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# NITDAA BASE HEALTH INSURANCE PROGRAM — RAG KNOWLEDGE BASE
# (Base Policy Only — STUP and Worldwide Coverage Removed)
################################################################################
# Version : 3.1 (2026-06-09)
# Plan Scope : Base Policy Only (Rs. 3 Lakhs and Rs. 5 Lakhs)
# Removed : Super Top-Up (STUP) insurance details
# Worldwide Critical Illness coverage details
# Text Fixes : IITMAA->NITDAA | IIT->NIT | IITM->NITD
# Madras->Durgapur | Chennai->Durgapur
# Indian Institute of Technology->National Institute of Technology
# Insurer : Aditya Birla Health Insurance Co. Ltd. (ABHI)
# Product UIN : ADIHLGP22190V032122 (Group Activ Health)
# Broker : Zopper Insurance Brokers Private Limited
# Master Holder : NIT Durgapur Alumni Association (NITDAA)
# Total Chunks : 33
# Optimized for : ChromaDB (VectorDB) | KuzuDB (GraphDB) | BM25 keyword search
################################################################################
# CHUNK FORMAT
# [CHUNK]
# id : globally unique identifier
# section : top-level section name
# subsection : sub-level section name
# topic_tags : BM25 keyword-rich comma-separated terms
# entities : pipe-separated Entity_Type:Entity_Name for KuzuDB nodes
# relationships : semicolon-separated subject|predicate|object for KuzuDB edges
# text : self-contained, descriptive, bulleted content for embedding
# [/CHUNK]
################################################################################
[CHUNK]
id : OVERVIEW_001
section : Plan Overview
subsection : Program Introduction and Key Parties
topic_tags : NITDAA, NIT Durgapur Alumni Association, health insurance, group policy, alumni, base plan, overview, welfare initiative, master policy, Aditya Birla, Zopper, Solvy Tech, floater, Group Activ Health, ADIHLGP22190V032122
entities : Organization:NITDAA|Organization:NIT_Durgapur_Alumni_Association|Plan:NITDAA_Base_Health_Insurance|Insurer:Aditya_Birla_Health_Insurance|Broker:Zopper_Insurance_Brokers|Tech_Partner:Solvy_Tech_Solutions|Policy:Group_Activ_Health
relationships : NITDAA|administers|NITDAA_Base_Health_Insurance;Aditya_Birla_Health_Insurance|underwrites|NITDAA_Base_Health_Insurance;Zopper_Insurance_Brokers|brokers|NITDAA_Base_Health_Insurance;NIT_Durgapur|is_master_policy_holder|NITDAA_Base_Health_Insurance
text :
NITDAA BASE HEALTH INSURANCE PROGRAM — OVERVIEW
WHAT IT IS:
- An exclusive group health insurance plan for NIT Durgapur alumni (NITDAA members) and
their eligible family members
- This is a welfare initiative; NITDAA and its representatives have no personal, financial,
or commercial interest in promoting this policy
- Terms are exclusive to NITD alumni — NOT available in the retail/open market
KEY PARTIES:
- Master Policyholder : NIT Durgapur (Institution) / NITDAA
- Insurer : Aditya Birla Health Insurance Co. Ltd. (ABHI)
- Product : Group Activ Health | UIN: ADIHLGP22190V032122
- Broker : Zopper Insurance Brokers Private Limited
- Technology Partner : Solvy Tech Solutions Private Limited
- Claim Servicing : In-house by ABHI (no separate TPA)
- Policy Type : Family Floater | Tenure: 1 Year (annual renewal)
- Sum Insured Options : Rs. 3 Lakhs or Rs. 5 Lakhs
DISCLAIMER: NIT Durgapur (Master Policyholder) is NOT responsible for claim settlement.
All claims are settled exclusively by Aditya Birla Health Insurance Co. Ltd.
ENROLLMENT WINDOW (2026):
- Enrollment Opens : 08 June 2026
- Payment Gateway : 10 June 2026 (payment processing begins)
- Enrollment Closes : 30 June 2026
PROGRAM SCALE:
- 3,000+ lives insured under Base policy
- Common Master Agreement across 6 NITs:
Calicut, Durgapur, Jamshedpur, Rourkela, Surathkal, Warangal
- Claim Settlement Ratio of Aditya Birla Health Insurance: 98%
KEY ADVANTAGES OVER RETAIL INDIVIDUAL POLICIES:
- No medical tests required at enrollment
- No negative list — members with ALL pre-existing conditions (PEDs) allowed to enroll
- Parents and parents-in-law can be covered (retail typically denies older members)
- Lifelong renewability once enrolled before 85 years
- Aggregate group buying power — better terms than retail
- Protection against claim rejection on flimsy grounds
- Pan-India NITD Champions network for emergency support
- Premiums eligible for Section 80D income tax deduction
- Completely digital end-to-end enrollment through NITDAA portal
- No registration fee charged by NITDAA on this group policy
[/CHUNK]
[CHUNK]
id : ELIGIBILITY_001
section : Eligibility
subsection : Family Members Who Can Be Covered
topic_tags : eligibility, who can be covered, family members, alumni, spouse, children, parents, parents-in-law, siblings not allowed, covered members, dependent children, proposer mandatory, three policy combinations, ASK policy
entities : Member_Type:Alumni|Member_Type:Spouse|Member_Type:Child_Max4|Member_Type:Parents_Max2|Member_Type:ParentsInLaw_Max2|Rule:Alumni_Must_Be_Proposer|Combo:ASK|Combo:Parents|Combo:Parents_in_Law
relationships : Alumni|is_mandatory_proposer|Policy;Alumni|can_add|Spouse;Alumni|can_add|Up_to_4_Children;Alumni|can_add|Up_to_2_Parents;Alumni|can_add|Up_to_2_Parents_in_Law;Siblings|NOT_eligible|Policy;Alumni_Self|must_enroll_before|Parents_or_InLaws
text :
WHO CAN BE COVERED — NITDAA BASE HEALTH INSURANCE
ELIGIBLE FAMILY MEMBERS (maximum per family):
- Alumni (NITD) : 1 — Mandatory proposer/primary policyholder
- Spouse : 1 — Lawfully wedded
- Dependent Children : Up to 4
NEW MEMBERS' children : Age Day 1 to 25 years (entry and exit at 26)
RENEWAL MEMBERS' children : If already above 25 and enrolled before turning 25,
coverage continues until age 30
- Parents : Up to 2 — Both parents of alumni
- Parents-in-Law : Up to 2 — Both parents of spouse
MANDATORY RULE:
- Alumni MUST be the proposer; alumni must enroll self BEFORE adding parents or parents-in-law
- Can take only a policy for self, or self+spouse+kids, before adding parents/in-laws
NOT ELIGIBLE:
- Siblings (never eligible under any circumstance)
- Children above 25 years — for NEW members/new enrollments only
(Renewal members whose children were already enrolled may continue until age 30)
- Friends, relatives beyond the eligible categories
- Members not connected to NITD alumni
THREE INDEPENDENT POLICY COMBINATIONS (each has its own separate Sum Insured):
1. Alumni + Spouse + Children (ASK Policy)
2. Parents (separate floater policy)
3. Parents-in-Law (separate floater policy)
ADDING MEMBERS AT RENEWAL:
- Spouse and children can be added during renewal window via Endorsement
- Newly added members: fresh 1-year PED waiting period applies
- Existing members at renewal: ZERO waiting period
PREMIUM RATE RULE:
- Rate determined by age of the OLDEST member in the family unit
- If both spouses are NITD alumni, do NOT use younger spouse as proposer to reduce rate
(age of oldest member governs the slab regardless)
[/CHUNK]
[CHUNK]
id : ELIGIBILITY_002
section : Eligibility
subsection : Entry and Exit Age Criteria
topic_tags : entry age, exit age, 85 years, lifelong renewability, child age 25, child age 30 renewal, parent age 41, alumni age 18, after 85 renewal, age limit, 26 exit, 30 renewal child, age criteria, new member child 25, renewal member child 30, age policy children
entities : Age_Criteria:Alumni_Spouse_18to85|Age_Criteria:Child_NewMember_Day1to25|Age_Criteria:Child_RenewalMember_26to30|Age_Criteria:Parent_41to85|Exit:Child_NewMember_26|Exit:Child_RenewalMember_30|Exit:Alumni_Spouse_Lifelong|Exit:Parent_Lifelong
relationships : Alumni_Spouse|entry_age_min|18;Alumni_Spouse|entry_age_max|85;Child_New|entry_age_min|Day1;Child_New|entry_age_max|25;Child_New|exit_at|26;Child_Renewal_already_enrolled|exit_at|30;Parent_ParentInLaw|entry_age_min|41;Parent_ParentInLaw|entry_age_max|85;Alumni_Spouse|exit|Lifelong_if_enrolled_before_85
text :
ENTRY AND EXIT AGE CRITERIA — NITDAA BASE HEALTH INSURANCE
ENTRY AGE:
Member Entry Age Range
-----------------------------------------------
Alumni & Spouse 18 years to 85 years
Dependent Children From Day 1 (newborn) to 25 years
Parents & Parents-in-Law 41 years to 85 years
EXIT AGE:
Member Exit Age
-----------------------------------------------
Alumni & Spouse Lifelong Renewability*
Dependent Children NEW MEMBER enrollment: exits at 26 years
RENEWAL MEMBER (already enrolled before 25): continues to 30 years
Parents & Parents-in-Law Lifelong Renewability*
*LIFELONG RENEWABILITY RULE:
- 85 years is ONLY the entry criteria, NOT a renewal exit criterion
- Once enrolled before age 85, the member can continue renewing INDEFINITELY
as long as the NITDAA program continues with the insurer
- Applies to alumni, spouse, parents, and parents-in-law
PREMIUM SLAB FOR 85+ MEMBERS:
- Costs are standard for members above 85 (not individually variable)
- Slab cost may change year-over-year based on group's overall claim ratio
AGE CALCULATION BASIS:
- Age = Completed age as on the policy issuance date (typically in July)
[/CHUNK]
[CHUNK]
id : ELIGIBILITY_003
section : Eligibility
subsection : NRI Alumni — Enrollment and Coverage Rules
topic_tags : NRI, non-resident Indian, overseas, foreign citizen, India only treatment, Indian mobile number, WhatsApp, diagnosis abroad, UAE, international number, NRI alumni enrollment, treatment within India, claims outside India not admissible
entities : Member_Type:NRI_Alumni|Rule:India_Only_Claims|Requirement:Indian_Mobile_Number|Alternative:International_WhatsApp_Number
relationships : NRI_Alumni|can_enroll|Yes;Policy|jurisdiction|India_Only;Claim|admissible_for|Treatment_within_India;Claim|NOT_admissible_for|Treatment_outside_India;Indian_Mobile_Number|required_for|Policy_Issuance
text :
NRI ALUMNI — ENROLLMENT AND COVERAGE RULES
ELIGIBILITY:
- NRI alumni (including foreign citizens) are eligible to enroll in this plan
- Alumni with foreign citizenship can also enroll self and cover parents with Indian citizenship
- Alumni must enroll themselves FIRST before adding parents or in-laws
COVERAGE SCOPE FOR NRI:
- This policy covers ONLY hospitalizations and treatments taken WITHIN INDIA
- Claims for any treatment availed OUTSIDE INDIA are NOT admissible
- A condition diagnosed outside India IS covered if treatment/hospitalization is sought within India
ENROLLMENT REQUIREMENTS FOR NRI:
- An Indian mobile number is required for policy issuance
- If the alumni does not have an Indian number:
Option 1: Use a family member's Indian mobile number
Option 2: Register your international number as WhatsApp number during enrollment journey
KEY Q&A FOR NRI ALUMNI:
Q: I am an NRI. Can I buy the Base insurance policy for myself and parents?
