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Sri Lanka Insurance Corporation Ltd

SURAKSHAMEDICAL INSURANCE POLICY FOR SCHOOL CHILDREN

Your Policy

This is your Medical Insurance Policy, and it contains details of benefits, conditions andexclusions relating to each insured person. This policy, the schedule and the table of benefitscontained herein will form the basis of on which we will settle all claims. It is only valid if

you have paid the appropriate premium in full as per the pre agreed payment scheme.

Any statement, information or declaration you have given on behalf of the Insured Persons,including any declaration made over the phone, or by fax, email or the internet at the time ofapplication, will form the basis of the contract.

The schedule and any further endorsements are all part of the policy.

Please read this policy carefully and if any error is found or if the cover is not in accordancewith your requirements, please return it to us immediately for correction.

Definitions

Accident or accidental means a sudden, unexpected event caused solely by violent, externaland visible means during the period of insurance and which must be the only cause ofinjury.

Endorsement means an authorized amendment to this policy.

Hospital means an establishment which is registered under the relevant national laws andregulations to care for and treat sick and injured people and which:

has organized facilities for diagnosis, treatment and major surgery;provides nursing services by registered nurses 24hours a day;is under the supervision of one or more medical practitioners; andis not mainly a clinic, a secure place to care for alcoholics or drug addicts, anursing or rest or convalescent home or a home for the elderly or similarestablishment;or is a government registered Ayurvedic Hospital;

Injury means damage or harm caused to the body by an external force suffered during theperiod of insurance and which is caused only by an accident.

Insured means the person/organization named and who has made a declaration on behalf ofinsured person and paid the premium as shown in the schedule.

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21, Vauxhall Street, Colombo 02, Sri Lanka. Tel: (94-11 ) 2357000, 2357457 Fax: (94-11 ) 2447742

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Insured person means the individual (or individuals) named in the schedule as the personwho is insured under this polity.

Losing means permanent and total loss of use or loss by having part of the body (as listed inthe scale of compensation table) cut or torn off, as confirmed by our medical practitioner.

Losing a limb means permanent and total loss of. or loss of use of. a hand at or above thewrist or a foot at or above the ankle. This must be confirmed by our medical practitioner.Losing sight means total and permanent loss of use of an eye which means you are absolutelyblind in that eye and which is beyond cure either by surgical or other treatment. This must beconf`irmed by our lnedical practitioner.

Medical practitioner means any person registered and legally qualified as a MedicalPractitioner by a medical degree (MBBS) in western medicine and authorized by the medicallicensing authority of that country to provide medical or surgical service within the scope oftheir license and training. The medieal practitioner should not be your. your familymember` partner, business parmer, employer, employee or agent.

Period of insurance means a period of 12 months from the start date as shown in theschedule and each further consecutive period of 12 months for which the polity applies fromor for any period of cover as agreed between you and us.

Permanently disabled or permallent disability means suffering from one of the items ofdisablement listed in the seals of compensation table in this policy, and which was causedonly by an accident, as long as:

-the disability lasts for 06 months in a row from the date Of accident; and-our medical practitioner confirms that it is not going to improve after 06 months

Permanent total disability means total disability caused only by an accident that:

- lasts for 06 months in a row from the date of the accident; and

- our medical practitioner confirms that it is not going to improve after 06 months.

Policy means this document, including any information provided or declaration made by youfor and on behalt` of the insured person, the schedule or renewal certificate and anyendorsements we have issued under this policy.

Pri>existing medical condition means any injury or sickness] including any complicationswhich rmay arise:a which you knew about before the start of your p®li€y;b which you have received diagnosis, consultationS medical treatment or prescribed

drugs for within 12months before the start of your policy; orc for which you have been asked to get medical treatment or medical advice by a

medical practitioner within I 2 months before the stan of yonr policy.

Schedule means the document which proves that you have the insurance cover. listing amongOther things, details of the insured person, the beneflts, the sum insured and the period ofinsurance covered under this policy.

Sickness means worsening physical health not caused by an accident, for which you need thetreatment of a medical practitioner.

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We, onr, us. Corporation and SLIC means Sri Lanka Insurance Corporation Limited

Yout your, yours and yourself means the insured and/or insured person referred to in thesehednle.

