10 Common Exclusions in Health Insurance Plans

Terms and Conditions

1. Declaration of Accuracy and Liability:

I/We, the proposer(s) or policyholder(s), hereby declare that the statements and particulars given in this Proposal form are complete, true, and accurate. I/We agree that Royal Sundaram Insurance Company will not be liable under the insurance contract if it is found that any of my/our statements or particulars or declarations in this proposal form or other documents are incorrect, misleading, or fraudulent in any respect, on any matter related to the grant of a cover or submission of a claim in the future.

2. Premium Payment:

I declare that the premium paid under this transaction to Royal Sundaram Insurance Company Limited is being paid by me as the proposer/policyholder through a bank account or a Credit/Debit Card or a Prepaid Payment Instrument or a UPI wallet (Wallet), held by me in my name as a primary holder (referred to as “source account”). I confirm that it is not a third-party payment made by any other person on my behalf. I understand that in the event of policy cancellation, the refund of premium as per policy terms and conditions may be credited back to such source account, and such electronic transfer will constitute full and final discharge of the Company’s obligation.

3. No Claims Bonus (NCB) Declaration:

I/We declare that the rate of NCB claimed by me/us is correct and that no claim has arisen in the expiring policy period (copy of the policy enclosed). I/We further undertake that if this declaration is found incorrect, all benefits under the policy in respect of Section I of the Policy will stand forfeited.

4. Pollution Under Control (PUC) Certificate:

I hereby affirmatively warrant that the Assured named herein/owner of the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of commencement of the Policy, and the same has been shown to the agent/authorized person of the intermediary. I further undertake to renew and maintain a valid and effective PUC Certificate during the duration of the Policy period. If the PUC certificate is not found valid on the date of loss, I understand that the Company reserves the right to cancel the policy.

5. Break in Insurance and Vehicle Inspection:

I/We agree that in case of a Break in Insurance, the policy would be issued subject to acceptance of risk after evaluation of the Vehicle Inspection report. Own Damage cover (Section – I) would not commence unless the satisfactory Vehicle Inspection report has been received by us. If the Company does not receive the Vehicle Inspection report or the report is adverse, the Company, at its discretion, will cancel the Policy as per the Motor Tariff.

6. Notification of Changes:

I/We further declare that I/we will notify in writing any change in the details so furnished hereinabove occurring after the proposal has been submitted but before communication of the risk acceptance by the Company. This includes changes in occupation or general health of the insured individuals.

7. Authorization and Sharing of Information:

I/We authorize the Company to share information pertaining to my proposal, including medical records, for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.

8. Consent for Communication:

By submitting my contact number and email ID, I authorize Royal Sundaram Insurance Company Limited to call, send SMS, messages over internet-based messaging applications like WhatsApp, and email to offer me information and services for the product(s) I have opted for as well as other products/services offered by Royal Sundaram Insurance Company Limited. Please note that such authorization will be over and above any registration of the contact number on TRAI’s NDNC registry.

9. Income Declaration:

This policy has been issued based on my declaration of Gross Annual Income, and the Base Sum Insured chosen is not more than 10 times of such Gross Annual Income. In the event the declaration is found to be incorrect/wrong and/or non-submission of income proof to justify this declaration, it may result in the inadmissibility of a claim and/or cancellation of the policy. I confirm that the Gross Annual Income of the family in this proposal is true and correct and undertake to submit relevant income proof(s) in the event of a claim in this regard.

10. Occupational Exclusions:

I confirm that the insured member(s) under this Policy do not work in Nuclear power plants, underground mines, explosives, hazardous material (e.g., fertilizers, asbestos fiber, toxic gases, toxic chemicals, pesticides, etc.). Furthermore, the insured member(s) do not work in underground mines, explosive magazines, or electrical installations with high tension supply, or are jockeys, circus personnel, engaged in racing on wheels or horseback, big game hunting, mountaineering, winter sports, skiing, ice hockey, river rafting, polo, or similar activities or occupations.

11. Declaration as Authorized Proposer:

I declare that all the information I have provided is true and accurate to the best of my knowledge, and I am authorized to propose on behalf of my family.

