Acko General Insurance Limited Acko Group Health Insurance Policy

Terms & Conditions

This is a summary of the key terms under the Acko Group Health Insurance (“Policy”) offered by Acko General Insurance Limited (“Acko”) to IBIBO Group Private Limited (“redBus”) 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 redBus customers. The insurance coverage period under this policy is valid as mentioned in the Certificate of Insurance.

1. Key Benefits

Benefit Table

Name of the Benefit	Sum Insured	Benefit Type	Additional Conditions
Out-Patient Treatment Cover (OPD)	₹ 5,000	Indemnity	Covered for OPD expenses (Doctor Consultation, Prescribed Diagnostic tests and Prescribed Pharmacy) due to Malaria, Dengue, Chikungunya, Lymphatic Filariasis, Typhoid, Japanese Encephalitis, Bird Flu, Pulmonary Tuberculosis, Swine flu, Meningitis. Also Covers One Teleconsultation (Doctor on call) with General Physicians for Cold and fever. We will cover maximum 2 consultations (including teleconsultation) up to ₹ 1,000 each. We will cover maximum 2 Prescribed Diagnostic tests up to ₹ 1,000 each. We will cover maximum 1 claim for prescribed pharmacy up to ₹ 1,000. Claim is payable only when the result of prescribed test for covered diseases meets the admissibility criteria. Any Pre-Existing disease is not covered. Initial waiting period of 7 days will be applicable except for cold and fever.

2. Special Conditions:

• The claim will be payable only if your test for the mentioned illnesses is found positive for the first time, after 7 days from the policy start date.
• Treatment taken for any illness, sickness or disease other than mentioned in benefit table is not covered.
• The Policy will be provided for a period of one month.
• Any Pre-Existing disease is not covered whether declared or not.
• Claim Admissibility Criteria

Diseases covered and Requirements for each disease is as follows:

Disease	Test	Indicative admissibility criteria
Malaria	Peripheral Blood Smear	Visualise the parasite
	Malarial Antigen test	Positive for Vivax, Falciparum or Ovale
Dengue	NS1 AG	Positive
	IGM for Dengue	Positive
	Platelet Count	< 1,50,000 or decreasing with above positive
Chikungunya	Chikungunya Ab IG G/M	Positive
Lymphatic Filariasis	Microfilaria	Positive
Typhoid	Widal Test O < 1 in 80 H < 1 in 160	Positive
Japanese Encephalitis	IgM MAC-ELISA	Positive
Bird Flu	Avian influenza A	Positive
Pulmonary Tuberculosis	Chest X-Ray, Sputum test	Positive
Swine flu	Influenza Type A & B	Positive
Meningitis	Spinal Tap (lumbar puncture)	Positive

3. General Conditions:

• We should be given immediate written notice of any event that may give rise to a claim under the Policy, in accordance with the claims procedure under the Policy;
• All claims made under the Policy will be subject to the applicable deductible, any sub-limits and availability of the Sum Insured.
• The Policy does not cover any contractual and consequential liability, except as covered in the Policy or the Certificate of Insurance issued to the customer.

4. Claim & Documents:

The redBus customer can reach at the Contact number(s) provided below for registration of claim:

Contact Number: 1800 266 2256

Any claim made by the customer will be validated with redBus or its service partner to confirm the incidence.

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

Sr. No.	Name of Benefit	Documents Required
	Common Documents	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;
1	Out-Patient Treatment Cover (OPD)	Investigation reports Photograph of the injured with reflecting disablement FIR / MLC Copy (if MLC is done) / Spot Panchnama-where applicable- Attested by issuing authority Leave certificate from the employer Details of any other related document Medical Bills with Prescription Medical reports, case histories, investigation reports, treatment papers as applicable Medical Investigations report with prescription First Consultation and subsequent prescription Test Reports as per the table below.