What this Polity Covers

Section I - Hospitalization and Medical Expenses

]t` you shall sustain siekness or injury which is contracted after the commencement of thisPolity which necessitates medical and / or surgical treatment. we undertake to reimbursevarious expenses incurred subject to the Table of Benefits, Terms, Conditions and Exclusionsherein contained.

Sectioli 2 - Personal Accident

2A Accidental death

lf you are involved in an accident and due only to this accident you die within 06months from the date of the accident we will pay your legal personal representativeup to the relevant limit show in the Table of Benefits. A disability or death that iscaused by Sickness (for example, a heart attack or stroke) and not by an injury is notconsidered hereunder.

28 Permanent Disability including permanent Total Disability

lf you are involved in an accident which causes you an injury and due only to thisaccident, we will pay you up to the maximum limits as shown in section 28 of theTab]e* of Eben€fits.

You sha]] not be entitled to claim more tllan one ben€rlt available under Section28 as a result of the same accident.

You shall only be entitled to claim either benef]t 2A or 28 as a resttlt of the sameaccident.

TABLE oF BEr`maFITs

Section I - Hospitalization and Medical Expenses

I A - Inpatient Ben€r]ts ( Private Hospifa]s) Including Ayurv€di€ Treatment

LKR

Any one event (per person) 00'000/-Any one year (per person) 200'000/-

I) Hospital maintenance charges ittcluding Room charges limit 30.000/-

Maximum limit for room charges per day 5'000/-

2) Consu!tant's and Specialist' s Fees, Surgcon' s and Anesthetists Fees 30.000/-

3) Medical and Operational Expenses, Nursing Charges including use of 40'000/-operating theatre.lt`vestigations & Special Treatment on the Recommendation of ConsultantSpecialist upon. Hospitalization.

18 - Inpatient Benefits (Govermm€nt Hesi}itais) Including Ayurvedi€ Treatment

I) Government Hospital per day (Maximum of30 days per year) I ,000/~

2)Expenses incurred on drugs purchased & test, sears, & x-rays undergone I 0'000/-whilst being an inpatient in a Goverrment Hospital (Subject to bills andprescriptio"s being produced) for any one event / any one year

Additi®mal Terms and Conditions Epplicablc to lA alld 18

I) Subsequent to a hospitalization, cost of follow up drugs shall be limited to one week onlyimmediately, post hospitalization.

2) Following tests expenses are reimbursed under lA 3) on the recommendation of a MedicalPractitioner, if done as a day procedure without admission to Hospitala. MRrb. Endoscopya. Colonoscopyd. Bronchoseopye. Sigmoidoscopyf, CTScans9. Dengue antigen (Nsi)h. DTPAScani. DMSAscan

i. Ultrasound scank. EEC

*The Medical Practitioner's charges payable for procedures a) -- k) above would be limited to

maximum of LKR.7`5cO/-per procedure

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. Table of Benefits Continued

lc -Outpatient Benerits

Cover is provided for cost of drugs (excluding vitamins) prescribed bye and LKR I 0'000/-Tests & Investigations recommended by a Medical Practitioner holding MBBSOrabove qualifications only for specified illnesses or treatrnerits given belowfor any one event, any one year

I. Cancer2. End state Renal Failure3. Multiple sclerosis4. Major organ Transplant5. Paralysis6. Blindness7. Third Degree Bums

Additional Terms and Conditions Applicable to lA -IC

i. All the professional charges/Medical practitioner's fees and Medical expenses will be paid onprevai ling market rates.

ii. C`,latms shall be settled ott re-imbursement basis based on proofofexpenses incurred.

Sc€tion 2 - Personal Accidental Cover -Maximum of Rs: loo,coo/-for the year

2A Accidental Death- Student LKR 100'000/--Parent ( Applicable for only one parent for the year) LKR 75'000/-

28 Permanent Disablement- Parent Not applicable- Student LKR loo,000/-

Permanent Partial Disablement

LKR 100$000/-LKR50`000/-

:: :§§i;: £g:h;;::fb£°:trho::e,:m°br }iv. Losingsightofoneeyeorlosing onelimb

What is not covered (General flxclusions - these €xc]u§ions apply throughout yourPuli€y)

We shall not be liable to make any payment if hospitalization or any claims are attributable to,or based on, or arising out of, or are directly or indirectly connected to any of the following:

I, Any pee-existing illnesses. diseases, injuries, symptoms or impairments {"Pre-existingMedical Conditions") from which the Insured Person is suffering, are excluded from thescope of the cover of the Polity. Complications arising out of preuexisting medicalconditions would also be deemed as preexisting.

