclaimer: This is not a comprehensive list of Section 45 of the
    Insurance Act, 1938 and only a simplified version prepared for
    general information. Policy Holders are advised to refer to the
    Section 45 of the Insurance Act, 1938, for complete and accurate
    details.]
    PROHIBITION OF REBATES SECTION 41 OF THE INSURANCE ACT,
    1938:
    1) No person shall allow or offer to allow, either directly or
    indirectly, as an inducement to any person to take out 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:
    2) Any person making default in complying with the provisions of
    this section shall be liable for a penalty which may extend to ten
    lakh rupees.
    31
    This product brochure gives only salient features of the plan. For
    further details please refer to the Policy document on our website
    www.licindia.in or contact our nearest Branch Office.
    BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS /
    FRAUDULENT OFFERS
    IRDAI is not involved in activities like selling insurance policies,
    announcing bonus or investment of premiums. Public receiving
    such phone calls are requested to lodge a police complaint
    Registered Office:
    Life Insurance Corporation of India
    Central Office, Yogakshema,
    Jeevan Bima Marg, Mumbai-400021
    Website: www.licindia.in
    Registration Number: 512
    32
    Day Care Procedure Benefit Annexure
    Sl. No. DAY CARE PROCEDURE LIST
    1 Stapedotomy
    2 Stapedectomy
    3 Revision of Stapedectomy
    4 Other operations on the auditory Ossicles
    5 Myringoplasty (Type-I Tympanoplasty)
    6 Tympanoplasty (Closure of Eardrum Perforation / reconstruction of the
    Auditory Ossicles)
    7 Myringotomy with grommet insertion
    8 Closure of Mastoid fistula
    9 Revision of a Tympanoplasty
    10 Other microsurgical operations on the Middle Ear
    11 Myringotomy
    12 Benign Tumour removal from the external ear
    13 Incision of the mastoid process and Middle ear
    14 Simple Mastoidectomy
    15 Reconstruction of the middle ear
    16 Other excisions of the middle and inner ear
    17 Fenestration of the inner ear
    18 Revision of fenestration of the inner ear
    19 Petrous Apicectomy
    20 Other microsurgical operations on the inner Ear
    21 Excision and destruction of diseased tissue of the nose
    22 Operation on Nasal Turbinates
    23 Septoplasty (medically necessitated)
    24 Functional Endoscopic Sinus Surgery
    25 Endoscopic placement /removal of stents
    26 Dacrocystorhinostomy
    27 Other Operations for tear gland/ duct lesions
    28 Tarsorraphy
    29 Excision of the diseased tissue of the eyelid
    30 Operations of canthus and epicanthus when done for adhesions due to
    chronic infections
    31 Corrective surgery of entropion
    32 Corrective surgery for blepharoptosis
    33 Excision of lacrimal sac and passage
    34 Removal of a deep or embedded foreign body from cornea
    35 Corrective surgery of ectropion
    36 Operations for Pterygium with or without grafting
    37 Other operations on the cornea
    38 Removal of a foreign body from the lens of the eye
    39 Removal of a foreign body from posterior chamber of the eye
    40 Removal of a foreign body from orbit and eyeball
    41 Cataract Surgery ( ECCE or Phacoemulsification with or without intraocular lens
    implant)
    42 Operation for glaucoma
    43 Repair of corneal laceration or wound with conjunctival flap
    44 Surgery for pilonidal sinus
    45
    Surgical excisional debridement of wound toilet (Wound debridement)
