Common use of TABLE OF BENEFITS Clause in Contracts

TABLE OF BENEFITS. Name Group Corona Kavach Policy, Max Bupa Health Insurance Co. Ltd. Product Type Individual/Floater Category of Benefit Indemnity/Benefit Sum Insured Rs. 50,000/- (Fifty Thousand) to 5,00,000 (Five Lakh) (in the multiples of fifty thousand) On Individual basis- SI shall apply to each individual family member On Floater basis- SI shall apply to the entire family. Policy Period Three and half months (3 ½ months), Six and half months (6 ½ months), Nine and half months (9 ½ months) including waiting periods Eligibility Policy can be availed by persons between the age of 18 Years up to 65 Years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. Policy can be availed for Self and the following family members 1. Legally wedded spouse 2. Parents & Parents-in-law 3. Dependent Children (i.e natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible. Hospitalization Expenses Medical Expenses of Hospitalization for Covid for a minimum period of 24 consecutive hours shall be admissible. Pre-Hospitalization For 15 days prior to the date of hospitalization/home care treatment Post Hospitalization 30 days from the date of discharge from the hospital/completion of home care treatment Sub-limits Hospital Daily Cash: 0.5% of Sum Insured per day subject to maximum of 15 days in a policy period for every insured member. Home Care Treatment: Maximum up to 14 days per incident AYUSH Medical Expenses incurred for inpatient care treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured during the Policy period as specified in the policy schedule. Home Care Treatment Expenses The Company shall indemnify costs of treatment incurred by the Insured person for availing treatment at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre maximum up to 14 days per incident, which in the normal course would require care and treatment at a hospital but is actually taken while confined at home subject to policy terms and conditions 1 BABY FOOD 2 BABY UTILITIES CHARGES 3 BEAUTY SERVICES 4 BELTS/ BRACES 5 BUDS 6 COLD PACK/HOT PACK 7 CARRY BAGS 8 EMAIL / INTERNET CHARGES 9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) 10 LEGGINGS 11 LAUNDRY CHARGES 12 MINERAL WATER 13 SANITARY PAD 14 TELEPHONE CHARGES 15 GUEST SERVICES 16 CREPE BANDAGE 17 DIAPER OF ANY TYPE 18 EYELET COLLAR 19 SLINGS 20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES 21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED 22 TELEVISION CHARGES 23 SURCHARGES 24 ATTENDANT CHARGES 25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE) 26 BIRTH CERTIFICATE 27 CERTIFICATE CHARGES 28 COURIER CHARGES 29 CONVEYANCE CHARGES 30 MEDICAL CERTIFICATE 31 MEDICAL RECORDS 32 PHOTOCOPIES CHARGES 33 MORTUARY CHARGES 34 WALKING AIDS CHARGES 35 SPIROMETRE 36 STEAM INHALER 37 ARMSLING 38 THERMOMETER 39 CERVICAL COLLAR 40 SPLINT 41 DIABETIC FOOT WEAR 42 KNEE BRACES (LONG/ SHORT/ HINGED) 43 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER 44 LUMBO SACRAL BELT 45 NIMBUS BED OR WATER OR AIR BED CHARGES 46 AMBULANCE COLLAR 47 AMBULANCE EQUIPMENT 48 ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ 49 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES 50 SUGAR FREE Tablets 51 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable) 52 ECG ELECTRODES 53 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC] 54 KIDNEY TRAY 55 OUNCE GLASS 56 PELVIC TRACTION BELT 57 PAN CAN 58 TROLLY COVER 59 UROMETER, URINE JUG 1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 2 HAND WASH 3 CRADLE CHARGES 4 COMB 5 EAU-DE-COLOGNE / ROOM FRESHNERS 6 GOWN 7 SLIPPERS 8 TISSUE PAPER 9 TOOTH PASTE 10 TOOTH BRUSH 11 BED PAN 12 FLEXI MASK 13 HAND HOLDER 14 SPUTUM CUP 15 DISINFECTANT LOTIONS 16 LUXURY TAX 17 HVAC 18 HOUSE KEEPING CHARGES 19 AIR CONDITIONER CHARGES 20 IM IV INJECTION CHARGES 21 CLEAN SHEET 22 BLANKET/WARMER BLANKET 23 ADMISSION KIT 24 DIABETIC CHART CHARGES 25 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES 26 DISCHARGE PROCEDURE CHARGES 27 DAILY CHART CHARGES 28 ENTRANCE PASS / VISITORS PASS CHARGES 29 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE 30 FILE OPENING CHARGES 31 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED) 32 PATIENT IDENTIFICATION BAND / NAME TAG 33 PULSEOXYMETER CHARGES 1 HAIR REMOVAL CREAM 2 DISPOSABLES RAZORS CHARGES (for site preparations)