12. Underwriting Policy and Premium Payment:

I declare that the premium paid under this transaction to Royal Sundaram Insurance Company Limited is being paid by me as the proposer/policyholder through a bank account or a Credit/Debit Card or a Prepaid Payment Instrument or a UPI wallet (Wallet), held by me in my name as a primary holder (referred to as “source account”). I confirm that it is not a third-party payment made by any other person on my behalf. I understand that in the event of policy cancellation, the refund of premium as per policy terms and conditions may be credited back to such source account, and such electronic transfer will constitute full and final discharge of the Company’s obligation.

13. Authorization for Medical Information:

I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything that affects the physical or mental health of the person to be insured/proposer. I also authorize the company to seek information from any insurer to whom an application for insurance on the person to be insured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.

14. Information Sharing:

I hereby permit/authorize Royal Sundaram Insurance Company Limited to collect, store, communicate, and process information relating to the policy(ies) and all transactions related therewith, including the sharing and disclosing the public authorities of any confidential information as required by law. I also authorize Royal Sundaram Insurance Company Limited to send me information in relation to the Policy and Royal Sundaram Insurance products & services, irrespective of whether I am registered with the National Customer Preference Register (NCPR) (formerly the National Do Not Call Registry) or not.

15. Consent for Electronic Communication:

To protect the environment and save paper, I consent to Royal Sundaram contacting me by email or phone instead of in physical form and to share all documents, updates, and alerts electronically.

16. Liability Commencement:

The Company's liability does not begin until the full premium has been collected by the Company, and the acceptance of the proposal has been formally intimated to the insured.

17. General Exclusions:

The Company shall not be liable under this Policy in respect of any accidental loss or damage and/or liability caused, sustained, or incurred outside the geographical area; any claim arising out of any contractual liability; any accidental loss, damage, and/or liability caused, sustained, or incurred whilst the vehicle insured herein is being used otherwise than in accordance with the Limitations as to Use or being driven by or is for the purpose of being driven by him/her in the charge of any person other than a Driver as stated in the Driver’s Clause; any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising therefrom or any consequential loss; any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purposes of this exception, combustion shall include any self-sustaining process of nuclear fission; any accidental loss damage or liability directly or indirectly caused by or contributed to by or arising from nuclear weapons material; any accidental loss or damage and/or liability directly or indirectly or proximately or remotely occasioned by or contributed to by or traceable to or arising out of or in connection with war, invasion, the act of foreign enemies, hostilities or warlike operations (whether before or after the declaration of war), civil war, mutiny rebellion, military or usurped power, or by any direct or indirect consequences of any of the said occurrences, and in the event of any claim hereunder, the Insured shall prove that the accidental loss, damage, and/or liability arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to any of the said occurrences or any consequences thereof, and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim.

18. Authorization as Proposer and Information Accuracy:

I/We hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers, and/or particulars given by me are true, complete, and accurate to the best of my knowledge. I/We am/are authorized to propose on behalf of these other persons. I understand that the information provided by me will form the basis of the insurance policy and is subject to the Board-approved underwriting policy of the insurance company. The policy will come into force only after full receipt of the premium chargeable.

I/We undertake that the applicable loadings have been informed and understood by me. I further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company.

I/We declare and consent to the company seeking medical information from any doctor or hospital who at any time has attended on the life to be insured/proposer or from any past or present employer concerning anything that affects the physical or mental health of the life to be assured/proposer. I also authorize the company to seek information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.

Additionally, I/We authorize the company to share information pertaining to my proposal, including medical records, for the sole purpose of proposal underwriting and/or claims settlement, with any Governmental and/or Regulatory authority.

Please refer to the policy documents for complete details of exclusions, inclusions, and terms and conditions.

For any further information or clarification, please feel free to contact Royal Sundaram Insurance at the following contact details:

Royal Sundaram General Insurance Co. Limited

Corporate Office Address :

Vishranthi Melaram Towers, No.2/319 , Rajiv Gandhi Salai (OMR), Karapakkam , Chennai - 600097.

Telephone : 91-44-7117 7117

Fax : 044 – 7117 7140