    and removal of diseased tissue of the skin and subcutaneous tissues under
    anaesthesia
    33
    46 Local excision or destruction of diseased tissue of skin and subcutaneous
    tissues under anaesthesia
    47 Surgery for pilonidal cyst
    48 Free skin transplantation, recipient site
    49 Revision of skin plasty
    50 Chemosurgery for skin cancer
    51 Incision, excision, and destruction of diseased tissue of the tongue.
    52 Partial glossectomy
    53 Reconstruction of the tongue
    54 Other Operations on the tongue
    55 Incision and lancing of salivary glands and Salivary ducts
    56 Excision of a diseased tissue of salivary glands and Salivary ducts
    57 Resection of a salivary gland with or without salivary duct
    58 Reconstruction of a salivary gland and salivary duct
    59 Open Sialolithotomy
    60 External incision and drainage in the region of the mouth, jaw and face
    61 Excision of the diseased hard and soft palate
    62 Excision biopsy and/or destruction of diseased structures from the oropharynx.
    63 Palatoplasty
    64 Other operations in the mouth
    65 Transoral incision and drainage of a pharyngeal abscess
    66 Tonsillectomy without adenoidectomy
    67 Tonsillectomy with adenoidectomy
    68 Excision and destruction of a lingual tonsil
    69 Drainage of tonsillar abscess/quinsy
    70 Incision and Drainage of the bone for septic and aseptic conditions
    71 Closed reduction of fracture
    72 Closed reduction of sub-luxation
    73 Epiphyseolysis with osteosynthesis
    74 Suture and other Operations on tendons and tendon sheath
    75 Reduction of dislocation under GA
    76 Arthoscopic knee aspiration
    77 Incision and Drainage of breast abscess
    78 Operations on the nipple except congenitally inverted nipples
    79 Incision and excision of tissue in the perianal region
    80 Surgical treatment of anal fistulas
    81 Surgical treatment of Haemorrhoids.
    82 Division of the anal sphincter (sphincterotomy)
    83 Other operations of the anus
    84 Ultrasound guided aspiration of deep-seated rectal abscess
    85 Sclerotherapy
    86 Dilation of digestive tract strictures
    87 Endoscopic gastrotomy
    88 Endoscopic decompression of colon
    89 Endoscopic Polypectomy
    90 Incision of the ovary
    91 Other operations on the Fallopian tubes
    92 Dilatation of the cervical canal
    93 Conisation of the uterine cervix
    94 Incision of the Uterus (Hysterectomy) not done as a part of MTP
    95 Therapeutic / diagnostic dilatation and curettage ( not done as part of MTP)
    96 Culdotomy
    34
    97 Hymenectomy
    98 Local excision and destruction of diseased tissue of the vagina and the pouch
    of Douglas
    99 Incision and drainage of the Vulva
    100 Operations on the Bartholin’s glands(cyst)
    101 Hysteroscope guided biopsy of uterus
    102 Suprapubic cytostomy
    103 Drainage of Prostatic abscess
    104 Transurethral excision and destruction of prostate tissue
    105 Percutaneous excision and destruction of prostate tissue
    106 Excision of seminal vesicle
    107 Incision and excision of periprostatic tissue
    108 Incision and Drainage of the Scrotum and tunica vaginalis testis
    109 Operations on testicular hydrocele
    110 Excision or Eversion of Hydrocele
    111 Incision and drainage of the testis
    112 Excision or destruction of testicular lesion
    113 Unilateral orchidectomy
    114 Other operations on the testis
    115 Surgical treatment of a varicocele and hydrocele of a spermatic cord
    116 Excision of epididymal cyst
    117 Epididymectomy
    118 Other operations on the spermatic cord, epididymis and ductus deferens
    (other than vasectomy)
    119 Circumcision and other Operations on the foreskin (if medically necessitated)
    120 Local excision and destruction of diseased tissue of the penis
    121 Other operations on the penis
    122 Cystoscopic removal of stones
    123 Lithotripsy
    124 Coronary angiography
    125 Bronchoscopic treatment of bleeding lesion
    126 Bronchoscopic treatment of fistula/stenting
    127 Bronchoalveolar lavage and biopsy
    128 Pericardiocentesis
    129 Insertion of filter in Inferior Vena cava
    130 Insertion of gel foam in artery or vein
    131 Carotid angioplasty or Artherectomy
    132 Renal angioplasty
    133 Tumor embolisation
    134 Endoscopic drainage of pseudo pancreatic cyst
    135 Varicose vein stripping or ligation