A: Yes. An Indian mobile number (yours or a family member's) is required for policy issuance.
Coverage is valid ONLY for treatments availed within India.
Claims for treatment taken outside India are NOT admissible.
Q: I have global employer coverage. I am 58, retiring in 2 years. Should I enroll now?
A: Yes. Enrolling now means by next year's renewal, PED waiting period will be waived.
Q: I am diagnosed outside India. Can I claim for treatment in India?
A: Yes. If treatment/hospitalization is taken within India, the claim is fully admissible.
[/CHUNK]
[CHUNK]
id : SUM_INSURED_001
section : Sum Insured
subsection : Options, Floater Structure, and Policy Combinations
topic_tags : sum insured, 3 lakhs, 5 lakhs, floater, policy combination, independent SI, ASK policy, parents policy, in-laws policy, sub-limit no capping, increase SI, decrease SI, multi-year not available, claim limit per year
entities : SI_Option:3_Lakhs|SI_Option:5_Lakhs|Cover_Type:Family_Floater|Combo:ASK_Alumni_Spouse_Kids|Combo:Parents|Combo:Parents_in_Law
relationships : Base_Plan|SI_options|3L_and_5L;Base_Plan|cover_type|Family_Floater;ASK_Combo|independent_SI_from|Parents_Combo;Sub_limits|apply|No_Capping;SI_Increase|subject_to|Insurer_Approval_at_Renewal;Multi_Year_Policy|available|No
text :
SUM INSURED OPTIONS — NITDAA BASE HEALTH INSURANCE
AVAILABLE SUM INSURED (Base Plan):
- Option 1 : Rs. 3 Lakhs (Floater basis)
- Option 2 : Rs. 5 Lakhs (Floater basis)
FLOATER STRUCTURE:
- Sum Insured is shared among all members in one policy combination per policy year
- Maximum payable per policy year = chosen Sum Insured
- Sub-limits or capping on ANY ailment/treatment: NONE (no capping applies)
THREE INDEPENDENT POLICY COMBINATIONS (each has its own Sum Insured):
Combo 1 : Alumni + Spouse + Children (ASK Policy)
Combo 2 : Parents (separate floater policy)
Combo 3 : Parents-in-Law (separate floater policy)
Example: If SI is Rs. 5L and you hold all 3 combos, each has independent Rs. 5L available
MULTIPLE CLAIMS IN ONE YEAR:
- No restriction on number of claims within a policy year
- Claims are payable up to the available sum insured for that combination
SUM INSURED MANAGEMENT:
- Increase at renewal : Subject to insurer approval (not guaranteed)
- Decrease at renewal : No restriction
- RECOMMENDATION : Take the HIGHEST affordable SI at FIRST enrollment
(If SI increase is disallowed next year, you'll be locked into lower cover)
- If SI increase is permitted: Fresh waiting period applies only to the incremental amount
- Multi-year policy : NOT available; policy is 1 year, renewed annually
[/CHUNK]
[CHUNK]
id : WAITING_001
section : Waiting Periods
subsection : New Member Waiting Periods — Three Types
topic_tags : waiting period, initial waiting 30 days, specific disease 12 months, PED 12 months, pre-existing disease, new member, accident exempt, no PED declaration, negative list, 12 month wait, Day 1 accident coverage
entities : Wait_Period:Initial_30Days|Wait_Period:Specific_Disease_12Months|Wait_Period:PED_12Months|Exception:Accident_Exempt_from_30Day|Rule:No_PED_Declaration|Rule:No_Negative_List
relationships : New_Member|subject_to|Initial_30Days_Wait;New_Member|subject_to|Specific_Disease_12Months_Wait;New_Member|subject_to|PED_12Months_Wait;Accident|exempt_from|Initial_30Days;Accident|exempt_from|Specific_Disease_Wait;PED|declaration_required|No
text :
WAITING PERIODS — NEW MEMBERS
THREE WAITING PERIODS FOR ALL NEW MEMBERS:
1. INITIAL WAITING PERIOD — 30 Days
- All illness-related claims within first 30 days from commencement: EXCLUDED
- EXCEPTION: Injury/Accident cases — covered from Day 1, no waiting period
- This waiting period is served ONCE; waived completely at renewal
2. SPECIFIC DISEASES WAITING PERIOD — 12 Months
- A defined list of conditions requires 12 months of continuous coverage before claims
- Complete disease list with body systems: see Section 5 chunks
- EXCEPTION: Accident-related claims for any listed condition: NOT subject to this wait
- Rule: If a specific disease is also a Pre-Existing Disease, the LONGER wait applies
(both are 12 months in this plan — they run concurrently)
3. PRE-EXISTING DISEASE (PED) WAITING PERIOD — 12 Months
- PED definition: Any condition diagnosed or treated within 36 months prior to policy start
- All PEDs covered AFTER 12 months of continuous coverage
- NO PEDs need to be declared at enrollment
- Members with ALL pre-existing conditions can enroll (no negative list)
- No medical tests required to verify PED status
- No documentation of health history required
IMPORTANT: PED waiting period applies ONLY to new members.
From Year 2 renewal onwards, zero waiting period for existing members.
[/CHUNK]
[CHUNK]
id : WAITING_002
section : Waiting Periods
subsection : Renewal Members — Zero Wait, Break Consequences, Portability
topic_tags : renewal waiting period, zero waiting, PED waiver, break in policy, lapse, re-entry, portability not possible, moratorium period, continuity benefit, no waiting renewal, early enrollment advised
entities : Rule:Zero_Wait_at_Renewal|Consequence:Break_Resets_All_Waits|Rule:No_Portability_Inward|Benefit:PED_Waiver_from_Year2
relationships : Renewal_Member|subject_to_wait|None;Renewal|waives|Initial_30Day_Wait;Renewal|waives|Specific_Disease_12Month_Wait;Renewal|waives|PED_12Month_Wait;Break_in_Policy|resets|All_Waiting_Periods;Portability_into_Plan|possible|No
text :
WAITING PERIODS — RENEWAL MEMBERS
FOR EXISTING RENEWAL MEMBERS:
- Zero waiting period of any kind from Year 2 onwards
- Initial 30-day wait: WAIVED
- Specific disease 12-month wait: WAIVED
- PED 12-month wait: WAIVED
- Full coverage from Day 1 of renewal
FOR MEMBERS NEWLY ADDED AT RENEWAL (e.g., adding spouse or child in Year 2):
- Newly added members = treated as new members
- Full 1-year PED waiting period applies to newly added members
- Existing members in the same policy retain their zero-wait renewal benefits
CONSEQUENCES OF BREAK IN POLICY (NON-RENEWAL):
- All waiting periods (30 days, 12-month specific diseases, 12-month PED) restart from scratch
- Cannot exit and rejoin while retaining waiting period credits
- Once you do not renew, ALL renewal benefits are permanently lost
- On re-joining, you are treated as a new member
- PORTABILITY FROM ANOTHER INSURER INTO THIS PLAN: NOT POSSIBLE
MIGRATION WITHIN ABHI (same insurer):
- Migration to another Aditya Birla product is possible
- Must apply for migration at least 30 days before renewal date
- All accrued continuity benefits transfer to the new ABHI product
RECOMMENDATION: Enroll now even if you do not immediately need cover.
The sooner you enroll, the sooner waiting periods are served and
PED waiver becomes available at next renewal.
[/CHUNK]
[CHUNK]
id : DISEASES_001
section : Specific Diseases — 12-Month Wait
subsection : Eye and ENT Conditions
topic_tags : specific diseases 12 months, eye, cataract surgery, glaucoma surgery, ENT, sinusitis, tonsillitis, tympanitis, deviated nasal septum, otitis media, adenoids, mastoiditis, cholesteatoma, named ailments, waiting period disease list
entities : Disease:Cataract|Disease:Glaucoma|Disease:Serous_Otitis_Media|Disease:Sinusitis|Disease:Rhinitis|Disease:Tonsillitis|Disease:Tympanitis|Disease:Deviated_Nasal_Septum|Disease:Otitis_Media|Disease:Adenoiditis|Disease:Mastoiditis|Disease:Cholesteatoma|System:Eye|System:Ear_Nose_Throat
relationships : Cataract|system|Eye;Cataract|wait_months|12;Cataract|surgery|Cataract_Surgery;Glaucoma|surgery|Glaucoma_Surgery;Sinusitis|system|ENT;Sinusitis|surgery|Sinus_Surgery;Tonsillitis|surgery|Tonsillectomy;Tympanitis|surgery|Tympanoplasty;Deviated_Nasal_Septum|surgery|DNS_Surgery;Otitis_Media|surgery|Treatment_for_Otitis_Media;Adenoiditis|surgery|Adenoidectomy;Mastoiditis|surgery|Mastoidectomy
text :
SPECIFIC DISEASES — 12-MONTH WAITING PERIOD (NEW MEMBERS)
Body System: EYE and EAR/NOSE/THROAT (ENT)
NOTE: Waiting periods do NOT apply to renewal members.
NOTE: Claims arising from ACCIDENTS are EXEMPT from this waiting period.
BODY SYSTEM: EYE
Illness | Treatment / Surgery
----------------------- | -------------------------
Cataract | Cataract Surgery
Glaucoma | Glaucoma Surgery
BODY SYSTEM: EAR, NOSE, THROAT (ENT)
Illness | Treatment / Surgery
------------------------- | -------------------------------------------------
Serous Otitis Media | (treatment covered after wait)
Sinusitis | Sinus Surgery
Rhinitis | Surgery for the Nose
Tonsillitis | Tonsillectomy
Tympanitis | Tympanoplasty
Deviated Nasal Septum | Surgery for Deviated Nasal Septum
Otitis Media | Surgery or Treatment for Otitis Media
Adenoiditis | Adenoidectomy
Mastoiditis | Mastoidectomy
Cholesteatoma | Resection of the Nasal Concha
[/CHUNK]
[CHUNK]
id : DISEASES_002
section : Specific Diseases — 12-Month Wait
subsection : Gynecology Conditions
topic_tags : specific diseases 12 months, gynecology, PCOD, polycystic ovarian disease, fibroids, endometriosis, uterine prolapse, DUB dysfunctional uterine bleeding, menorrhagia, breast lumps, pelvic inflammatory disease, cysts polyps, hysterectomy, myomectomy
entities : Disease:Cysts_Polyps_Female_Genito_Urinary|Disease:PCOD|Disease:Uterine_Prolapse|Disease:Fibroids|Disease:Breast_Lumps|Disease:DUB|Disease:Endometriosis|Disease:Menorrhagia|Disease:Pelvic_Inflammatory_Disease|System:Gynecology
relationships : PCOD|system|Gynecology;PCOD|wait_months|12;Cysts_Polyps|surgery|Dilatation_and_Curettage;PCOD|surgery|Myomectomy;Uterine_Prolapse|surgery|Uterine_Prolapse_Surgery;Fibroids|surgery|Hysterectomy_unless_malignancy;Menorrhagia|treatment|Any_Treatment_for_Menorrhagia
text :
SPECIFIC DISEASES — 12-MONTH WAITING PERIOD (NEW MEMBERS)
Body System: GYNECOLOGY
NOTE: Waiting periods do NOT apply to renewal members.
NOTE: Claims arising from ACCIDENTS are EXEMPT.
