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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
	################################################################################