Acko General Insurance Limited Group Health & Accident Care

GoNiyo T&Cs

This is a summary of the key terms under the Group Health & Accident Care (“Policy”) offered by Acko General Insurance Limited (“Acko”) to Finnew Solutions Private Limited (“Go NiYO”) subject to the receipt of premium in full in respect of the Insured Persons and the terms, conditions and exclusions of underlying Policy. The covers available under the Policy can be availed only by Go NiYO customers. The insurance coverage period under this policy is valid as mentioned in the Certificate of Insurance.

1. Key Benefits

Key benefits available to the Insured person is as follows:

Sr. No.	Benefit Name	Sum Insured	Benefit Type	Additional Conditions
1	Hospital Daily Allowance	₹1000 / 1500 per day (as per the plan opted)	Fixed Benefit	Minimum Hospitalization of 24 hours is required Cover Maximum for 15 days of hospitalization

2. Benefit Definition

Hospital Daily Allowance:

If an Insured Person requires Hospitalization due to an Injury or Illness specified in the Schedule / Certificate of Insurance, suffered or contracted during the Coverage Period, then We will pay the daily allowance amount specified against this Benefit in the Certificate of Insurance, for each continuous and completed period of 24 hours of Hospitalisation;

This benefit will be payable provided that:

1. Our liability to make any payment under this benefit shall commence only after a continuous and completed 24 hours of Hospitalization of the Insured Person for each claim.
2. The Hospitalization is for Medically Necessary Treatment and is commenced and continued on the written advice of the treating Medical Practitioner;
3. Our liability to make any payment under this benefit shall be in excess of the Deductible of the number of days specified in the Certificate of Insurance for each claim.
4. This Benefit shall not be payable in respect of the Insured Person for more than the maximum number of days specified in the Certificate of Insurance for each Coverage Period.
5. Only one daily allowance amount is payable for each day of Hospitalization, regardless of number of the Illnesses contracted/Injuries sustained.

3. General Exclusions

We shall not be liable to make any payment for any claim under the Policy in respect of an Insured Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following:

1. Suicide or attempted suicide, intentional self-inflicted Injury or acts of self-destruction, whether the Insured Person is medically sane or insane.
2. Working in underground mines, tunnelling or explosives, or involving electrical installation with high tension supply, or as jockeys or circus personnel, or engaging in Hazardous Activities.
3. Any change of profession after inception of the Policy which results in the enhancement of Our risk under the Policy, if not accepted and endorsed by Us on the Certificate of Insurance.
4. Medical or surgical treatment except as necessary solely and directly as a result of an Accident.
5. Death or disability resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy or a consequence thereof including ectopic pregnancy unless specifically arising due to Accident.
6. Any Illness or Critical Illness arising within the Waiting Periods specified in the Policy or in the Schedule or Certificate of Insurance.
7. All Waiting Periods shall commence concurrently, and would be considered to have been served to the extent that the Insured Person was insured continuously and without interruption under another Indian insurer’s individual health / Family Health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital.
8. Any External Congenital Anomalies or in consequence thereof.
9. Any certification provided by a Medical Practitioner who shares the same residence as the Insured Person or who is an Immediate Relative.
10. Hospitalization, if applicable, for the following treatments:
    1. Laser treatment for correction of eye due to refractive error;
    2. Aesthetic or change-of-life treatments of any description such as sex transformation operations, treatment towards changes in appearance or any procedure which is aimed to improve physical appearance;
    3. Cosmetic treatments (including any complications arising out of cosmetic treatments) unless necessitated by traumatic Injury, or Illness;
    4. Vaccination or inoculation unless forming a part of post-animal bite treatment;
    5. Treatment of obesity (including morbid obesity) and any other weight control program, general debility, convalescence, run—down conditions, rest cure, treatment of sleep apnea.
    6. Naturopathy Treatments.
    7. Sterility, treatment whether to effect or to treat infertility; any fertility, sub—fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services;
    8. Any dental treatment or Surgery of a corrective, cosmetic or aesthetic nature unless carried out under general anaesthesia and is necessitated by Illness or Injury during the Coverage Period.
11. Any claim arising from or caused due to use, abuse or a consequence or influence of an abuse of any substance, intoxicant, drug, alcohol or hallucinogen.
12. Any claim arising or resulting from the Insured Person committing any breach of law or participating in an actual or attempted felony, riot, crime, misdemeanour or civil commotion with criminal intent.
13. Any claim caused by participation of the Insured Person in any flying activity, except as a bona fide, fare-paying passenger of a recognized airline on regular routes and on a scheduled timetable.
14. Any claim arising out of or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country during war or at peace time), participation in any naval, military or air-force operation, civil war, public defence, rebellion, revolution, insurrection, military or usurped power.
15. Any claim arising from or caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense from any nuclear waste from the combustion of nuclear fuel, nuclear, Chemical attack or weapons, or Biological attack or weapons.
    1. Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disability or death.
    2. Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) microorganisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disability or death.