Illness | Treatment / Surgery
----------------------------------------------- | --------------------------------------------------
All Cysts & Polyps of female genito-urinary sys | Dilatation & Curettage
Polycystic Ovarian Disease (PCOD) | Myomectomy
Uterine Prolapse | Uterine Prolapsed Surgery
Fibroids (Fibromyoma) | Hysterectomy unless necessitated by malignancy
Breast Lumps | Any treatment for Menorrhagia
Prolapse of the Uterus | —
Dysfunctional Uterine Bleeding (DUB) | —
Endometriosis | —
Menorrhagia | —
Pelvic Inflammatory Disease | —
[/CHUNK]
[CHUNK]
id : DISEASES_003
section : Specific Diseases — 12-Month Wait
subsection : Orthopedic, Rheumatological, and Gastroenterology Conditions
topic_tags : specific diseases 12 months, orthopedic, gout, rheumatoid arthritis, osteoarthritis, osteoporosis, disc prolapse, spondylopathies, joint replacement, gastroenterology, gall bladder, bile duct, cholecystitis, pancreatitis, piles hemorrhoids, fistula, GERD, ulcers, cirrhosis
entities : Disease:Gout|Disease:Rheumatoid_Arthritis|Disease:Non_Infective_Arthritis|Disease:Osteoarthritis|Disease:Osteoporosis|Disease:Disc_Prolapse|Disease:Spondylopathies|Disease:Gall_Bladder_Stone|Disease:Cholecystitis|Disease:Pancreatitis|Disease:Fissure_Fistula_Piles|Disease:GERD|Disease:Gastric_Ulcers|Disease:Cirrhosis|System:Orthopedic|System:Gastroenterology
relationships : Gout|system|Orthopedic;Gout|wait_months|12;Gout|surgery|Joint_Replacement;Disc_Prolapse|surgery|Surgery_Intervertebral_Disc;Gall_Bladder_Stone|system|Gastroenterology;Gall_Bladder_Stone|surgery|Cholecystectomy;Gastric_Ulcers|surgery|Surgery_for_Ulcers
text :
SPECIFIC DISEASES — 12-MONTH WAITING PERIOD (NEW MEMBERS)
Body Systems: ORTHOPEDIC / RHEUMATOLOGICAL and GASTROENTEROLOGY
NOTE: Waiting periods do NOT apply to renewal members.
NOTE: Claims arising from ACCIDENTS are EXEMPT.
BODY SYSTEM: ORTHOPEDIC / RHEUMATOLOGICAL
Illness | Treatment / Surgery
------------------------------------ | -----------------------------------------------
Gout | Joint Replacement Surgery
Rheumatism | Surgery for Prolapse of Intervertebral Disc
Rheumatoid Arthritis | —
Non-infective Arthritis | —
Osteoarthritis | —
Osteoporosis | —
Prolapse of the Intervertebral Disc | —
Spondylopathies | —
BODY SYSTEM: GASTROENTEROLOGY (Alimentary Canal and Related Organs)
Illness | Treatment / Surgery
------------------------------------------------------------ | ------------------------------------
Stone in Gall Bladder and Bile Duct | Cholecystectomy / Surgery Gall Bladder
Cholecystitis | Surgery for Ulcers (Gastric/Duodenal)
Pancreatitis | —
Fissure, Fistula in Ano, Hemorrhoids (Piles), | —
Pilonidal Sinus, Ano-rectal & Perianal Abscess |
Rectal Prolapse | —
Gastric or Duodenal Erosions/Ulcers + Gastritis/Duodenitis | —
Gastro Esophageal Reflux Disease (GERD) | —
Cirrhosis | —
[/CHUNK]
[CHUNK]
id : DISEASES_004
section : Specific Diseases — 12-Month Wait
subsection : Urogenital, Skin, and General Surgery Conditions
topic_tags : specific diseases 12 months, urogenital, kidney stones, ureter, bladder, prostate BHP BEP, hernia, hydrocele, varicocele, spermatocoele, skin tumour, skin diseases, varicose veins, varicose ulcers, general surgery, cyst, nodule, polyp, benign
entities : Disease:Urinary_Stones|Disease:BHP_BEP|Disease:Hernia|Disease:Hydrocele|Disease:Varicocoele|Disease:Skin_Tumour|Disease:All_Skin_Diseases|Disease:Varicose_Veins|System:Urogenital|System:Skin|System:General_Surgery
relationships : Urinary_Stones|system|Urogenital;BHP_BEP|surgery|Prostate_Surgery;Hernia|surgery|Surgery_for_Hernia;Hydrocele|surgery|Surgery_for_Hydrocele;Varicocoele|surgery|Surgery_for_Varicocoele;Skin_Tumour|surgery|Removal_unless_malignant;Varicose_Veins|surgery|Surgery_Varicose_Veins
text :
SPECIFIC DISEASES — 12-MONTH WAITING PERIOD (NEW MEMBERS)
Body Systems: UROGENITAL, SKIN, GENERAL SURGERY
NOTE: Waiting periods do NOT apply to renewal members.
NOTE: Claims arising from ACCIDENTS are EXEMPT.
BODY SYSTEM: UROGENITAL (Urinary and Reproductive System)
Illness | Treatment / Surgery
----------------------------------------------------------- | -----------------------------------------------
Stones in Urinary System (Kidney, Ureter, Urinary Bladder) | Prostate Surgery
Benign Hypertrophy/Enlargement of Prostate (BHP/BEP) | Surgery for Hydrocele, Rectocele and Hernia
Hernia, Hydrocele | Surgery for Hydrocele, Rectocele and Hernia
Varicocoele / Spermatocoele | Surgery for Varicocoele / Spermatocoele
BODY SYSTEM: SKIN
Illness | Treatment / Surgery
------------------------------ | -----------------------------------
Skin Tumour (unless malignant) | Removal of such tumour unless malignant
All Skin Diseases | —
BODY SYSTEM: GENERAL SURGERY
Illness | Treatment / Surgery
---------------------------------------------------------- | -----------------------------------------------
Any swelling, tumour, cyst, nodule, ulcer, polyp anywhere | Surgery for cyst, tumour, nodule, polyp
in the body (unless malignant) | unless malignant
Varicose Veins, Varicose Ulcers | Surgery for Varicose Veins and Varicose Ulcers
[/CHUNK]
[CHUNK]
id : BENEFITS_001
section : Covered Benefits
subsection : Core Coverage Summary — All Key Features
topic_tags : benefits, room rent single private AC, pre-hospitalization 60 days, post-hospitalization 90 days, ambulance 10000, day care all covered, no sub-limit no capping, modern treatment 100 percent, AYUSH 100 percent, co-payment zero no co-pay, lasik surgery 6.5, internal congenital, external congenital life threatening, domiciliary 3 days, organ donor, COVID covered, no consumables, no maternity, no OPD
entities : Benefit:Room_Rent_Single_Private_AC|Benefit:PreHosp_60Days|Benefit:PostHosp_90Days|Benefit:Ambulance_10000|Benefit:DayCare_All|Benefit:No_Sub_Limit|Benefit:Modern_Treatment_100pct|Benefit:AYUSH_100pct|Benefit:Zero_CoPay|Benefit:Lasik_6point5|Benefit:Internal_Congenital|Benefit:Domiciliary_Min3Days|Benefit:Organ_Donor|Benefit:COVID
relationships : Base_Plan|room_entitlement|Single_Private_AC;Base_Plan|pre_hosp|60_days;Base_Plan|post_hosp|90_days;Base_Plan|ambulance_max|Rs_10000;Base_Plan|sub_limit|None;Base_Plan|modern_treatment|100pct_of_SI;Base_Plan|AYUSH|100pct_of_SI;Base_Plan|copay|Zero
text :
COVERED BENEFITS — NITDAA BASE HEALTH INSURANCE (SUMMARY TABLE)
Benefit | Coverage Detail
---------------------------------|------------------------------------------------------------------
Day Care Treatment | ALL day care procedures covered; no restricted list
In-patient Hospitalization | Minimum 24 consecutive hours; medically necessary
Domiciliary Hospitalization | Covered; minimum 3 consecutive days required
Room Rent Entitlement | Single Private AC Room (base entitlement)
ICU Charges | Covered; NOT subject to proportionate deduction
Pre-Hospitalization | 60 days prior to admission (same illness)
Post-Hospitalization | 90 days after discharge (same illness)
Emergency Ambulance (Road) | Maximum Rs. 10,000 per claim
Sub-Limits on Ailments | NO CAPPING — no sub-limits on any ailment or treatment
Modern Treatments | Covered up to 100% of Sum Insured (full list in Section 7)
AYUSH Treatment (In-patient) | Covered up to 100% of Sum Insured
Co-Payment | NIL — Zero co-pay
Lasik Surgery | Covered if refractive power +/- 6.5 diopters or more
Internal Congenital Anomaly | Covered
External Congenital Anomaly | Covered ONLY in life-threatening cases
Organ Donor Expenses | Covered up to Sum Insured (Transplantation of Human Organs Act 1994)
COVID-19 Treatment | Covered
Consumables | NOT covered under Base plan
Maternity | NOT covered under Base plan
OPD Treatment (without hosp.) | NOT covered
ROOM RENT PROPORTIONATE DEDUCTION RULE:
If admitted to a room HIGHER than Single Private AC entitlement:
- Associated Medical Expenses (room, nursing, OT, doctor fees) subject to proportionate deduction
- Pharmacy, consumables, implants, diagnostics: NOT subject to proportionate deduction
- ICU charges: NEVER subject to proportionate deduction
[/CHUNK]
[CHUNK]
id : BENEFITS_002
section : Covered Benefits
subsection : Domiciliary Hospitalization — Conditions and Excluded Illnesses
topic_tags : domiciliary hospitalization, home treatment, 3 consecutive days, excluded from domiciliary, asthma, hypertension, diabetes, epilepsy, arthritis, gastroenteritis, psychiatric, bronchitis, tonsillitis
entities : Benefit:Domiciliary|Rule:Min_3_Days|Exclusion_Domiciliary:Asthma|Exclusion_Domiciliary:Hypertension|Exclusion_Domiciliary:Diabetes|Exclusion_Domiciliary:Epilepsy|Exclusion_Domiciliary:Arthritis|Exclusion_Domiciliary:Gastroenteritis|Exclusion_Domiciliary:Psychiatric
relationships : Domiciliary|minimum_duration|3_Consecutive_Days;Domiciliary|payment_from|Day_1_once_threshold_met;Domiciliary|excludes|Asthma;Domiciliary|excludes|Hypertension;Domiciliary|excludes|Diabetes;Domiciliary|excludes|Epilepsy;Domiciliary|excludes|Psychiatric_Disorders
text :
DOMICILIARY HOSPITALIZATION — COVERAGE AND RESTRICTIONS
ELIGIBILITY CONDITIONS (must meet at least one):
- Patient's condition does not allow transfer to hospital, OR
- Hospital bed unavailable
- Minimum duration: 3 CONSECUTIVE DAYS
- Payment from Day 1 once the 3-day threshold is met
- Pre-hospitalization (60 days) and Post-hospitalization (90 days) also payable
when domiciliary claim is accepted
CONDITIONS SPECIFICALLY EXCLUDED UNDER DOMICILIARY HOSPITALIZATION:
(These conditions require actual hospital admission — domiciliary claim NOT admissible)
- Asthma, bronchitis, tonsillitis, upper respiratory tract infections
- Laryngitis, pharyngitis, cough, cold, influenza
- Arthritis, gout, rheumatism
- Chronic nephritis and nephritic syndrome
- Diarrhea, all types of dysenteries, gastroenteritis
- Diabetes mellitus and insipidus
- Epilepsy
- Hypertension
- Psychiatric or psychosomatic disorders (all kinds)
- Pyrexia of unknown origin
[/CHUNK]
[CHUNK]
id : BENEFITS_003
section : Covered Benefits
subsection : Modern Treatments — Full List at 100% Sum Insured
topic_tags : modern treatment, robotic surgery, oral chemotherapy, immunotherapy monoclonal antibody, deep brain stimulation, HIFU high intensity focused ultrasound, balloon sinuplasty, intra vitreal injections, stereotactic radio surgery, bronchial thermoplasty, prostate vaporization green laser holmium, IONM intra operative neuro monitoring, stem cell therapy hematological, uterine artery embolization, 100 percent coverage
entities : Modern_Tx:Uterine_Artery_Embolization_HIFU|Modern_Tx:Balloon_Sinuplasty|Modern_Tx:Deep_Brain_Stimulation|Modern_Tx:Oral_Chemotherapy|Modern_Tx:Immunotherapy_Monoclonal|Modern_Tx:Intra_Vitreal|Modern_Tx:Robotic_Surgery|Modern_Tx:Stereotactic_Radio|Modern_Tx:Bronchial_Thermoplasty|Modern_Tx:Prostate_Vaporization|Modern_Tx:IONM|Modern_Tx:Stem_Cell_Hematological
relationships : All_Modern_Treatments|covered_at|100pct_of_Sum_Insured;Robotic_Surgery|is_modern_treatment|Yes;Stem_Cell_Therapy|limited_to|Hematological_Conditions
text :
MODERN TREATMENTS COVERED — 100% OF SUM INSURED
All 12 modern treatments below are covered up to 100% of the chosen Sum Insured.