    136 Excision of dupuytren’s contracture
    137 Carpal tunnel Decompression
    138 PCNS (Percutaneous neprostomy)
    139 PCNL(Percutaneous nephro lithotomy)
    140 Nail bed deformity/resection and reconstruction
    141 Vertebral angioplasty or Atherectomy
    142 Injection of sclerosing agent into vein
    143 Repair of esophageal stricture
    144 Incision of rectal stricture
    145 Repair of perirectal fistula
    146 Ablation of esophageal neoplasm by endoscopic approach
    35
    147 Control of esophageal bleeding by endoscopic approach
    148 Insertion of Sengstaken tube (Esophageal tamponade for bleeding varices)
    149 Esophageal varices banding by endoscopic approach
    150 Injection of esophageal varices by endoscopic approach
    151 Laparoscopic appendectomy
    152 Open Appendectomy
    153 Closure of appendiceal fistula
    154 Percutaneous [endoscopic] gastrostomy [PEG]
    155 Endoscopic excision or destruction Gastric varices
    156 Percutaneous aspiration of gallbladder
    157 Endoscopic retrograde cholangiography [ERC]
    158 Endoscopic retrograde pancreatography [ERP]
    159 Endoscopic insertion of stent (tube) into bile duct
    160 Endoscopic Retrograde Cholangiopancreatography (ERCP) with or without
    insertion of Stent into Bile duct
    161 Intra-abdominal venous shunt-mesocaval
    162 Intra-abdominal venous shunt-portacaval
    163 Intra-abdominal venous shunt-portal vein to inferior vena cava
    164 Intra-abdominal venous shunt-splenic and renal veins
    165 TIPS procedure for portal Hypertension (trans jugular intrahepatic Porto
    systemic shunt)
    166 Incision and lancing of parotid gland and duct
    167 Closure of salivary fistula
    168 Suture of laceration of salivary gland
    169 Probing of salivary duct
    170 Injection of hemorrhoids
    171 Temporary colostomy
    172 Removal of foreign body from tonsil and adenoid by incision
    173 Excision of lesion of tonsil and adenoid
    174 Drainage (oral) (transcervical) of retropharyngeal abscess
    175 Drainage (oral) (transcervical) of peritonsillar abscess
    176 Drainage (oral) (transcervical) of parapharyngeal abscess
    177 Other Operations on the Middle and Internal Ear
    178 Adenoidectomy without tonsillectomy
    179 Tracheostomy
    180 Correction of Eyelid ptosis
    181 Repair of postoperative wound dehiscence of cornea
    182 Destruction of chorioretinal lesion by laser photocoagulation/cyrotherapy
    183 Repair of retinal tear by photocoagulation
    184 Repair of retinal detachment with cryotherapy
    185 Repair of retinal detachment with laser photocoagulation
    186 Laproscopic/ Abdominal Hysterectomy for begnin conditions (with/without
    Pelvic floor repair, with/without Salpingo- Oophorectomy)
    187 Removal of ectopic pregnancy
    188 Operation On Ovarian Cyst
    189 Amputation of toe/fingers
    190 Open reduction of fracture with internal fixation (carpals and metacarpals,
    phalanges of hand, tarsals and metatarsals, phalanges of foot)
    191 Debridement of open fracture, unspecified site
    192 Open reduction of fracture with internal fixation, unspecified site
    193 Application of external fixator device (Humerus, Radius and Ulna, Carpals &
    Metacarpals)
    36
    194 Application of external fixator device (Femur, Patella, tibia and fibula, tarsals
    and metatarsals)
    195 Application of external fixator device, Scapula, Clavicle and thorax
    196 Reduction of alveolar fracture with stabilization of teeth
    197 Insertion of intercostal catheter for drainage
    198 Release of tarsal tunnel
    199 Repair of Hernia
    200 Biopsy of bone marrow
    201 Injection or infusion of cancer chemotherapeutic substance
    (Chemoembolization/Injection or infusion of antineoplastic agent)
    202 Radioisotopic Teleradiotherapy
    203 Superficial radiation (Contact radiation [up to 150 KVP])
    204 Orthovoltage radiation (Deep radiation [200-300 KVP])
    205 Infusion of liquid brachytherapy radioisotope – I-125 radioisotope
    (Includes: removal of radioisotope)
    206 Intracavitary brachytherapy (Includes: removal of radioisotope)
    207 Teleradiotherapy of other particulate radiation
    (Neutrons/Protons/Non specific)
    208 Implantation or insertion of radioactive elements – Intravascular brachytherapy
    209 Injection or instillation of radioisotopes
    210 Other radiotherapeutic procedure