TABLE OF BENEFITS. Name Group Corona Kavach Policy, Max Niva Bupa Health Insurance Co. Ltd. Product Type Individual/Floater Category of Benefit Indemnity/Benefit Sum Insured Rs. 50,000/- (Fifty Thousand) to 5,00,000 (Five Lakh) (in the multiples of fifty thousand) On Individual basis- SI shall apply to each individual family member On Floater basis- SI shall apply to the entire family. Policy Period Three and half months (3 ½ months), Six and half months (6 ½ months), Nine and half months (9 ½ months) including waiting periods Eligibility Policy can be availed by persons between the age of 18 Years up to 65 Years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. Policy can be availed for Self and the following family members 1. Legally wedded spouse 2. Parents & Parents-in-law 3. Dependent Children (i.e natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible. Hospitalization Expenses Medical Expenses of Hospitalization for Covid for a minimum period of 24 consecutive hours shall be admissible. Pre-Hospitalization For 15 days prior to the date of hospitalization/home care treatment Post Hospitalization 30 days from the date of discharge from the hospital/completion of home care treatment Sub-limits Hospital Daily Cash: 0.5% of Sum Insured per day subject to maximum of 15 days in a policy period for every insured member. Home Care Treatment: Maximum up to 14 days per incident AYUSH Medical Expenses incurred for inpatient care treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured during the Policy period as specified in the policy schedule. Home Care Treatment Expenses The Company shall indemnify costs of treatment incurred by the Insured person for availing treatment at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre maximum up to 14 days per incident, which in the normal course would require care and treatment at a hospital but is actually taken while confined at home subject to policy terms and conditions 1 BABY FOOD 2 BABY UTILITIES CHARGES 3 BEAUTY SERVICES 4 BELTS/ BRACES 5 BUDS 6 COLD PACK/HOT PACK 7 CARRY BAGS 8 EMAIL / INTERNET CHARGES 9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) 10 LEGGINGS 11 LAUNDRY CHARGES 12 MINERAL WATER 13 SANITARY PAD 14 TELEPHONE CHARGES 15 GUEST SERVICES 16 CREPE BANDAGE 17 DIAPER OF ANY TYPE 18 EYELET COLLAR 19 SLINGS 20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES 21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED 22 TELEVISION CHARGES 23 SURCHARGES 24 ATTENDANT CHARGES 25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE) 26 BIRTH CERTIFICATE 27 CERTIFICATE CHARGES 28 COURIER CHARGES 29 CONVEYANCE CHARGES 30 MEDICAL CERTIFICATE 31 MEDICAL RECORDS 32 PHOTOCOPIES CHARGES 33 MORTUARY CHARGES 34 WALKING AIDS CHARGES 35 SPIROMETRE 36 STEAM INHALER 37 ARMSLING 38 THERMOMETER 39 CERVICAL COLLAR 40 SPLINT 41 DIABETIC FOOT WEAR 42 KNEE BRACES (LONG/ SHORT/ HINGED) 43 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER 44 LUMBO SACRAL BELT 45 NIMBUS BED OR WATER OR AIR BED CHARGES 46 AMBULANCE COLLAR 47 AMBULANCE EQUIPMENT 48 ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ 49 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES 50 SUGAR FREE Tablets 51 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable) 52 ECG ELECTRODES 53 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC] 54 KIDNEY TRAY 55 OUNCE GLASS 56 PELVIC TRACTION BELT 57 PAN CAN 58 TROLLY COVER 59 UROMETER, URINE JUG 1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 2 HAND WASH 3 CRADLE CHARGES 4 COMB 5 EAU-DE-COLOGNE / ROOM FRESHNERS 6 GOWN 7 SLIPPERS 8 TISSUE PAPER 9 TOOTH PASTE 10 TOOTH BRUSH 11 BED PAN 12 FLEXI MASK 13 HAND HOLDER 14 SPUTUM CUP 15 DISINFECTANT LOTIONS 16 LUXURY TAX 17 HVAC 18 HOUSE KEEPING CHARGES 19 AIR CONDITIONER CHARGES 20 IM IV INJECTION CHARGES 21 CLEAN SHEET 22 BLANKET/WARMER BLANKET 23 ADMISSION KIT 24 DIABETIC CHART CHARGES 25 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES 26 DISCHARGE PROCEDURE CHARGES 27 DAILY CHART CHARGES 28 ENTRANCE PASS / VISITORS PASS CHARGES 29 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE 30 FILE OPENING CHARGES 31 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED) 32 PATIENT IDENTIFICATION BAND / NAME TAG 33 PULSEOXYMETER CHARGES 1 HAIR REMOVAL CREAM 2 DISPOSABLES RAZORS CHARGES (for site preparations)

