NATIONAL INSURANCE COMPANY LIMITED

POLICY SCHEDULE
Tailor-made Floater Group Medilaim Poli! No" - #$%&''()$(%#(*+''''',-&
Insured's Name & Address Policy Issung Office -Gurgaon DO-II ( 3619!
Pu./a0 Natio.al 1a.2
- 3 14i2a/i Cama Plae5 Ne6 Del4i" - %%''$$
#*$ 3 #*-5 Old Rail6a! Road5 7ao0pura5
Gur8ao.5 Ha!a.a" - %,,''%
De9elopme.t O::ier(1ro2er - #$%&'' ;Diret<
Date o: Propo=al > Delaratio. - #%"%,",'%#
Re.e6al o: Poli! No" - -#$%&''()$(%,(*+'''''#++
Poli! Period - From '%-'%-,'%) to Mid.i84t o: #%"%,",'%)
Net Premium - R=" %5*,5)+5'''"''
Ser9ie Ta? - R=" ,,5++5'*,"''
Total Premium - R=" ,5'+5''5'*,"'' ;T6o Crore= Fi9e La= Ei84t! T6o<
Colletio. No" - #$%&''(*%(%#(''''''$)$- Dated- '%-'%-,'%)
Descri"#ion $o#al %um Insured
%$'- Retired Emplo!ee= o: PN1 6it4 t4eir
Spou=e= :or t4e Sum I.=ured o: %(,(# La24= ;a=
opted<
R=" ,*5-#5''5'''"'' ;T6e.t! Ei84t Crore= a.d
Se9e.t! T4ree La24= O.l!"<
Ri=2 Co9ered - Medilaim a= per lau=e= a.d A..e?ure 3 I atta4ed"
Loatio. - All o9er I.dia"
Su0/et to Clau=e - Sta.dard Group Medilaim Poli! > A..e?ure atta4ed"
Speial E?e== - Nil
Speial Co.ditio.= - O. Ca=4le== 1a=i= > a= per A..e?ure 3 I Atta4ed"
Name o: TPA - Par2 Medilaim
I. @it.e== 64ereo: t4i= Poli! 4a= 0ee. =i8.ed at Gur8ao. o. %+"'%",'%)"
For A.d O. 1e4al: o:
Natio.al I.=ura.e Compa.! Limited"
Dul! Co.=tituted Attor.e!
ANNEAURE 3 I
SPECIAL CONDITIONS TO 1E ATTACHED @ITH > FORMING PART OF POLICY NO"
#$%&''()$(%#(*+''''',-&
%" Domiiliar! Ho=pitaliBatio. 1e.e:it= are deleted :rom t4e =ope o: t4e poli!"
," Pre 3 4o=pitaliBatio. a.d po=t 3 4o=pitaliBatio. e?pe.=e= ;a= me.tio.ed i. Pt" .o" #"% > #",
o: t4e lau=e= atta4ed< are o9ered o.l! :or - da!= ea4"
#" Poli! doe= .ot o9er Mater.it! E?pe.=e= 1e.e:it a= me.tio.ed i. Pt" No" #"+ o: t4e lau=e
atta4ed"
)" E?lu=io. No" )"% a= me.tio.ed i. t4e lau=e atta4ed5 i. re=pet o: pre-e?i=ti.8 di=ea=e=5 i=
deleted" C"2
+" E?lu=io. No" )", a= me.tio.ed i. t4e lau=e atta4ed5 i. re=pet o: di=ea=e= o.trated
duri.8 t4e :ir=t #' da!= :rom t4e omme.eme.t date o: t4e poli!5 i= deleted"
$" E?lu=io. No" )"# a= me.tio.ed i. t4e lau=e atta4ed5 i. re=pet o: e?pe.=e= o. treatme.t
o: ertai. =pei:ied di=ea=e= duri.8 t4e :ir=t !ear o= t4e operatio. o: i.=ura.e o9er5 i=
deleted"
-" Sum I.=ured me.tio.ed a8ai.=t ea4 per=o. o9ered ;a= per A..e?ure 3 ii 3 Li=t o:
mem0er=< 6ould 0e :loati.8 o. t4e mem0er= o9ered a.d 4i=(4er =pou=e" Ho6e9er5 t4e
:ollo6i.8 6ould 0e =u0-limit= o: t4e o9era8e"
;Amou.t i. R="<
Descri"#ion&%um Insured 1''&- (''&- 3''&-
Room re.t ;ma?imum per da!< %5'''(- ,5'''(- #5'''(-
ICU ;ma?imum per da!< %5+''(- #5'''(- )5+''(-
E?pe.=e= o. operatio. o: a.trat -5+''(- %'5'''(- %,5+''(-
Ho=pitaliBatio. e?pe.=e= :or treatme.t
o: di=ea=e= a= me.tio.ed i. Pt" No" * a=
i.door patie.t= ;o. produtio. o:
ori8i.al 0ill(a=4 memo=<
-'5'''(- %5)'5'''(- ,5%'5'''(-
Ho=pitaliBatio. e?pe.=e= :or =ur8ial
a.d No.-=ur8ial i.ter:ere.e a=
i.door patie.t= :or di=ea=e= ot4er t4a.
a0o9e ;o. produtio. o: ori8i.al
0ill=(a=4 memo=<
#'5'''(- $'5'''(- &'5'''(-

-,-
*" Li=t o: =pei:i di=ea=e= :or 64i4 t4ere i= a =eparate limit o: Sum I.=ured a= me.tio.ed
i. ta0le i. Pt" No" -"
&" Nep4riti= o: a.! Etiolo8! plu= 1aterial re.al :ailure reDuiri.8 Eid.e! Tra.=pla.tatio.
a.d(or Dial!=i="
%'" Cere0ra or Fa=ular Stro2e="
%%" Ope. a.d Clo=e Heart Sure8er! ;i.lu=i9e o: C"A"1"G" I.lu=i9e o=t o: 9al9e=5 PTCA5
Heart Failure"
%," Mali8.a.! di=ea=e5 64i4 6ere o.:irmed o. Hi=topat4olo8ial report"
%#" E.ep4aliti= ;Firal<"
%)" Neuro Sure8er!"
%+" Total Replaeme.t o: /oi.t="
%$" Li9er di=order ;Hepatiti= 1 > C < a==oiated 6it4 omploatio.= li2e irr4o=i= o: li9er
;e?ludi.8 au=ed 0! Alo4ol<"
%-" Grie9ou= i./ur! i.ludi.8 multiple :rature= o: lo.8 0o.e=5 4ead i./ur! leadi.8 to
u.o.=iou=.e==5 0ur.= o: more t4a. )' G i./ur! reDuiri.8 arti:iial 9e.tilator! =upport
plu= Ferte0ral Colum. i./ur!"
For a.d O. 1e4al: o:
Natio.al I.=ura.e Compa.! Limited"
Dul! Co.=tituted Attor.e!"