    211 Arterio -Venous Fistula for renal Dialysis
    212 Prostatolithotomy
    213 Drainage of periprostatic abscess
    214 Excision of hematocele of tunica vaginalis
    215 Fulguration of lesion of scrotum
    216 Reduction of elephantiasis of scrotum
    217 Partial scrotectomy of scrotum
    218 Repair of scrotal fistula
    219 Suture of laceration of scrotum and tunica vaginalis
    220 Excision or destruction of lesion or tissue of scrotum
    221 Removal of blood clot from ureter or renal pelvis without incision
    222 Removal of calculus from ureter or renal pelvis without incision
    223 Removal of foreign body from ureter or renal pelvis without incision
    224 Maintenance Heamo Dialysis for Chronic renal failure
    225 Peritoneal dialysis or Heamo Dialysis for Acute Renal Failure
    226 Extracorporeal shockwave lithotripsy [ESWL] of the kidney, ureter and/or
    bladder
    227 Transurethral excision and destruction of prostate tissue
    228 Cutting of urethral sphincter
    229 Internal urethral meatotomy
    230 Urethrolysis
    231 Dilation of urethrovesical junction
    232 Passage of sounds through urethra
    233 Removal of calculus from urethra without incision
    234 Closed [percutaneous] [needle] biopsy of kidney
    235 Open biopsy of kidney
    236 Excision of vocal cords
    237 Excision of laryngeal cartilage
    238 Epiglottidectomy
    239 Other lavage of bronchus and trachea
    240 Closure of bronchostomy
    241 Marsupialization of laryngeal cyst
    37
    242 Full-thickness skin graft to hand
    243 Other skin graft to hand
    244 Full-thickness skin graft to other sites
    Major Surgical Benefit Annexure
    Sl. No LIST OF MAJOR SURGERIES
    % of
    Major
    Surgical
    Benefit
    Sum
    Assured
    Category
    I CARDIOVASCULAR SYSTEM
    1 Major Surgery of Aorta 100% Category 1
    2 CABG (Coronary Artery Bypass Grafting) 100% Category 1
    3 Heart Valve Replacement using Tissue or Prosthetic
    valve
    100% Category 1
    4 Aortic root transplantation with coronary artery
    reimplantation for proximal aortic aneurysm
    100% Category 1
    5 Endovascular repair of defect of thoracic aorta with
    graft(s) or device(s)
    100% Category 1
    6 Endovascular repair of abdominal aortic aneurysm
    with graft(s) or device(s)
    100% Category 1
    7 Resection of vessel with anastomosis, aorta 100% Category 1
    8 Initial implantation of permanent pacemaker in
    the heart
    60% Category 2
    9 Mitral valve repair (Open Heart Valvuloplasty) 60% Category 2
    10 Aortic valve repair (Open Heart Valvuloplasty) 60% Category 2
    11 Tricuspid valve repair (Open Heart Valvuloplasty) 60% Category 2
    12 Pulmonary valve repair (Open Heart Valvuloplasty) 60% Category 2
    13 Excision of benign mediastinal lesions 60% Category 2
    14 Excision of Malignant mediastinal lesions 60% Category 2
    15 Pericardectomy 40% Category 3
    16 Coronary Angioplasty with Stent implantation (two
    or more coronary arteries or two or more stents
    implanted)
    40% Category 3
    17 Major vein repair with or without grafting for
    traumatic & nontraumatic lesions
    40% Category 3
    18 Percutaneous angioplasty with or without
    insertion of intracranial vascular stent(s)
    40% Category 3
    19 Basilar angioplasty or Atherectomy 40% Category 3
    20 Closed Heart Valvotomy 40% Category 3
    21 Construction of venous valves (peripheral) 40% Category 3
    22 Other endovascular repair (of aneurysm) of other
    vessels with Endograft(s)
    40% Category 3
    23 Other endovascular repair (of aneurysm) of other
    vessels with Coil embolization or occlusion
    40% Category 3
    24 Other endovascular repair (of aneurysm) of
    other vessels with Liquid tissue adhesive (glue)
    embolization or occlusion
    40% Category 3
    25 Repair of blood vessel with tissue patch graft or
    with Synthetic patch graft.
    40% Category 3
    26 Embolectomy / Thrombectomy with or without
    Graft
    40% Category 3
    27 Endarterectomy with or without Graft 40% Category 3
    28 Pericardiotomy 20% Category 4
    29 Clipping or repair of Aneurysm 20% Category 4
    38
    30 Coronary Angioplasty with Single Stent
    implantation
    20% Category 4
    31 Exploratory thoracotomy 20% Category 4
    32 Arterioplasty (Non-Specific) 20% Category 4
    33 Plication of vein (peripheral) 20% Category 4