2. Hospitalization / Medical expenses not directly related to the specific illness or injury forwhich hospitalization took place and the expenses which are not approved by the attendingMedical Practitioner.

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3. Any treatment not performed by a Medical Practitioner.

4. Expenses whieh are not for actual, necessary and reasonable expenses incurred in thetreatment of the Sicluness or injury, or any elective surgery or treatment which is notmedically necessary«

5. Any medical or non-medical expenses incurred in respect of harvesting and storage ofstem cells when carried out as a preventive measure against possible future ai lments.

6. Hospitalization for correction of birth defects or congenital anomalies

7. Any sexually transmitted diseases or any condition directly or indirectly caused by orassociated with Human Immune Deficiency Virus (HIV) or any Syndrome or condition ofa similar kind commonly referred to as AIDS (Acquired Immune Deficiency Syndrome).

8. Dental treatment or surgery of any kind unless necessitated by an Accident.

9. Cost of spectacles contact lenses hearing aids and the cost of treatment for visioncorrection.

10. Self affected injuries or conditions (attempted suicide) and/or the treatment directly orindirectly arising from alcoholism or drug abuse and any sickness or injury which may besuffered after consumption of intoxicating liquors or drugs,

I 1. Nan-al]opathic methods of surgery and treatment.

12. Hospitalization for donation of an organ unless specified otherwise and subject to termsand conditions of the policyt

13. Medical expenses incurred due to Ventral / Incisional Hernia unless the company has paidfor the first operation.

14. Medical or surgical treatment for weight reduction or weight improvement regardless ofwhether the same is caused (directly or indirectly) by a medical condition.

15, Psychiatric, mental disorders (including mental health treatments)a Parkinson andAlzheimer's disease, general debility or exhaustion (*`runrdown conditions"), stem cellimplantation or surgery, or growth hormone therapy.

16« Any experimental or unproven procedures or treaments, devices or pharmacologicalregimens of any description.

17. Stay in rhospital for domestic reason where no active regular treatment is given by aMedical Practitioner.

18. Medical expenses relating to any Hospitalization primarily for diagnostic, X-ray or anyother investigations.

I 9. Charges for services received in convalescent home and nursing homes® nature cure clinicsand similar establishments.

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20. Circumcision unless necessary for treatment due to an accident or ailment and subject toterms and conditions of the policy.

21. Plastic surgery or cosmetic surgery unless necessary as a part of medically necessarytreatment certified by the attending Medical Practitioner for reconstruction following anaccident or siekness,

22. Any treatment related to sleep disoi.der or sleep apnoea syndrome.

23. Expenses for any routine or prescribed medical check-up or examination, external and ordurable Medical / Nan medical equipment of any kind used for diagnosis and/or treatmentand/or monitoring and/or maintenance and/ or support including CPAP, CAPD` Infusionpump. oxygen concentrator etc3 anbulatory devices like walker, crutches` belts* collars®caps, splints. stings, braces, stockings, gloves, hand soaps ctc. of any kind. Diabeticfootwear, glucometer/ thermometer and similar related items and also an.v medicalequipment, which are subsequently used at home, administrative fees, biomedical wastefees, medical records charges and any luxury taxes.

24. Any kind of service charges, surcharges, adndssion fees, taxes, registration charges etc.levied by the Hospital.

25. Any natural peril (including but not limited to avalanche, earthquake, volcanic eruptions®or any kind of natural hazard}, nuclear disaster, radioactive contamination andfor releaseof nuclear or atomic energy.

26. War, iftvasion, acts of foreign enemies, hostilities (whether war be declared or not), civilwar, all kinds of terrorism, rebellion, active participation in strikes. riots or civilcommotion, revolution, insurrection or military or usurped power, and full-time service inany of`thc armed forces.

27. Expenses incurred for procurement of a replacement organ, transportation costs of thereplacement organ associated administration costs and expenses incurred by the donor.