No sub-limit applies.
1. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)
2. Balloon Sinuplasty
3. Deep Brain Stimulation
4. Oral Chemotherapy
5. Immunotherapy — Monoclonal Antibody (injection form only)
6. Intra Vitreal Injections
7. Robotic Surgery
8. Stereotactic Radio Surgeries
9. Bronchial Thermoplasty
10. Vaporization of Prostate (Green Laser treatment or Holmium Laser treatment)
11. IONM — Intra Operative Neuro Monitoring
12. Stem Cell Therapy: Hematological conditions ONLY
NOTE: Stem cell therapy is covered ONLY for hematological conditions.
Stem cell therapy for all other purposes is EXCLUDED.
[/CHUNK]
[CHUNK]
id : EXCLUSIONS_001
section : Exclusions
subsection : Standard, Behavioural, and Circumstantial Exclusions
topic_tags : exclusions, not covered, obesity surgery BMI criteria, cosmetic surgery, gender change, hazardous sports professional, breach of law criminal intent, alcohol drug abuse, sterility infertility IVF, maternity childbirth, unproven treatment, investigation only, rehabilitation, health hydro spa, suicide, war nuclear
entities : Excl:Investigation_Only|Excl:Rest_Cure|Excl:Obesity_Surgery|Excl:Gender_Change|Excl:Cosmetic_Surgery|Excl:Hazardous_Sports_Pro|Excl:Breach_of_Law|Excl:Alcohol_Drug|Excl:Unproven_Treatment|Excl:Sterility_Infertility_IVF|Excl:Maternity|Excl:Suicide|Excl:War_Nuclear_Terror
relationships : Policy|excludes|Investigation_Only;Policy|excludes|Cosmetic_Surgery_Non_Medical;Policy|excludes|Hazardous_Sports_Professional;Policy|excludes|Sterility_and_Infertility;Policy|excludes|Maternity;Policy|excludes|Suicide
text :
STANDARD AND BEHAVIOURAL EXCLUSIONS — NITDAA BASE HEALTH INSURANCE
STANDARD EXCLUSIONS (IRDAI mandated):
1. Investigation & Evaluation Only: Admissions primarily for diagnostics without active treatment
2. Rest Cure / Rehabilitation: Enforced bed rest; custodial care; palliative care
3. Obesity/Weight Control Surgery: EXCLUDED unless ALL four conditions met simultaneously:
- Doctor's advice + clinically supported protocols
- Patient 18+ years
- BMI >= 40, OR BMI >= 35 with severe co-morbidities (obesity cardiomyopathy, coronary
heart disease, severe sleep apnea, uncontrolled Type 2 Diabetes) after failure of
non-invasive methods
4. Gender Change Treatments: Any treatment to change body characteristics to opposite sex
5. Cosmetic/Plastic Surgery: EXCLUDED unless post-accident reconstruction, post-burns/cancer,
or medically necessary as certified by treating doctor
6. Hazardous/Adventure Sports (Professional): Para-jumping, rock climbing, mountaineering,
rafting, motor racing, horse racing, scuba diving, hand gliding, sky diving, deep-sea diving
7. Breach of Law with Criminal Intent
8. Alcohol, Drug, or Substance Abuse: Treatment for addiction and consequences
9. Health Hydros, Nature Cure Clinics, Spas, and similar establishments
10. Dietary Supplements (without prescription): Unless prescribed during hospitalization
11. Refractive Error below 7.5 diopters (Lasik covered if power >= 6.5D)
12. Unproven/Experimental Treatments: Lacking significant medical documentation
13. Sterility and Infertility: Contraception, sterilization, IVF, ZIFT, GIFT, ICSI,
gestational surrogacy, reversal of sterilization
14. Maternity Expenses: Childbirth (including complicated delivery, C-section), miscarriage
(unless accident), termination of pregnancy
EXCEPTION: Ectopic pregnancy complications covered under In-patient Hospitalization
BEHAVIOURAL EXCLUSIONS:
- Suicide or attempted suicide; wilfully self-inflicted injury
- Illegal acts committed by insured person
- Treatment for injury from alcohol, intoxicating substances, or non-prescribed drugs
CIRCUMSTANTIAL EXCLUSIONS:
- War, acts of war, nuclear/chemical/biological weapons, radioactive contamination
- Direct participation in terrorist acts
[/CHUNK]
[CHUNK]
id : EXCLUSIONS_002
section : Exclusions
subsection : Medical, Device, Treatment, and Geographical Exclusions
topic_tags : exclusions, OPD not covered, preventive vaccination, external congenital, stem cell excluded except hematological, dental implants, hearing aids, spectacles, contact lens, cochlear implant, CPAP, glucometer, nebulizer, prosthetics, RFQMR ECP EECP hyperbaric, cyber knife, femto laser, bioabsorbable stent, outside India geographical exclusion, treatment outside India excluded
entities : Excl:OPD_No_Hospitalization|Excl:Preventive_Vaccination|Excl:External_Congenital|Excl:Stem_Cell_Non_Hematological|Excl:Dental|Excl:Hearing_Aids|Excl:Spectacles_Contact_Lens|Excl:Cochlear_Implant|Excl:CPAP_Glucometer|Excl:RFQMR_ECP_EECP|Excl:Hyperbaric_Oxygen|Excl:Cyber_Knife|Excl:Bioabsorbable_Stent|Excl:Treatment_Outside_India
relationships : Policy|excludes|OPD_Without_Hospitalization;Policy|excludes|Preventive_Vaccination_Except_Post_Bite;Policy|excludes|External_Congenital_Except_Life_Threatening;Policy|excludes|Stem_Cell_Except_Hematological;Policy|excludes|All_Treatment_Outside_India
text :
MEDICAL, DEVICE, TREATMENT, AND GEOGRAPHICAL EXCLUSIONS
MEDICAL EXCLUSIONS:
- Routine examinations and preventive health check-ups
- Circumcision (unless medically required for illness/injury)
- OPD Treatment without hospitalization (no OPD benefit in Base plan)
- Preventive care, vaccinations/inoculations (EXCEPT post-bite treatment)
- Psychiatric/psychological examinations without hospitalization
- Nutritional/electrolyte supplements (unless certified consequence of covered claim)
- External Congenital Anomalies (EXCEPT life-threatening cases)
- Stem Cell Therapy (EXCEPT hematopoietic stem cells for bone marrow transplant
for hematological conditions)
- Growth Hormone Therapy or Hormone Replacement Therapy
- Dentures, implants, artificial teeth
- Health check-ups for employment/travel/certification purposes
PROSTHETICS AND DEVICE EXCLUSIONS:
- Hearing aids, spectacles, contact lenses, multifocal lenses, optometric therapy
- Wigs and toupees; wheelchairs; crutches
- Nebulizers, oxygen concentrators for asthma/COPD conditions
- Glucometers, ambulatory blood pressure/blood sugar monitors
- CPAP/BIPAP devices for sleep apnea
- External prosthetics, corrective devices, and artificial limbs
- Cochlear implants (EXCEPT if caused by Accident)
SPECIFIC TREATMENT EXCLUSIONS:
- RFQMR, ECP, EECP, Hyperbaric Oxygen Therapy, KTP Laser Surgeries
- Cyber Knife treatment, Femto Laser Surgeries
- Bioabsorbable stents, bioabsorbable valves, bioabsorbable implants
- RF probe ablation
GEOGRAPHICAL EXCLUSION:
- All treatment taken OUTSIDE INDIA is EXCLUDED under this Base policy
- This applies without exception; there is no overseas coverage benefit in this plan
[/CHUNK]
[CHUNK]
id : ENROLLMENT_001
section : Enrollment Process
subsection : How to Enroll, Portal, Verification, Rules
topic_tags : enrollment, how to enroll, NITDAA portal, digital enrollment, alumni verification, no medical test, enrollment window 08 June 30 June, exit not allowed, rejoin not allowed, medical records not required, nitdaa.org
entities : Process:Digital_Enrollment|Portal:NITDAA_Portal|Rule:No_Medical_Test|Rule:Cannot_Exit_and_Rejoin|Window:08Jun_to_30Jun_2026|Rule:Alumni_Verified_by_NITDAA
relationships : Enrollment|process|Digital_Only;Enrollment|portal|NITDAA_Portal;Medical_Test|required|No;Exit_and_Rejoin|allowed|No;Alumni_Status|verified_by|NITDAA;Base_Policy_Window|dates|08Jun_to_30Jun_2026
text :
ENROLLMENT PROCESS — NITDAA BASE HEALTH INSURANCE
HOW TO ENROLL:
- Completely end-to-end digital; no paperwork or physical visits required
- Through the NITDAA web portal only (exclusive to NITD alumni)
- Portal URL: https://www.nitdaa.org/external_insurance.dz
- All portal users are verified alumni — registration enabled only through NITDAA portal
- Alumni status verified by NITDAA
ENROLLMENT WINDOW 2026:
- Base Policy : 08 June 2026 to 30 June 2026
- Payment Gateway Opens : 10th June 2026
(Enrollment portal opens 08 June; actual payment processing begins 10 June 2026)
PRE-ENROLLMENT REQUIREMENTS:
- Medical check-up/tests : NOT required
- Medical records : NOT required at enrollment
- PED declaration : NOT required; all PEDs accepted with 1-year wait by default
- No negative list : Members with ALL pre-existing conditions are allowed to enroll
IMPORTANT RULES:
- Alumni can enroll ONLY during the open enrollment window (not any time of year)
- Cannot exit the plan and rejoin later — rejoining means entering as new member with
fresh waiting periods and loss of all accumulated renewal benefits
- Early enrollment strongly recommended: PED wait period begins from enrollment date;
delay by 1 year = PED waiver available 1 year later
ALUMNI STATUS:
- NITDAA verifies alumni status
- Certain programs without regular alumni status but with portal access may also enroll
CANNOT PARTICIPATE:
- Siblings, friends, relatives — exclusive plan for alumni and eligible family members only
- Cannot pay directly to insurer to get this plan (only through NITDAA portal)
[/CHUNK]
[CHUNK]
id : PREMIUM_001
section : Premium and Payment
subsection : Amount, Tax Benefit, Payment Flow, Group Pricing
topic_tags : premium, annual, section 80D tax deduction, payment via Zopper Solvy Tech, receipt from insurer, group rate, age band, premium increase, city neutral, oldest member age, claims ratio, no individual loading, no monthly option, no registration fee
entities : Premium:Annual_Frequency|Tax:Section_80D|PayFlow:Via_Solvy_Tech_Zopper|Receipt:From_Insurer|Rate:Based_on_Oldest_Member|Rate:Group_Claims_Ratio|Rate:City_Neutral
relationships : Premium|frequency|Annual_Only;Premium|tax|Section_80D;Receipt|issued_by|Insurance_Company;Payment|collected_by|Solvy_Tech_Zopper;Rate|based_on|Oldest_Family_Member_Age;Rate_Change|basis|Group_Claims_Ratio;Premium|city_variation|None
text :
PREMIUM AND PAYMENT — NITDAA BASE HEALTH INSURANCE
PAYMENT FREQUENCY: Annual only (no monthly, quarterly, or half-yearly option)
TAX BENEFIT: Premiums eligible for Section 80D income tax deduction
PAYMENT FLOW:
1. Member pays via NITDAA portal
2. Collected by Solvy Tech Solutions (Zopper) on behalf of NITDAA
3. Zopper transfers to Aditya Birla Health Insurance for policy issuance
4. Receipt issued by Insurance Company (NOT by NITDAA)
PREMIUM DETERMINATION:
- Rate is determined by age of the OLDEST member in the family unit covered
- Flat rate across all cities and tiers (Tier 1, Tier 2, Tier 3 — all same premium)
- No individual loading: your personal claims history does NOT affect your premium
- Premium change (increase/decrease) applies to the entire group by age band
PREMIUM CHANGES AT RENEWAL:
- Based on the entire group's claims ratio (not individual performance)
- Expected rise: depends on group claims ratio for that year
- If you do not renew due to premium increase: all accumulated benefits lost permanently
WHERE TO CHECK PREMIUM:
- Log in to NITDAA Alumni portal
- Email: nitdaahealthplan@zopper.com
- Call Satyam Mishra: 8130301854
REGISTRATION FEE: No registration fee charged by NITDAA on this group policy.