    34 Percutaneous (balloon) Valvuloplasty 20% Category 4
    35 Ligation of vena cava (inferior) (superior) 20% Category 4
    II NERVOUS SYSTEM
    36 Repair of Cerebral or Spinal Arterio- Venous
    Malformations or aneurysms
    100% Category 1
    37 Craniotomy for malignant Cerebral tumours 100% Category 1
    38 Excision of pineal gland 100% Category 1
    39 Total Excision of the pituitary gland, unspecified
    approach
    100% Category 1
    40 Hemispherectomy 100% Category 1
    41 Lobectomy of brain 100% Category 1
    42 Curettage/ Debridement of brain 100% Category 1
    43 Marsupialization of brain cyst 100% Category 1
    44 Trans temporal (mastoid) excision of brain tumor 100% Category 1
    45 Lobotomy and tractotomy (Division of Brain tissue/
    Cerebral tracts)
    100% Category 1
    46 Percutaneous (radiofrequency) cingulotomy 100% Category 1
    47 Amygdalohippocampotomy 100% Category 1
    48 Drainage of intracerebral hematoma 100% Category 1
    49 Craniotomy for non-malignant space occupying
    lesions
    60% Category 2
    50 Operations on Surbaracahnoid space of brain 60% Category 2
    51 Intracranial transection of Cranial nerve 60% Category 2
    52 Other operations on the meninges of the Brain 60% Category 2
    53 Microvascular decompression of cranial nerves/
    nervectomy
    60% Category 2
    54 Craniotomy with removal of epidural abscess 60% Category 2
    55 Craniotomy with removal of foreign body of skull 60% Category 2
    56 Open biopsy of brain 60% Category 2
    57 Craniectomy (Debridement/Sequestrectomy) of
    skull
    60% Category 2
    58 Excision of acoustic neuroma by craniotomy 60% Category 2
    59 Craniotomy for Drainage of Extradural, subdural or
    intracerebral space
    40% Category 3
    60 Decompression surgery for Entrapment Syndrome 40% Category 3
    61 Peripheral nerve Graft 40% Category 3
    62 Free Fascia Graft for Facial Nerve Paralysis 40% Category 3
    63 Excision of deep-seated peripheral nerve tumour 40% Category 3
    64 Multiple Miscrosurgical Repair of digital nerve 40% Category 3
    65 Fixation of fracture of spine 40% Category 3
    66 Biopsy of skull 40% Category 3
    67 Closed [percutaneous] [needle] biopsy of brain
    (Burr hole approach/Stereotactic method)
    40% Category 3
    68 Closed [percutaneous] [needle] biopsy of cerebral
    meninges
    40% Category 3
    69 Decompression of trigeminal nerve root 40% Category 3
    70 Other cranial nerve decompression 40% Category 3
    71 Division of trigeminal nerve (Retrogasserian
    neurotomy)
    40% Category 3
    39
    72 Endovascular removal of obstruction from head
    and neck vessel(s)
    40% Category 3
    73 Anastomosis of ventricle to cisterna magna/
    Ventriculocisternal intubation and Insertion of
    Holter valve (Ventriculostomy)
    40% Category 3
    74 Cranial nerve Graft 40% Category 3
    75 Cryohypophysectomy, complete transfrontal
    approach (Total)
    40% Category 3
    76 Ablation of pituitary by implantation (strontiumyttrium) (Y) transfrontal approach (Total)
    40% Category 3
    77 Partial excision of pituitary gland, transfrontal
    approach
    40% Category 3
    78 Partial excision of pituitary gland, unspecified
    approach
    40% Category 3
    79 Bur-hole Drainage of Extradural, subdural or
    intracerebral space
    20% Category 4
    80 Cranial puncture Aspiration of: subdural space 20% Category 4
    81 Cranial puncture Aspiration of: anterior fontanel 20% Category 4
    82 Decompression of spinal canal-laminectomy/
    Foraminotomy
    20% Category 4
    83 Laminectomy for exploration of intraspinal canal 20% Category 4
    84 Excision or destruction of intervertebral disc 20% Category 4
    85 Ventricular shunt to thoracic cavity
    (Ventriculopleural anastomosis)
    20% Category 4
    86 Ventricular shunt to abdominal cavity
    and organs (Ventriculocholecystostomy/
    Ventriculoperitoneostomy)
    20% Category 4
    87 Replacement of ventricular shunt 20% Category 4
    88 Total/Partial Excision of pituitary gland,
    transsphenoidal approach
    20% Category 4
    III RESPIRATORY SYSTEM
    89 Pneumonectomy 60% Category 2
    90 Diaphragmatic/Hiatus Hernia Repair 60% Category 2
    91 Thoracotoplasty 60% Category 2
    92 Open Lobectomy of Lung 60% Category 2
    93 Partial Extirpation of Bronchus 60% Category 2
    94 Partial Pharyngectomy 60% Category 2
    95 Total Pharyngectomy 60% Category 2