This exclusion are not applicable:

1. Any Pre-Existing Disease or any Injury or disability arising out of a Pre-Existing Disease or any complication arising therefrom.
2. Bacterial infections (except pyogenic infection which occurs through a cut or wound due to Accident).

4. Claim & Documents:

Insured may notify a claim using one of the following communication channels:

• Email notification to Acko email address niyocare@acko.com
• By another form of written intimation (letter) mailing it to “Acko Claims Desk. #36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102.

Insured needs to submit following documents in case of a claim:

Sr. No.	Name of Benefit	Documents Required
1	Hospital Daily Allowance	Our duly filled and signed Claim Form Name and address of the Insured Person in respect of whom the claim is being made; Copies of valid KYC documents of the Nominee/claimant, any other regulatory requirements, as amended from time to time; Copy of the Discharge Summary Copy of First Information Report (FIR) /Medico-Legal certificate (MLC) (if MLC is done)-where applicable- Attested by issuing authority Treating doctor certificate giving details of Injury Sustained Bill / invoice and payment receipts

Note: Any additional document might be asked by Acko, if required.

5. Cancellation

In case the loan is cancelled within 15 days of the issuance of the Certificate of Insurance, we will refund the full premium if no claim is made. In case the cancellation request is made after 15 days, the premium refund will be done as per the table mentioned in the section below.

You may terminate this Policy at any time by giving Us written notice, and the Policy will terminate when such written notice is received. If no claim has been made under the Policy, then We will refund premium in accordance with the table below:

Cancellation Period	% of Premium
Within 25% of the Coverage Period	60%
25%-50% of the Coverage Period	40%
50%-75% of the Coverage Period	20%
Exceeding 75% of the Coverage Period	0%

We may at any time terminate this Policy on grounds of misrepresentation, fraud or non-disclosure of material facts by You or any Insured Person upon 30 days’ notice by sending an endorsement to Your address shown in the Schedule without refund of premium.

6. Grievance Redressal:

For resolution of any query or grievance, the Insured Person may write an e-mail at gro@acko.com.

In case Insured Person is not satisfied with the resolution, the Insured Person may write to Acko’s Grievance Redressal Officer at the following address:

Grievance Redressal Officer
Acko General Insurance Limited
36/5, Hustlehub One East, Somasandrapalya,
27th Main Rd, Sector 2, HSR Layout,
Bengaluru, Karnataka 560102
gro@acko.com

In the event of unsatisfactory response from the Grievance Officer, he/she may, register a complaint in the Integrated Grievance Management System (IGMS) of the IRDAI.

Where the grievance is not resolved, the insured may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance.

In case Insured’s complaint is not fully addressed by Acko, You may use the Integrated Grievance Management System (IGMS) for escalating the complaint to IRDAI. Through IGMS, the insured can register the complaint online and track its status. For registration, please visit IRDAI website www.irdai.gov.in

Please note that these terms and conditions are only indicative, and the full list of policy conditions and exclusions are available at http://www.acko.com/download.