[/CHUNK]
[CHUNK]
id : RENEWALS_001
section : Renewals and Continuity
subsection : Renewal Benefits, Grace Period, Moratorium, Underwriting
topic_tags : renewal, renewal benefits, grace period 30 days, moratorium 60 months, no fresh underwriting, no loading individual claims, lifelong renewability, premium modification 3 months notice, renewal not denied for claims, product withdrawal 90 days
entities : Renewal:Zero_Wait|GracePeriod:30Days|Moratorium:60_Months|Rule:No_Individual_Loading|Rule:No_Fresh_Underwriting|Rule:Renewal_Not_Denied_for_Claims|Rule:Product_Withdrawal_90Days
relationships : Renewal|waives|All_Waiting_Periods;Grace_Period|duration|30_Days_Annual;Moratorium|duration|60_Continuous_Months;Renewal|denied_for_claims|No;Fresh_Underwriting_at_Renewal|required|No;Individual_Claims|affects_premium|No;Premium_Change|notice|3_Months
text :
RENEWALS AND CONTINUITY — NITDAA BASE HEALTH INSURANCE
BENEFITS OF CONTINUOUS RENEWAL:
- Zero waiting periods: initial 30-day, specific disease 12-month, and PED 12-month all WAIVED
- Full coverage from Day 1 of each renewal year
- Accumulated continuity credits count toward 60-month moratorium period
- No fresh medical underwriting required at renewal
- No loading applied based on individual claims history
GRACE PERIOD FOR RENEWAL:
- 30 days for annual/half-yearly/quarterly payment modes
- 15 days for monthly payment mode
- Coverage is NOT available during grace period
- Renewing within grace period preserves ALL accrued continuity benefits
MORATORIUM PERIOD:
- After 60 continuous months of coverage, policy is NOT contestable by insurer on grounds
of non-disclosure or misrepresentation
- Exception: Established fraud is ALWAYS contestable regardless of moratorium
- Original Sum Insured: 60-month clock applies from first enrollment
- Enhanced Sum Insured (increase at renewal): own separate 60-month clock begins
RENEWAL RULES (IRDAI):
- Renewal CANNOT be denied because the insured made claims in prior years
- No premium loading based on individual claims experience
- Fresh underwriting only if Sum Insured is increased; applies only to incremental SI
- Insurer must notify 3 months before modifying premium rates or terms
PRODUCT WITHDRAWAL:
- If product is withdrawn, insurer notifies insured 90 days before policy expiry
- Insured can migrate to similar Aditya Birla (ABHI) product with all accrued continuity benefits
[/CHUNK]
[CHUNK]
id : ALUMNI_DEATH_001
section : Alumni Death — Policy Continuation
subsection : Coverage After Alumni's Demise and Associate Member Status
topic_tags : alumni death, policy after death, family coverage continuation, surviving spouse, associate member, medical insurance continuity, renewal after death, NITDAA portal access, both spouses alumni, surviving alumni spouse renewal
entities : Event:Alumni_Death|Coverage:Family_Current_Year|Status:Associate_Member_for_Insurance_Only|Process:NITDAA_Team_Portal_Access|Rule:No_Other_Alumni_Benefits_for_Surviving_Spouse
relationships : Alumni_Death|family_covered_until|Next_Renewal;After_Next_Renewal|surviving_spouse_inducted_as|Associate_Member;Associate_Member|benefits|Medical_Insurance_Continuity_Only;Associate_Member|NOT_entitled_to|Other_Alumni_Access_or_Benefits;Surviving_Alumni_Spouse|can_renew|Own_Alumni_Status
text :
POLICY CONTINUATION AFTER ALUMNI'S DEATH
CURRENT POLICY YEAR:
- Family remains FULLY COVERED until the next renewal date
- No interruption in coverage for the current policy year
FOR SUBSEQUENT RENEWALS (after next renewal):
- Surviving spouse and family members MUST contact NITDAA Alumni team to request portal access
- NITDAA team facilitates enrollment window access for the family
ASSOCIATE MEMBER STATUS (Important — 2026 Policy):
- The surviving spouse will be inducted as an ASSOCIATE MEMBER
- Associate Member status is granted ONLY for Medical Insurance continuity purposes
- This Associate Member status does NOT carry any other access or benefits of Alumni membership
- Associate membership is not equivalent to full alumni membership
IF BOTH SPOUSES ARE NITD ALUMNI:
- The surviving spouse can renew the policy independently on their own alumni status
- Survivor joins the plan as an alumni in their own right
- No Associate Member status needed — they already hold full alumni credentials
COVERAGE AGES STILL APPLY:
- Lifelong renewability for all members who enrolled before age 85
- All existing members retain their coverage continuity
[/CHUNK]
[CHUNK]
id : CLAIMS_001
section : Claims Process
subsection : Claim Types, Timelines, and Document Requirements
topic_tags : claims, cashless, reimbursement, 72 hours planned pre-auth, 24 hours emergency, 48 hours reimbursement notice, 30 days documents, claim settlement 30 days, 45 days investigation, penal interest 2 percent RBI, ABHI in-house, documents list, discharge card, hospital bill, pharmacy bills, MLC FIR
entities : Process:Cashless_Planned_72hrs|Process:Cashless_Emergency_24hrs|Process:Reimbursement_48hrs|Timeline:Documents_30Days|Timeline:Settlement_30Days|Timeline:Investigation_45Days|PenalInterest:2pct_above_RBI
relationships : Cashless_Planned|pre_auth|72_hours_before;Cashless_Emergency|intimate|within_24_hours;Reimbursement|notice|within_48_hours_or_before_discharge;All_Claims|documents|within_30_days_discharge;Normal_Settlement|within|30_days;Investigation_Settlement|within|45_days
text :
CLAIMS PROCESS — NITDAA BASE HEALTH INSURANCE
CLAIM SERVICING: In-house by Aditya Birla Health Insurance (ABHI) — no separate TPA
TWO MODES OF CLAIM:
1. CASHLESS: Available at ABHI Network Hospitals only
- Insurer pays the hospital directly; no out-of-pocket payment at hospital
2. REIMBURSEMENT: Any hospital (network or non-network)
- Member pays the hospital; submits documents to ABHI for reimbursement
INTIMATION TIMELINES:
Cashless (Planned Treatment) : Pre-authorise at LEAST 72 HOURS before admission
Cashless (Emergency) : Intimate insurer within 24 HOURS of hospitalization
Reimbursement : Written notice within 48 HOURS of admission OR before
discharge (whichever earlier)
Document Submission : Within 30 DAYS of discharge from hospital
Pre/Post-Hospitalization Claims : Within 30 days of completion of post-hospitalization treatment
DOCUMENTS REQUIRED FOR REIMBURSEMENT:
1. Completed claim form
2. Photo ID, Age proof, and KYC documents
3. Health card and policy copy
4. Original discharge card / day care summary / transfer summary
5. Original final hospital bill with all deposit and payment receipts
6. Original invoices + implant stickers (lens sticker for cataract; stent invoice for angioplasty)
7. All previous consultation papers (history and treatment for current ailment)
8. All original diagnostic reports with doctor's prescription and bills
9. All original pharmacy/medicine bills with treating doctor's prescriptions
10. MLC/FIR copy (ACCIDENT cases only)
11. Death summary and death certificate (DEATH claims only)
12. Indoor case papers with nursing sheet (if available)
CLAIM SETTLEMENT TIMELINES (IRDAI mandated):
- Normal settlement : 30 days from receipt of all documents
- Investigation cases : 45 days from receipt of all documents
- Delay beyond mandated timeline: Penal interest at 2% ABOVE RBI Bank Rate
DIAGNOSIS OUTSIDE INDIA, TREATMENT IN INDIA:
- If condition is diagnosed outside India but hospitalization/treatment is within India:
CLAIM IS ADMISSIBLE
ZOPPER SUPPORT: nitdaahealthplan@zopper.com
ABHI DIRECT: WhatsApp 8368742074 | Toll Free 1800 270 7000
NETWORK HOSPITALS: https://www.adityabirlacapital.com/healthinsurance/locate-care/hospital-listing
[/CHUNK]
[CHUNK]
id : CLAIMS_002
section : Claims Process
subsection : Multiple Policy Coordination and Cashless Pre-Authorization
topic_tags : multiple policies, coordination of benefits, primary insurer, employer insurance NITDAA, works alongside, pre-authorization, authorization letter 1 hour, 15 day validity, network hospital cashless TPA desk, secondary claim contribution
entities : Process:Multiple_Policy_Coordination|Role:Primary_Insurer_Chosen_by_Insured|Rule:Works_with_Employer_Insurance|Rule:Works_with_Retail_Insurance|Process:Pre_Auth_Letter_1Hour|Pre_Auth:Valid_15Days
relationships : NITDAA_Plan|works_with|Employer_Group_Insurance;NITDAA_Plan|works_with|Individual_Retail_Insurance;Primary_Insurer|chosen_by|Insured;Pre_Auth_Letter|issued_within|1_hour;Pre_Auth|valid_for|15_days
text :
MULTIPLE POLICIES AND CASHLESS PRE-AUTHORIZATION
USING ALONGSIDE OTHER POLICIES:
- Works TOGETHER with employer-provided group health insurance
- Works TOGETHER with individually purchased retail health insurance plans
- This is an ADDITIONAL health insurance (not a replacement for existing policies)
MULTIPLE POLICY RULES (IRDAI):
- Insured can choose any one policy as the PRIMARY insurer for any claim
- Primary insurer settles claim within its policy limits and terms
- Remaining unsettled amount can be claimed from secondary/other policies
- If claim exceeds one policy's SI, primary insurer coordinates with other insurers
- Under indemnity: insured will be indemnified only for actual costs (no double recovery)
ADDITIONAL DOCUMENTS FOR SECONDARY/CONTRIBUTION CLAIMS:
- Photocopy of complete claim documents attested by primary insurer or TPA
- Original payment receipts for expenses not settled by primary insurer
- Discharge voucher or settlement letter from primary insurer