    96 Total Laryngectomy 60% Category 2
    97 Excision of Diaphragmatic tumours 60% Category 2
    98 Wide excision and Major reconstruction of
    malignant Oro-pharyngeal tumours
    60% Category 2
    99 Thoracoscopic segmental resection of lung/Partial
    lobectomy
    60% Category 2
    100 Open Segmental resection of lung/Partial
    lobectomy
    60% Category 2
    101 Thoracoscopic lobectomy of lung 60% Category 2
    102 Resection (wide sleeve) of bronchus 60% Category 2
    103 Pleurectomy or Pleural decortication 40% Category 3
    104 Tracheal reconstruction for various lesion 40% Category 3
    105 Hemilaryngectomy 40% Category 3
    106 Partial laryngectomy 40% Category 3
    107 Other excision or destruction of lesion or tissue of
    larynx
    40% Category 3
    IV DIGESTIVE SYSTEM
    108 Excision of esophagus and stomach 100% Category 1
    40
    109 Abdominal-Perineal Pull Through Resection of
    rectum with Colo-Anal Anastomosis
    100% Category 1
    110 Total Pancreatectomy with synchronous
    duodenectomy
    100% Category 1
    111 One-stage pancreaticoduodenal resection with
    choledochojejunal anastomosis, pancreaticojejunal
    anastomosis, and gastrojejunostomy
    100% Category 1
    112 Two-stage pancreaticoduodenal resection (first
    stage) (second stage)
    100% Category 1
    113 Radical Pancreaticoduodenectomy (Whipples
    procedure)
    100% Category 1
    114 Splenectomy 60% Category 2
    115 Total excision of oesophagus 60% Category 2
    116 Total excision of stomach 60% Category 2
    117 Partial Resection of Liver 60% Category 2
    118 partial pancreatectomy 60% Category 2
    119 Total hepatic lobectomy with partial excision of
    other lobe
    60% Category 2
    120 Radical subtotal pancreatectomy 60% Category 2
    121 Unilateral or Bilateral sympathectomy 40% Category 3
    122 Resection and Anastomosis of any part of digestive
    tract
    40% Category 3
    123 Open Surgery for treatment of Peptic Ulcer 40% Category 3
    124 Total Glossectomy 40% Category 3
    125 Cholecystectomy /Choledochotomy for various
    Gall bladder lesions
    40% Category 3
    126 Pancreatolithotomy 40% Category 3
    127 Transcatheter embolization for gastric or duodenal
    bleeding for Peptic ulcer
    40% Category 3
    128 Partial excision of esophagus 40% Category 3
    129 Partial Gastrectomy 40% Category 3
    130 Radical glossectomy with Neck dissection and
    tracheostomy
    40% Category 3
    131 Excision or avulsion of sympathetic nerve 40% Category 3
    132 Surgical/ Open Gastrostomy 20% Category 4
    133 Permanent colostomy 20% Category 4
    V MUSCULOSKELETAL SYSTEM
    134 Replantation of upper limb 60% Category 2
    135 Replantation of lower limb 60% Category 2
    136 Major reconstructive oro-maxillafacial surgery due
    to trauma or burns and not for cosmetic purpose
    60% Category 2
    137 Total prosthetic replacement of hip joint using
    cement
    40% Category 3
    138 Total prosthetic replacement of hip joint not using
    cement
    40% Category 3
    139 Other total prosthetic replacement of hip joint 40% Category 3
    140 Total prosthetic replacement of knee joint using
    cement
    40% Category 3
    141 Total prosthetic replacement of knee joint not
    using cement
    40% Category 3
    142 Other total prosthetic replacement of knee joint 40% Category 3
    143 Total prosthetic replacement of other joint using
    cement
    40% Category 3
    144 Total prosthetic replacement of other joint not
    using cement
    40% Category 3
    145 Other total prosthetic replacement of other joint 40% Category 3
    41
    146 Prosthetic replacement of head of femur using
    cement
    40% Category 3
    147 Prosthetic replacement of head of femur not using
    cement
    40% Category 3
    148 Other prosthetic replacement of head of femur 40% Category 3
    149 Prosthetic replacement of head of humerus using
    cement
    40% Category 3
    150 Prosthetic replacement of head of humerus not
    using cement
    40% Category 3
    151 Other prosthetic replacement of head of humerus 40% Category 3
    152 Prosthetic replacement of any other bone using
    cement
    40% Category 3
    153 Prosthetic replacement of any other bone not
    using cement
    40% Category 3
    154 Other prosthetic replacement of any other bone 40% Category 3
    155 Prosthetic interposition reconstruction of joint 40% Category 3