TABLE OF BENEFITS. Name Group Corona Kavach Policy, Max Niva Bupa Health Insurance Co. Ltd. Product Type Individual/Floater Category of Benefit Indemnity/Benefit Sum Insured Rs. 50,000/- (Fifty Thousand) to 5,00,000 (Five Lakh) (in the multiples of fifty thousand) On Individual basis- SI shall apply to each individual family member On Floater basis- SI shall apply to the entire family. Policy Period Three and half months (3 ½ months), Six and half months (6 ½ months), Nine and half months (9 ½ months) including waiting periods Eligibility Policy can be availed by persons between the age of 18 Years up to 65 Years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. Policy can be availed for Self and the following family members 1. Legally wedded spouse 2. Parents & Parents-in-law 3. Dependent Children (i.e natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible. Hospitalization Expenses Medical Expenses of Hospitalization for Covid for a minimum period of 24 consecutive hours shall be admissible. Pre-Hospitalization For 15 days prior to the date of hospitalization/home care treatment Post Hospitalization 30 days from the date of discharge from the hospital/completion of home care treatment Sub-limits Hospital Daily Cash: 0.5% of Sum Insured per day subject to maximum of 15 days in a policy period for every insured member. Home Care Treatment: Maximum up to 14 days per incident AYUSH Medical Expenses incurred for inpatient care treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured during the Policy period as specified in the policy schedule. Home Care Treatment Expenses The Company shall indemnify costs of treatment incurred by the Insured person for availing treatment at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre maximum up to 14 days per incident, which in the normal course would require care and treatment at a hospital but is actually taken while confined at home subject to policy terms and conditions 1 BABY FOOD 2 BABY UTILITIES CHARGES 3 BEAUTY SERVICES 4 BELTS/ BRACES 5 BUDS 6 COLD PACK/HOT PACK 7 CARRY BAGS 8 EMAIL / INTERNET CHARGES 9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) 10 LEGGINGS 11 LAUNDRY CHARGES 12 MINERAL WATER 13 SANITARY PAD 14 TELEPHONE CHARGES 15 GUEST SERVICES 16 CREPE BANDAGE 17 DIAPER OF ANY TYPE 18 EYELET COLLAR 19 SLINGS 20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES 21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED 22 TELEVISION CHARGES 23 SURCHARGES 24 ATTENDANT CHARGES 25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE) 26 BIRTH CERTIFICATE 27 CERTIFICATE CHARGES 28 COURIER CHARGES 29 CONVEYANCE CHARGES 30 MEDICAL CERTIFICATE 31 MEDICAL RECORDS 32 PHOTOCOPIES CHARGES 33 MORTUARY CHARGES 34 WALKING AIDS CHARGES 35 SPIROMETRE 36 STEAM INHALER 37 ARMSLING 38 THERMOMETER 39 CERVICAL COLLAR 40 SPLINT 41 DIABETIC FOOT WEAR 42 KNEE BRACES (LONG/ SHORT/ HINGED) 43 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER 44 LUMBO SACRAL BELT 45 NIMBUS BED OR WATER OR AIR BED CHARGES 46 AMBULANCE COLLAR 47 AMBULANCE EQUIPMENT 48 ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ 49 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES 50 SUGAR FREE Tablets 51 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable) 52 ECG ELECTRODES 53 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC] 54 KIDNEY TRAY 55 OUNCE GLASS 56 PELVIC TRACTION BELT 57 PAN CAN 58 TROLLY COVER 59 UROMETER, URINE JUG 1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 2 HAND WASH 3 CRADLE CHARGES 4 COMB 5 EAU-DE-COLOGNE / ROOM FRESHNERS 6 GOWN 7 SLIPPERS 8 TISSUE PAPER 9 TOOTH PASTE 10 TOOTH BRUSH 11 BED PAN 12 FLEXI MASK 13 HAND HOLDER 14 SPUTUM CUP 15 DISINFECTANT LOTIONS 16 LUXURY TAX 17 HVAC 18 HOUSE KEEPING CHARGES 19 AIR CONDITIONER CHARGES 20 IM IV INJECTION CHARGES 21 CLEAN SHEET 22 BLANKET/WARMER BLANKET 23 ADMISSION KIT 24 DIABETIC CHART CHARGES 25 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES 26 DISCHARGE PROCEDURE CHARGES 27 DAILY CHART CHARGES 28 ENTRANCE PASS / VISITORS PASS CHARGES 29 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE 30 FILE OPENING CHARGES 31 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED) 32 PATIENT IDENTIFICATION BAND / NAME TAG 33 PULSEOXYMETER CHARGES 1 HAIR REMOVAL CREAM 2 DISPOSABLES RAZORS CHARGES (for site preparations)