CASHLESS PRE-AUTHORIZATION — PLANNED TREATMENT:
- Contact ABHI at least 72 hours before proposed admission through hospital TPA desk
- Required: health card, KYC docs, policy number, patient details, illness, treating doctor,
hospital name, proposed admission date
- Authorization letter issued within 1 HOUR of receiving complete information
- Pre-authorization valid for 15 days from authorization date
CASHLESS PRE-AUTHORIZATION — EMERGENCY:
- Intimate within 24 hours of hospitalization
- Same documentation as planned treatment
- Authorization letter issued within 1 hour of complete information
[/CHUNK]
[CHUNK]
id : TERMS_001
section : Policy Terms and Conditions
subsection : Cancellation, Free Look Period, Fraud, Misrepresentation
topic_tags : cancellation 7 days, proportionate refund, no refund after claim, free look 30 days, fraud forfeiture, misrepresentation void policy, material fact non-disclosure, policy terms modification, IRDAI renewal rules
entities : Term:Cancellation_7Days_Notice|Term:Proportionate_Refund|Term:No_Refund_After_Claim|Term:Free_Look_30Days|Term:Fraud_Forfeits_Benefits|Term:Misrepresentation_Voids_Policy
relationships : Cancellation_by_Member|notice|7_days;Refund|basis|Proportionate_Unexpired;Refund|not_available_if|Claim_Admitted;Free_Look|duration|30_days;Fraud|consequence|All_Benefits_Forfeited;Misrepresentation|consequence|Policy_Void
text :
POLICY TERMS AND CONDITIONS
CANCELLATION BY POLICYHOLDER:
- Written notice of 7 days required
- Refund: proportionate premium for unexpired policy period (annual frequency only)
- No refund if any claim has been admitted or benefit availed
- No refund for half-yearly, quarterly, or monthly premium frequencies
CANCELLATION BY INSURER:
- Can cancel on: misrepresentation, non-disclosure of material facts, fraud
- Minimum 15 days written notice given to insured
- No premium refund on cancellation for fraud/misrepresentation/non-disclosure
FREE LOOK PERIOD:
- 30 days from date of policy document receipt (electronic or physical)
- Applicable to new individual policies ONLY
- Not applicable at renewal, porting, or migration
- Full refund if no claim made; deduct medical examination costs, stamp duty,
proportionate risk premium
FRAUD AND MISREPRESENTATION:
- Policy void and all premiums forfeited for misrepresentation, mis-description,
or non-disclosure of material facts
- All benefits forfeited if fraudulent means used to obtain a claim
- Fraudulent claim amounts already paid must be repaid to insurer
TERMS MODIFICATION:
- Insurer may revise policy terms and premiums with prior committee approval
- Insured persons notified 3 months before changes take effect
[/CHUNK]
[CHUNK]
id : LIFESTAGE_001
section : Life Stage Evaluation Guide
subsection : Age 22-30 and Age 30-45 — Base Policy Recommendations
topic_tags : life stage, age 22-30, low risk, employer cover, base policy optional, age 30-45, medium high risk, parents retired no health cover, base policy consider, job insecure, employer cover not portable, one fine dining meal
entities : Age:22_30|Risk:Low|Rec_Base:Not_Mandatory|Age:30_45|Risk:Medium_High|Rec_Base:Consider_Strongly
relationships : Age_22_30|risk_level|Low;Age_22_30|base_recommendation|Consider_if_Job_Insecure_or_Parents_Need;Age_30_45|risk_level|Medium_to_High;Age_30_45|base_recommendation|Consider_Strongly
text :
LIFE STAGE EVALUATION — BASE POLICY (AGE 22–45)
AGE 22–30 | Risk Level: LOW
Typical Profile:
- Start of career; employer provides health cover (approx. Rs. 5-10 Lakhs)
- One or both parents still employed with employer health cover
- No dependents or just married; generally healthy
Base Policy (3L/5L): NOT AN IMMEDIATE MUST
Consider if any of these apply:
- Going entrepreneurial or job-insecure (employer cover will lapse)
- Parents or in-laws need health cover and cannot get retail insurance
- Any other special situation requiring personal health cover
Key advantage of enrolling now even if not immediately needed:
- PED waiting period starts from enrollment; Year 2 renewal = zero wait
-----------------------------------------------------------------------
AGE 30–45 | Risk Level: MEDIUM TO HIGH
Typical Profile:
- High growth, high-stress work; increasing job insecurities
- Married with children; rising financial demands
- Parents and in-laws likely retired — NO health cover from any employer
- Parents/in-laws cannot buy retail policy due to age or pre-existing conditions
- Beginning health episodes for self, parents, or in-laws
Base Policy (3L/5L): STRONGLY CONSIDER
Key reasons:
- Employer cover is risky — not portable across job changes
- This plan is often the ONLY accessible route for elderly parents and in-laws
- Very affordable at this income level
- Year 2 onwards: full PED waiver for all accumulated conditions
[/CHUNK]
[CHUNK]
id : LIFESTAGE_002
section : Life Stage Evaluation Guide
subsection : Age 45-60 and Age 60+ — Base Policy Recommendations
topic_tags : life stage, age 45-60, high risk, employer cover unreliable, age 60 plus, very high risk, retired, retail market unavailable, base policy recommended, retirement savings, financially independent, pre-existing conditions retail denied
entities : Age:45_60|Risk:High|Rec_Base:Recommended|Age:60_Plus|Risk:Very_High|Rec_Base:Strongly_Recommended
relationships : Age_45_60|risk_level|High;Age_45_60|employer_cover|Unreliable_From_This_Stage;Age_60_Plus|risk_level|Very_High;Retail_Market|accessible_for_60Plus|No_due_to_PED_Age
text :
LIFE STAGE EVALUATION — BASE POLICY (AGE 45+)
AGE 45–60 | Risk Level: HIGH
Typical Profile:
- Peak work-related insecurities; high financial demands
- Children's education and increasing responsibilities
- Parents and in-laws dependent with growing health risks
- Consolidating personal finances; building retirement corpus
Base Policy (3L/5L): RECOMMENDED
Key reasons:
- Employer cover is not fully reliable from this stage onwards
- Job transitions or early retirement = immediate loss of employer cover
- This plan provides a portable, personal insurance base
- Continuity benefits built from this stage ensure PED waiver from Year 2
-----------------------------------------------------------------------
AGE 60+ | Risk Level: VERY HIGH
Typical Profile:
- Likely retired or working independently
- Need to remain financially independent
- Increasing potential health risks and existing conditions
- Retail market is practically inaccessible:
→ Very high premiums with many conditions
→ High wait periods on pre-existing diseases
→ High claim refusal risk
→ Age-based denial common
Base Policy (3L/5L): STRONGLY RECOMMENDED
Key reasons:
- This plan accepts ALL pre-existing conditions (12-month wait for new members)
- No medical tests required — retail always requires tests
- Protects savings from being eroded by medical expenses
- Entry up to age 85; lifelong renewability once enrolled
- Having this policy from this stage prevents complete dependence on savings or family
[/CHUNK]
[CHUNK]
id : CONTACTS_001
section : Contacts and Support
subsection : Zopper Support Matrix and ABHI Direct Contacts
topic_tags : contact, Zopper support, phone number, product support, claims support, endorsement support, Satyam Mishra 8130301854, Pradeep Kumar 9319640944, Hrithik Khatana 8800902249, Sujit Shekhar 8860746253, Mohit Sachwani 6362568835, Boudhaayan Paul 7032220850, ABHI 1800 270 7000, WhatsApp 8368742074, nitdaahealthplan zopper
entities : Contact:Satyam_Mishra_8130301854|Contact:Pradeep_Kumar_9319640944|Contact:Hrithik_Khatana_8800902249|Contact:Sujit_Shekhar_8860746253|Contact:Mohit_Sachwani_6362568835|Contact:Boudhaayan_Paul_7032220850|Contact:ABHI_1800_270_7000|Contact:ABHI_WhatsApp_8368742074
relationships : Satyam_Mishra|level|L1;Satyam_Mishra|support_type|Product_Enrolment;Pradeep_Kumar|level|L1;Pradeep_Kumar|support_type|Claims;Hrithik_Khatana|level|L2;Sujit_Shekhar|level|L2;Sujit_Shekhar|support_type|Claims_Endorsement;Mohit_Sachwani|level|L3;Boudhaayan_Paul|level|L4
text :
CONTACTS AND SUPPORT — NITDAA HEALTH PLAN
ZOPPER INSURANCE BROKERS — NITDAA PLAN SUPPORT:
General Email: nitdaahealthplan@zopper.com
Level | Name | Mobile | Support Type
------|--------------------|--------------|------------------------------------------
L1 | Satyam Mishra | 8130301854 | Product / Enrolment Support
L1 | Pradeep Kumar | 9319640944 | Claims Support
L2 | Hrithik Khatana | 8800902249 | Product / Enrolment Support
L2 | Sujit Shekhar | 8860746253 | Claims / Endorsement Support
L3 | Mohit Sachwani | 6362568835 | Product / Endorsement Support
L4 | Boudhaayan Paul | 7032220850 | Product / Claims / Endorsement Support
ADITYA BIRLA HEALTH INSURANCE (ABHI) DIRECT:
WhatsApp : 8368742074
Claims Email : abhicl.claim@adityabirlacapital.com
Toll Free : 1800 270 7000
General Email : care.healthinsurance@adityabirlacapital.com
Website : www.adityabirlacapital.com/healthinsurance
Senior Citizens : seniorcitizen.abh@adityabirla.com
Registered Office: 9th Floor, Tower 1, One World Centre, Jupiter Mills Compound,
841, Senapati Bapat Marg, Elphinstone Road, Mumbai 400013
NETWORK HOSPITALS:
https://www.adityabirlacapital.com/healthinsurance/locate-care/hospital-listing
DISCLAIMER: NIT Durgapur (Master Policyholder) is NOT responsible for settlement of claims.
All claims settled exclusively by Aditya Birla Health Insurance Co. Ltd.