    156 Other interposition reconstruction of joint 40% Category 3
    157 Excision reconstruction of joint 40% Category 3
    158 Other reconstruction of joint 40% Category 3
    159 Implantation of prosthesis for limb 40% Category 3
    160 Amputation of arm 40% Category 3
    161 Amputation of leg 40% Category 3
    162 Elevation, Exploration and Fixation of fractured
    Zygoma
    40% Category 3
    163 Forequarter amputation (Interthoracoscapular
    amputation)
    40% Category 3
    164 Hindquarter amputation (Abdominopelvic
    amputation/ Hemipelvectomy)
    40% Category 3
    165 Atlas-axis spinal fusion with or without Bone Graft/
    device (s)
    40% Category 3
    166 Other cervical fusion, anterior technique, C2 level
    or below with or without Bone Graft/device (s)
    40% Category 3
    167 Other cervical fusion, posterior technique with or
    without Bone Graft/device (s)
    40% Category 3
    168 Dorsal and dorsolumbar fusion, anterior technique,
    with or without Bone Graft/device (s)
    40% Category 3
    169 Dorsal and dorsolumbar fusion, posterior
    technique, with or withoutBone Graft/device (s)
    40% Category 3
    170 Anterior lumbar interbody fusion (ALIF), with or
    without Bone Graft/device (s)
    40% Category 3
    171 Lumbar and lumbosacral fusion, lateral transverse
    process technique, with or without Bone Graft/
    device (s)
    40% Category 3
    172 Lumbar and lumbosacral fusion, Posterior lumbar
    interbody fusion (PLIF), with or without Bone Graft/
    device (s)
    40% Category 3
    173 Lumbar and lumbosacral fusion, Transforaminal
    lumbar interbody fusion (TLIF), with or without
    Bone Graft/device (s)
    40% Category 3
    174 Amputation of hand 20% Category 4
    175 Amputation of foot 20% Category 4
    176 Therapeutic endoscopic operations on cavity of
    knee joint
    20% Category 4
    177 Replantation of finger following traumic
    amputation
    20% Category 4
    178 Surgical Drainage and Curettage for osteomyelitis 20% Category 4
    179 Disarticulation of elbow, wrist, shoulder, hip, ankle,
    and knee
    20% Category 4
    42
    180 Thumb reattachment 20% Category 4
    181 Toe reattachment 20% Category 4
    182 Foot reattachment 20% Category 4
    183 Open reduction of fracture with internal fixation,
    humerus
    20% Category 4
    184 Open reduction of fracture with internal fixation,
    radius and ulna
    20% Category 4
    185 Open reduction of fracture with internal fixation,
    femur
    20% Category 4
    186 Open reduction of fracture with internal fixation,
    tibia and fibula
    20% Category 4
    187 Excision of Semilunar cartilage of knee 20% Category 4
    188 Synovectomy, knee 20% Category 4
    189 Five-in-one repair of knee (Medial meniscectomy,
    medial collateral ligament repair, vastus medialis
    advancement, semitendinosus advancement, and
    pes anserinus transfer)
    20% Category 4
    190 Triad knee repair (Medial meniscectomy with repair
    of the anterior cruciate ligament and the medial
    collateral ligament O’Donoghue procedure)
    20% Category 4
    191 Repair of the cruciate ligaments of joint of lower
    extremity
    20% Category 4
    192 Therapeutic endoscopic operations on cavity of
    Shoulder joint
    20% Category 4
    VI ORO-MAXILLOFACIAL SURGERY
    193 Osteotomy including segmental resection with
    bone grafting for Mandibular and maxillary lesions
    60% Category 2
    194 Debridement of compound fracture of skull (due to
    trauma or burns and not for cosmetic purpose)
    60% Category 2
    195 Decompression of skull fracture due to trauma or
    burns (due to trauma or burns and not for cosmetic
    purpose)
    60% Category 2
    196 Reduction of skull fracture (due to trauma or burns
    and not for cosmetic purpose)
    60% Category 2
    197 Closed/Open reduction of orbital fracture/Orbit
    rim or wall
    (due to trauma or burns and not for cosmetic
    purpose)
    40% Category 3
    VII ENDOCRINE SYSTEM
    198 Unilateral/Bilateral excision of adrenal gland 60% Category 2
    199 Complete excision of Thyroid gland 60% Category 2
    200 Complete excision of Parathyroid gland 60% Category 2
    201 Partial excision of adrenal glands 40% Category 3
    202 Partial excision of Thyroid gland 40% Category 3
    203 Partial excision of Parathyroid gland 40% Category 3