Diseases covered and Requirements for each disease is as follows:

Disease	Test	Indicative admissibility criteria
Malaria	Peripheral Blood Smear	Visualise the parasite
	Malarial Antigen test	Positive for Vivax, Falciparum or Ovale
Dengue	NS1 AG	Positive
	IGM for Dengue	Positive
	Platelet Count	< 1,50,000 or decreasing with above positive
Chikungunya	Chikungunya Ab IG G/M	Positive
Lymphatic Filariasis	Microfilaria	Positive
Typhoid	Widal Test O < 1 in 80 H < 1 in 160	Positive
Japanese Encephalitis	IgM MAC-ELISA	Positive
Bird Flu	Avian influenza A	Positive
Pulmonary Tuberculosis	Chest X-Ray, Sputum test	Positive
Swine flu	Influenza Type A & B	Positive
Meningitis	Spinal Tap (lumbar puncture)	Positive

5. Definition:

5.1 Out-patient (“OPD”) and Wellness Benefit Category

5.1.1 Benefits

This Section defines the Benefits under this coverage category. The following Benefits shall trigger in the event of the Insured Person undergoing any Medically Necessary Treatment as an Out-Patient, or incurring Medical Expenses in relation to such Medically Necessary Treatment. Claims under this coverage category will be admissible subject to the fulfilment of the following conditions with respect to the Insured Person’s OPD Treatment or Medical Expenses incurred:

1. The Insured Person incurs the Medical Expenses during the Coverage Period.
2. The date of consultation / diagnostics / Treatment is within the Coverage Period.
3. The Medically Necessary Treatment is undergone on the written advice of a qualified Medical Practitioner, and the Medical Expenses are certified to be for such Medically Necessary Treatment by the treating Medical Practitioner.

5.1.1.1 Out-Patient Treatment Cover (OPD)

We will indemnify the Medical Expenses incurred by an Insured Person in respect of any Medically Necessary Treatment availed/provided, in a Hospital or Day Care Centre or by any service provider as an Out-Patient, of the following nature and subject to the limits as specified in the Policy Schedule / Certificate of Insurance:

1. Physical Consultation: Medical advice taken from a general or specialist Medical Practitioner;
2. Online Consultation: A web-based consultation from a qualified Medical Practitioner
3. Diagnostics: Any diagnostic procedures undergone by the Insured Person
4. Pharmacy: Discounts on medicine/pharmacy costs or/and indemnify the cost of medicines/pharmacy duly supported by the prescriptions of the Medical Practitioner attending to the Insured Person
5. Dietician: Advise on wellness coaching from dieticians
6. Doctor on Call: A telephonic consultation from a general Medical Practitioner

We shall not be liable to indemnify any Medical Expenses under this Benefit for the following:

1. Facilities and services availed for pleasure or rejuvenation or as a preventive aid, such as beauty treatments, Panchakarma, purification or detoxification.

Cost of spectacles, hearing aids, braces, implants, prosthetic devices, and lenses etc as Medical Aids.

6. Permanent Exclusions:

We will not make any payment for any claim in respect of any Insured Person arising from or caused by any of the following unless expressly stated to the contrary in this Policy.

Non-Medical Exclusions

1. Breach of law: Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self-injury or attempted suicide while sane or insane.

Medical Exclusions

Substance abuse and de-addiction programs: Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.

Inpatient Care and Day Care Treatments will not be covered.

Naturopathy treatment(s) will not be covered.

Laser Surgery for Treatment of focal error correction – other than for focal error of +/- 7 or more and which is a Medically Necessary Treatment.

7. Grievance Redressal:

For resolution of any query or grievance, insured may write an e- mail at gro@acko.com. In case the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company at the following address:

Grievance Redressal Officer
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.

Please note that this is only a basic description of the key terms of the Policy and the full list of policy conditions and exclusions are available at: https://www.acko.com/download/

Once you have taken the cover, you will receive a Certificate of Insurance from Acko which will contain complete details of your cover under the Policy, and the applicable conditions and exclusions.