[/CHUNK]
[CHUNK]
id : GRIEVANCE_001
section : Grievance Redressal
subsection : Escalation Levels — ABHI, Ombudsman, IRDAI IGMS
topic_tags : grievance, complaint, escalation, ombudsman, IRDAI IGMS, insurance ombudsman rules 2017, ABHI customer care, 1800 270 7000, dispute resolution, legal jurisdiction India, penal interest
entities : Process:Level1_ABHI|Process:Level2_Insurance_Ombudsman|Process:Level3_IRDAI_IGMS|Legal:Indian_Courts_Jurisdiction
relationships : Grievance|first_to|ABHI_Customer_Care;Unresolved|escalate_to|Insurance_Ombudsman;Unresolved|escalate_to|IRDAI_IGMS;Legal_Dispute|jurisdiction|Indian_Courts
text :
GRIEVANCE REDRESSAL — NITDAA BASE HEALTH INSURANCE
LEVEL 1 — Aditya Birla Health Insurance (ABHI):
Email : care.healthinsurance@adityabirlacapital.com
Toll Free : 1800 270 7000
Website : www.adityabirlacapital.com/healthinsurance
Branch : Any ABHI branch office
Senior Citizens: seniorcitizen.abh@adityabirla.com
LEVEL 2 — Insurance Ombudsman:
- If not satisfied with ABHI's resolution
- Governed by Insurance Ombudsman Rules 2017
- Contact details available on ABHI website (Annexure I of policy document)
LEVEL 3 — IRDAI Integrated Grievance Management System:
URL: https://igms.irda.gov.in/
LEGAL DISPUTES:
- Interpretation of policy terms governed by INDIAN LAW
- Subject to jurisdiction of INDIAN COURTS
CLAIM SETTLEMENT PENAL INTEREST:
- Delay beyond 30 days (normal) or 45 days (investigation):
Penal interest at 2% ABOVE RBI Bank Rate from date of last document receipt
[/CHUNK]
[CHUNK]
id : DEFINITIONS_001
section : Key Policy Definitions
subsection : Core Terms — PED, Hospitalization, Day Care, Domiciliary, Room Rent, Grace Period
topic_tags : definitions, pre-existing disease PED 36 months, hospitalization 24 hours, day care less than 24 hours, domiciliary hospitalization, room rent single private, grace period 30 days, cashless facility, co-payment zero, reasonable customary charges, medically necessary treatment, network provider
entities : Def:PED_36months|Def:Hospitalization_24hrs|Def:DayCare_under24hrs|Def:Domiciliary|Def:SinglePrivateRoom|Def:GracePeriod_30days|Def:Cashless|Def:CoPay_Zero|Def:ReasonableCustomaryCharges|Def:MedicallyNecessaryTreatment
relationships : PED|diagnosis_window|36_months;Hospitalization|minimum|24_hours;DayCare|duration|Under_24_hours;Grace_Period|duration|30_days_annual;CoPay|amount|Zero_in_Base;Network_Provider|enables|Cashless_Facility
text :
KEY POLICY DEFINITIONS
PRE-EXISTING DISEASE (PED):
Any condition, ailment, injury, or disease:
(a) Diagnosed by a physician within 36 months PRIOR to policy commencement, OR
(b) For which medical advice/treatment was recommended or received within 36 months prior
(Declaration NOT required; all PEDs accepted; 12-month wait for new members)
HOSPITALIZATION:
Admission in a Hospital for MINIMUM 24 consecutive in-patient care hours,
EXCEPT for specified day care procedures.
DAY CARE TREATMENT:
Medical treatment or surgical procedure under general/local anaesthesia in less than 24 hours,
which would otherwise require 24+ hour hospitalization.
OPD treatment NOT included.
DOMICILIARY HOSPITALIZATION:
Medical treatment for illness requiring hospital care but taken at home because:
(i) Patient cannot be moved to hospital, OR (ii) No hospital bed available.
Minimum: 3 consecutive days.
SINGLE PRIVATE ROOM:
Basic (cheapest) single-patient room with attached toilet.
This is the Base plan's room rent entitlement.
REASONABLE AND CUSTOMARY CHARGES:
Standard charges for that provider in that locality for identical/similar services.
Actual charges must not exceed what would be charged if the person were uninsured.
MEDICALLY NECESSARY TREATMENT:
Treatment that: (i) Is required for medical management; (ii) Does not exceed level of care
needed; (iii) Is prescribed by a Medical Practitioner; (iv) Conforms to accepted professional
standards in India or internationally.
CO-PAYMENT:
Specified % of admissible claim borne by policyholder. Amount: ZERO in NITDAA Base plan.
GRACE PERIOD:
30 days (annual/quarterly/half-yearly) or 15 days (monthly) after premium due date.
Renewal within grace period preserves all continuity benefits.
Coverage is NOT available during the grace period.
NETWORK PROVIDER:
Hospital enlisted by ABHI for cashless treatment.
List: https://www.adityabirlacapital.com/healthinsurance/locate-care/hospital-listing
[/CHUNK]
[CHUNK]
id : DEFINITIONS_002
section : Key Policy Definitions
subsection : Critical Illness Definitions with Diagnostic Criteria
topic_tags : critical illness definition, cancer specified severity, myocardial infarction heart attack ECG troponin, CABG bypass sternotomy, coma 96 hours life support, kidney failure dialysis, stroke 3 months deficit, organ transplant, paralysis 2 limbs 3 months, motor neuron ALS, multiple sclerosis 6 months, angioplasty 50 percent blockage, benign brain tumour 90 days
entities : CI_Def:Cancer|CI_Def:Myocardial_Infarction|CI_Def:CABG|CI_Def:Heart_Valve|CI_Def:Coma_96hrs|CI_Def:Kidney_Failure|CI_Def:Stroke_3months|CI_Def:Organ_Transplant|CI_Def:Paralysis_2limbs|CI_Def:Motor_Neuron|CI_Def:Multiple_Sclerosis_6months|CI_Def:Angioplasty_50pct|CI_Def:Benign_Brain_Tumour
relationships : Coma|requires_no_response|96_consecutive_hours;Stroke|requires_permanent_deficit|3_months;Paralysis|requires|2_limbs_AND_3_months;Multiple_Sclerosis|requires_impairment|6_months;Angioplasty|requires_blockage|50_percent_major_coronary
text :
CRITICAL ILLNESS DEFINITIONS — KEY DIAGNOSTIC CRITERIA
1. CANCER OF SPECIFIED SEVERITY
Malignant tumour with uncontrolled growth; histological evidence required.
EXCLUDED: Carcinoma in situ; benign/pre-malignant; non-melanoma skin without metastasis;
Prostate Gleason <= 6; Thyroid T1N0M0; CLL < RAI stage 3.
2. MYOCARDIAL INFARCTION (First Heart Attack)
Must have ALL three: (i) Typical clinical symptoms; (ii) New characteristic ECG changes;
(iii) Elevation of infarction enzymes, Troponins, or specific biochemical markers.
EXCLUDED: Other acute coronary syndromes; angina pectoris.
3. OPEN CHEST CABG
Coronary artery bypass via sternotomy or minimally invasive keyhole.
Supported by coronary angiography. EXCLUDED: Angioplasty, intra-arterial procedures.
4. OPEN HEART REPLACEMENT/REPAIR OF HEART VALVES
Actual open-heart surgery; catheter-based/balloon valvotomy excluded.
5. COMA OF SPECIFIED SEVERITY
No response to external stimuli for >= 96 CONSECUTIVE HOURS; life support necessary;
permanent neurological deficit assessed at least 30 days after onset.
EXCLUDED: Coma from alcohol or drug abuse.
6. KIDNEY FAILURE REQUIRING REGULAR DIALYSIS
End-stage renal disease requiring regular haemodialysis/peritoneal dialysis or renal transplant.
7. STROKE RESULTING IN PERMANENT SYMPTOMS
Cerebrovascular incident with permanent neurological deficit for >= 3 MONTHS.
Confirmed by CT/MRI. EXCLUDED: TIA; traumatic brain injury.
8. MAJOR ORGAN / BONE MARROW TRANSPLANT
Transplant of: heart, lung, liver, kidney, or pancreas (end-stage failure), OR
bone marrow using haematopoietic stem cells.
9. PERMANENT PARALYSIS OF LIMBS
Total and irreversible loss of use of 2 or more limbs.
Must be present for MORE THAN 3 MONTHS.
10. MOTOR NEURON DISEASE WITH PERMANENT SYMPTOMS
SMA, progressive bulbar palsy, ALS, or primary lateral sclerosis.
Significant permanent functional neurological impairment >= 3 CONTINUOUS MONTHS.
11. MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS
Unequivocal MRI findings + current clinical motor/sensory impairment >= 6 MONTHS.
EXCLUDED: SLE and other neurological damage.
12. ANGIOPLASTY
Percutaneous coronary intervention with balloon +/- stent for >= 50% blockage in major
coronary artery. Medically necessary per cardiologist; supported by CAG.
EXCLUDED: Diagnostic angiography without angioplasty/stent insertion.
13. BENIGN BRAIN TUMOUR
Life-threatening non-cancerous tumour; confirmed by CT/MRI.
Must result in: permanent neurological deficit for >= 90 continuous days,
OR surgical resection or radiation therapy.
EXCLUDED: Cysts, granulomas, AVM, hematomas, abscesses, pituitary tumours.