    204 Unilateral Thyroid lobectomy/Hemithyroidectomy 40% Category 3
    VIII RENAL/GENITO URINARY SYSTEM
    205 Radical prostatovesiculectomy 60% Category 2
    206 Microvascular reattachment of penis following
    traumatic amputation
    60% Category 2
    207 Total nephrectomy due to medical advice (not as a
    transplant donor)
    40% Category 3
    208 Partial nephrectomy due to medical advice (not as
    a transplant donor)
    40% Category 3
    209 Open extirpation of lesion of kidney 40% Category 3
    210 Partial ureterectomy (Excision of lesion of ureter/
    Shortening of ureter with reimplantation)
    40% Category 3
    43
    211 Total excision of bladder (total cystectomy with
    urethrectomy)
    40% Category 3
    212 Kidney injury repair 40% Category 3
    213 Pyloplasty / Ureterocalcycostomy for pelvic ureteric
    junction obstruction
    40% Category 3
    214 Amputation of penis 40% Category 3
    215 Total ureterectomy 40% Category 3
    216 Non Specified Uretrectomy. 40% Category 3
    217 Nephrotomy 40% Category 3
    218 Radical cystectomy 40% Category 3
    219 Partial cystectomy (Urinary bladder)
    -Trigonectomy, Wedge resection of bladder,
    Excision of bladder
    20% Category 4
    220 Therapeutic ureteroscopic operations on ureter 20% Category 4
    221 Urinary diversion 20% Category 4
    222 Replantation of ureter 20% Category 4
    223 Unilateral or Bilateral excision of testes 20% Category 4
    224 Other operations on Scrotum and tunica vaginalis
    testis
    20% Category 4
    225 Reconstruction of the testis 20% Category 4
    226 Open surgical excision and destruction of prostate
    tissue
    20% Category 4
    227 Suprapubic prostatectomy 20% Category 4
    228 Retropubic prostatectomy 20% Category 4
    229 Endoscopic resection of bladder lesion/Tissue 20% Category 4
    230 Orchiopexy 20% Category 4
    231 Radical bilateral orchiectomy (with
    epididymectomy and lymph node dissection )
    20% Category 4
    IX ORGAN TRANSPLANT
    232 Heart/Heart-Lung Transplant 100% Category 1
    233 Bone Marrow transplant (as recipient) 100% Category 1
    234 Lung Transplantation (as recipient) 100% Category 1
    235 Liver Transplantation (as recipient) 100% Category 1
    236 Renal transplant (as recipient) 100% Category 1
    X ENT
    237 Total ear amputation with reconstruction 60% Category 2
    238 Transmastoid removal cholesteatoma with
    extended Mastoidectomy
    60% Category 2
    239 Total Nasal Reconstruction due to Traumatic lesions 60% Category 2
    240 Labyrinthotomy for various lesions 40% Category 3
    241 Operations on frontal sinus 40% Category 3
    242 Operations on maxillary antrum using sublabial
    approach
    20% Category 4
    XI EYE
    243 Orbit Tumour Exenteration /Flap reconstruction 40% Category 3
    244 Corneal or Retinal Repair for Traumatic eye injuries 20% Category 4
    245 Penetrating injuries of the eye or repair of ruptured
    globe
    20% Category 4
    XII GYNECOLOGY
    246 Hysterectomy for malignant conditions 60% Category 2
    247 Excision of vagina 40% Category 3
    248 Unilateral or Bilateral excision of adnexa of uterus 40% Category 3
    249 Extirpation of lesion of vulva 20% Category 4
    250 Excision of vulva 20% Category 4
    44
    XIII STEREOTACTIC RADIOSURGERY
    251 Stereotactic radiosurgery- Single source photon
    radiosurgery
    (Linear accelerator -LINAC/High energy x-rays)
    60% Category 2
    252 Stereotactic radiosurgery- Particulate radiosurgery
    (Particle beam radiation (cyclotron)/Proton
    accelerator)
    60% Category 2
    253 Stereotactic radiosurgery- Multi-source photon
    radiosurgery
    (Cobalt 60 radiation/Gamma irradiation)
    60% Category 2
    254 Other Stereotactic radiosurgery 40% Category 3
    XIV OTHERS
    255 Major Excision and grafting of Lymphoedema 60% Category 2
    256 Radical Mastectomy 60% Category 2
    257 Malignant soft tissue tumour excision and
    reconstruction
    40% Category 3
    258 Excision and Major Flap Repair of skin and
    Subcutaneous tissue due to Major Burns
    40% Category 3
    259 Excision of Retroperitoneal Tumor 40% Category 3
    260 Wide local Excision for oral leukoplakia 20% Category 4
    261 Simple Mastectomy 20% Category 4
    262 Repair of Hernia – Inguinal, Incisional, Femoral,
    Umblical
    20% Category 4
    263 Radical Excision of malignant tumor in bones 20% Category 4