[/CHUNK]
[CHUNK]
id : GRAPH_SCHEMA_NODES
section : KuzuDB Graph Schema
subsection : Node Table Definitions and Instances
topic_tags : KuzuDB, graph schema, node tables, entity types, knowledge graph, RAG pipeline, CREATE NODE TABLE, Organization, Plan, Member_Type, Benefit, Waiting_Period, Disease, Exclusion, Contact_Person, Body_System
entities : Schema:Node_Tables
relationships : Schema|defines|KuzuDB_Node_Tables
text :
KUZU GRAPH DB — NODE TABLE DEFINITIONS
CREATE NODE TABLE Organization (
name STRING PRIMARY KEY,
type STRING, -- insurer | broker | alumni_association | regulator | tech_partner
contact_email STRING,
contact_phone STRING,
website STRING
);
Instances: NITDAA, Aditya_Birla_Health_Insurance, Zopper_Insurance_Brokers,
NIT_Durgapur, IRDAI, Insurance_Ombudsman, Solvy_Tech_Solutions
CREATE NODE TABLE Plan (
plan_id STRING PRIMARY KEY,
name STRING,
si_min_lakhs FLOAT,
si_max_lakhs FLOAT,
cover_type STRING, -- floater
tenure_years INT64,
copay_pct FLOAT,
no_negative_list BOOLEAN,
enrolment_start DATE,
enrolment_end DATE
);
Instances: NITDAA_Base_3L {si:3, copay:0, enrol_start:2026-06-08, enrol_end:2026-06-30}
NITDAA_Base_5L {si:5, copay:0, enrol_start:2026-06-08, enrol_end:2026-06-30}
CREATE NODE TABLE Member_Type (
type_id STRING PRIMARY KEY,
relationship STRING, -- alumni | spouse | child | parent | parent_in_law
entry_age_min INT64,
entry_age_max INT64,
exit_age STRING, -- "lifelong" | integer as string
max_count INT64
);
Instances: Alumni {entry:18-85, exit:lifelong, max:1}
Spouse {entry:18-85, exit:lifelong, max:1}
Child {entry:0-25, exit:"26_new_member_OR_30_renewal", max:4}
-- NEW MEMBER: child exits at 26
-- RENEWAL MEMBER (enrolled before 25): continues to age 30
Parent {entry:41-85, exit:lifelong, max:2}
Parent_in_Law {entry:41-85, exit:lifelong, max:2}
CREATE NODE TABLE Benefit (
benefit_id STRING PRIMARY KEY,
name STRING,
coverage_type STRING, -- monetary | percentage | days
limit_value STRING,
covered_in_base BOOLEAN
);
CREATE NODE TABLE Waiting_Period (
wp_id STRING PRIMARY KEY,
type STRING, -- initial | specific_disease | PED
duration_days INT64,
applies_new_members BOOLEAN,
applies_renewal_members BOOLEAN,
accident_exempt BOOLEAN
);
CREATE NODE TABLE Disease (
disease_id STRING PRIMARY KEY,
name STRING,
body_system STRING,
wait_months INT64,
associated_surgery STRING
);
CREATE NODE TABLE Exclusion (
excl_id STRING PRIMARY KEY,
name STRING,
category STRING, -- standard | behavioural | medical | device | geographical
exception_note STRING
);
CREATE NODE TABLE Contact_Person (
contact_id STRING PRIMARY KEY,
name STRING,
organization STRING,
phone STRING,
support_type STRING,
level INT64
);
Instances: Satyam_Mishra{phone:8130301854, level:1, type:Product_Enrolment}
Pradeep_Kumar{phone:9319640944, level:1, type:Claims}
Hrithik_Khatana{phone:8800902249, level:2, type:Product_Enrolment}
Sujit_Shekhar{phone:8860746253, level:2, type:Claims_Endorsement}
Mohit_Sachwani{phone:6362568835, level:3, type:Product_Endorsement}
Boudhaayan_Paul{phone:7032220850, level:4, type:Product_Claims_Endorsement}
CREATE NODE TABLE Body_System (
system_id STRING PRIMARY KEY,
name STRING
);
Instances: Eye, Ear_Nose_Throat, Gynecology, Orthopedic_Rheumatological,
Gastroenterology, Urogenital, Skin, General_Surgery
[/CHUNK]
[CHUNK]
id : GRAPH_SCHEMA_EDGES
section : KuzuDB Graph Schema
subsection : Edge/Relationship Table Definitions
topic_tags : KuzuDB, graph schema, edge tables, relationships, CREATE REL TABLE, ADMINISTERS, UNDERWRITES, COVERS, EXCLUDES, HAS_WAITING_PERIOD, BELONGS_TO_SYSTEM, HANDLES_SUPPORT, ESCALATES_TO, knowledge graph traversal
entities : Schema:Edge_Tables
relationships : Schema|defines|KuzuDB_Edge_Tables
text :
KUZU GRAPH DB — EDGE/RELATIONSHIP TABLE DEFINITIONS
CREATE REL TABLE ADMINISTERS (FROM Organization TO Plan);
-- NITDAA ADMINISTERS NITDAA_Base_3L, NITDAA_Base_5L
CREATE REL TABLE UNDERWRITES (FROM Organization TO Plan);
-- Aditya_Birla_Health_Insurance UNDERWRITES NITDAA_Base_3L, NITDAA_Base_5L
CREATE REL TABLE BROKERS (FROM Organization TO Plan);
-- Zopper_Insurance_Brokers BROKERS NITDAA_Base_3L, NITDAA_Base_5L
CREATE REL TABLE COVERS (FROM Plan TO Benefit, coverage_pct FLOAT, max_amount INT64);
-- NITDAA_Base COVERS Room_Rent, PreHosp_60d, PostHosp_90d, Modern_Tx_100pct, etc.
CREATE REL TABLE EXCLUDES (FROM Plan TO Exclusion, exception_note STRING);
CREATE REL TABLE MEMBER_ELIGIBLE (FROM Member_Type TO Plan, max_count INT64);
CREATE REL TABLE HAS_WAITING_PERIOD (FROM Disease TO Waiting_Period, duration_months INT64);
-- All ~30 diseases from Sections 5 map to Specific_Disease_12_Month waiting period
CREATE REL TABLE BELONGS_TO_SYSTEM (FROM Disease TO Body_System);
-- Cataract -> Eye; Sinusitis -> ENT; PCOD -> Gynecology; Gout -> Orthopedic, etc.
CREATE REL TABLE ASSOCIATED_SURGERY (FROM Disease TO Treatment, surgery_name STRING);
CREATE REL TABLE HANDLES_SUPPORT (FROM Contact_Person TO Support_Category, level INT64);
CREATE REL TABLE ESCALATES_TO (FROM Organization TO Organization);
-- ABHI_Grievance -> Insurance_Ombudsman -> IRDAI_IGMS
CREATE REL TABLE COMPATIBLE_WITH (FROM Plan TO External_Insurance_Category STRING);
-- NITDAA_Base COMPATIBLE_WITH "Employer_Group_Insurance"
-- NITDAA_Base COMPATIBLE_WITH "Individual_Retail_Insurance"
CREATE REL TABLE HAS_ENROLMENT_WINDOW (FROM Plan TO Date_Range, start DATE, end DATE);
-- NITDAA_Base -> {2026-06-08 to 2026-06-30}
EXAMPLE GRAPH TRAVERSAL QUERIES (KuzuDB Cypher):
-- Find all Eye diseases with 12-month wait:
MATCH (d:Disease)-[:BELONGS_TO_SYSTEM]->(s:Body_System {name:'Eye'})
RETURN d.name, d.associated_surgery, d.wait_months
-- Find who handles claims support at Level 1:
MATCH (c:Contact_Person)
WHERE c.level = 1 AND c.support_type CONTAINS 'Claims'
RETURN c.name, c.phone
-- All diseases with 12-month waiting period:
MATCH (d:Disease)-[:HAS_WAITING_PERIOD]->(w:Waiting_Period {type:'specific_disease'})
RETURN d.name, d.body_system, d.associated_surgery ORDER BY d.body_system
[/CHUNK]
[CHUNK]
id : CHROMADB_CONFIG
section : ChromaDB Collection Configuration
subsection : Collection Setup, Metadata Schema, Query Routing, BM25 Config
topic_tags : ChromaDB configuration, vector database, metadata schema, query routing, embedding model, BM25, collection name, RAG pipeline config, hybrid search, cosine distance, RRF
entities : Config:ChromaDB_Collection|Config:BM25_Settings|Config:Query_Routing
relationships : Config|collection_name|nitdaa_health_insurance_kb_2026
text :
CHROMADB COLLECTION CONFIGURATION
COLLECTION NAME: nitdaa_health_insurance_kb_2026
METADATA SCHEMA (for .add() calls):
{
"id" : <chunk_id string>,
"section" : <top-level section name>,
"subsection" : <sub-level section name>,
"topic_tags" : <comma-separated BM25 keyword string>,
"doc_version" : "3.1",
"policy_year" : "2026",
"insurer" : "Aditya_Birla_Health_Insurance",
"plan_type" : "Base_Only"
}
EMBEDDING RECOMMENDATIONS:
Primary Model : text-embedding-3-small (OpenAI) or all-MiniLM-L6-v2 (open-source)
Chunk Strategy : Semantic chunking at section/subsection boundaries (not character splits)
Chunk Size : ~300-800 tokens per chunk
Overlap : None required (semantic boundaries used)
Distance : cosine
BM25 HYBRID SEARCH CONFIGURATION:
BM25 index fields : id, topic_tags, text
Tokenizer : whitespace + lowercase + domain stopwords removed
Domain terms to boost (BM25 weight 1.5x):
"NITDAA", "PED", "waiting period", "sum insured", "cashless", "reimbursement",
"pre-hospitalization", "post-hospitalization", "ABHI", "Aditya Birla",
"specific diseases", "moratorium", "domiciliary", "co-payment",
"NRI", "alumni", "enrolment", "floater", "critical illness",
"NIT Durgapur", "pre-existing disease", "12 months"
QUERY ROUTING BY METADATA FILTER (ChromaDB where clause):
Coverage questions -> section = "Covered Benefits"
Waiting period questions -> section in ["Waiting Periods", "Specific Diseases — 12-Month Wait"]
Exclusion questions -> section = "Exclusions"
Claims questions -> section = "Claims Process"
Eligibility questions -> section = "Eligibility"
NRI questions -> subsection CONTAINS "NRI"
Contact questions -> section = "Contacts and Support"
Definition questions -> section = "Key Policy Definitions"
Critical illness definitions -> subsection CONTAINS "Critical Illness"
Life stage questions -> section = "Life Stage Evaluation Guide"
Alumni death questions -> section = "Alumni Death — Policy Continuation"
Premium questions -> section = "Premium and Payment"
Renewal questions -> section = "Renewals and Continuity"
HYBRID RETRIEVAL PIPELINE (recommended):
1. BM25 pass: retrieve top-10 by keyword match on topic_tags + text
2. Vector pass: retrieve top-10 by cosine similarity on text embedding
3. Merge and re-rank: RRF score = 1/(60+rank_bm25) + 1/(60+rank_vector)
4. Return top-5 chunks (k=60, standard RRF constant)
KUZU + CHROMA INTEGRATION PATTERN:
- Graph (KuzuDB): structured entity lookups (disease by body system, contact by level)
- Vector (ChromaDB): semantic queries (what is covered for heart problems?)
- Agent routing: structured entity queries -> KuzuDB; open questions -> ChromaDB
[/CHUNK]
[CHUNK]
id : ELIGIBILITY_004
section : Eligibility
subsection : Children Age Policy — New vs Renewal Members (Critical Distinction)
topic_tags : children age limit, child coverage 25 years, child coverage 30 years, renewal member child age 30, new member child age 25, child exit age, children above 25 covered, age 26 27 28 29 30 child renewal, child continue coverage renewal, children age policy difference
entities : Rule:New_Member_Child_Max25|Rule:Renewal_Member_Child_Continues_to_30|Age:Child_New_Entry_Max25|Age:Child_Renewal_Exit_30|Policy:Children_Age_Split
relationships : New_Member|child_coverage_until|25_years_entry_26_exit;Renewal_Member_Child_above25|coverage_continues_until|30_years;Child_Already_Enrolled|special_rule|Continue_to_30;New_Child_Enrollment|entry_cap|25_years
text :
CHILDREN AGE POLICY — NEW MEMBERS vs RENEWAL MEMBERS
THIS IS A CRITICAL POLICY DISTINCTION (2026 Update):
FOR CHILDREN OF NEW MEMBERS (first-time enrollment):
- Entry age : Day 1 (newborn) to 25 years
- Coverage exits: Age 26 (upon turning 26)
- Children above 25 years CANNOT be newly enrolled under new memberships
FOR CHILDREN OF RENEWAL MEMBERS (already in the program):
- If the child was enrolled before turning 25 and the policy is being renewed:
- Coverage CONTINUES up to age 30
- Children of renewal members who are currently 26, 27, 28, or 29 years old
will remain covered under the renewal policy until they turn 30
- This is a continuity benefit for loyal renewal members only
PRACTICAL EXAMPLES:
Example 1 — New Enrollment (2026):
Alumni joining fresh in 2026 → can add child aged 24 → child covered until 26
Cannot add child aged 26 or above as a new member enrollment
Example 2 — Renewal Member (was enrolled previously):
Alumni renewing in 2026 → child who is 27 years old → continues to be covered
This child will exit the policy when they turn 30
SUMMARY TABLE:
Scenario | Child Age at Exit
--------------------------------------|--------------------
New member enrollment | 26 years
Renewal member (child already enrolled)| 30 years
NOTE: Payment gateway for 2026 enrollment opens on 10th June 2026.
Enrollment portal opens 08 June 2026; payment processing begins 10 June 2026.
CONTACT for age eligibility clarification:
Satyam Mishra: 8130301854 | nitdaahealthplan@zopper.com
[/CHUNK]
################################################################################
# END OF KNOWLEDGE BASE
################################################################################
# Total Chunks : 33
# Version : 3.1 | Generated : 2026-06-09
# Plan Scope : Base Policy Only — STUP and Worldwide Coverage excluded
# Policy Year : 2026
# Insurer : Aditya Birla Health Insurance | UIN: ADIHLGP22190V032122
################################################################################
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