28. Any Insured Person committing or attempting to commit a criminal or illegal act whilesane or insane.

29. Nan Medical expenses including personal comfort and convenience items or services suchas telephone, television, personal attendant or harbor or beauty servicest diet charges,food, cosmetics, napkins. toiletry items, guest services and similar incidental expenses orservices.

30. Any hospitalization or medical expenses incurred outside of Republic of Sri Lanka.

Exclusions Applicable only to Section 2 Of your Polity

We shall not be liable for any claims directly or indirectly caused by or arising from:

I. you take part in flying or other aerial activities except as a fare paying passenger in alicensed passenger carrying aircraft.

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2. you taking part in any professional sports or in any sports for which you would or couldCam or receive any form of pay.

3. you taking part in any kind of speed contest or racing (other than on foot)

4. you taking pert in any dangerous activities or sports including caving. potholing. rockclimbing or mountaineering which involves using ropes3 any underwater activitiesinvolving underwater breathing apparatus, sky diving, cliff diving, bungee jumping,BASE (building® antenna, span, earth) jumping, paragliding, hang-gliding, parachuting,white-water rafting, dragon boating, hunting, horse riding, polo. show jumping, mountainbiking unless we have otherwise agreed in writing

in respect of the life of the parent covered under the policy.

Conditions

You should read this policy and the schedule together as one contract and any word orexpression to which a specific meaning has been attached in any part of this policy or of theschedule shall bear such specific meaning wherever it may appear.

I. Receipts

No payment in respect of any premium shall be deemed to be payment to us unless aprinted form of receipt for the same shall have been given to you.

2. Change in risk

You should give notice in writing to us of any change in the details.

3. Discharge

W€ shall not be bound to notice or be affected by any notice of trust, charge or alienationrelating to this polity, and the receipt Of you or your nominated person shall in all caseseffectually di scharge the Corporation.

4. Claims procedure

All certificatcs, information and evidence required by us shall be furnished at the expenseof each Insured Person and shall be in such form and of such nature as we haveprescribed. All documentation should be submitted to us within 90 days of occurrence.I Iowever, at the completion of any one annual period of insurance only 30 days from theend date of the Policy shall be granted for submission of claim documentation. AnInsured Pei.son as often as required shall submit to medical examination on behalf of theCorporation in respect of any alleged bodily injury. We may in the case of the death ofInsured Person require to have a post-mortem examination repoll where applicable. Youshall, as soon as possible after the occurrence of any injury obtain and follow the adviceof a duly qualified medical practitioner, and we shall not be liable for any consequencesarising by reason of your failure to obtain and follow such advice and use such appliancesor remedies as may be prescribed.

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5. Renewal

We shall not be bound to accept any renewal of this polity or to send any notice of therenewal premium becoming due.

6. Cancellation

This policy either in its entirety or in respect of any particular section may be cancelled byus at any time by registered letter sent to you at yoilr last known address, provided thatsuch cancellation shall be without prejudice to the rights of you in respect of prior lossconsequent Hpon injury to Insured Person, and provided that we return to you the lastpremium paid by you either for the peliey in its entirety or for the paticuLar sectionconcerned less a pro-rata part thereof for the period for which the polity has been inforce. either in its entirety or in respect of the said section, whichever the case may be. Bylike notice to us w€ may at any time cancel this policy. in which case we will retain aproportionate premium on the customary short period rates for the time the policy hasbeen in force either in its entirety or in respect of the said section, as the case may be. Therefund of premium, on cancellation by either party is subject to no claim having beenlodged on the Corperation you or an Insured Person during the period of insuran€€.

7. Arbitration

All disputes or differences of any kind whatsoever which may arise between the parties inconnection with or arising out of this Agreement and remaining unsettled for a period offourteen ( 14) days from the date of notification of such disputes shall be, failing amicableresolution, referred to arbitration by each party in accordance with the Arbitration Act No11 of 1995, The place of arbitration shall be Colombo, Sri Lanka and the language of theproceedings shall be English.

If the Corporation shall disclaim liability to the Insured for any claim hereunder andsuch claim shall not within twelve calendar months from the date of such disclaimer havebeen referred to arbitration under the provisions herein contained] then the claim shall forall purposes be deemed to have been abandoned and shall not thereafter be recoverablehereunder.

8. Observance of terms and conditions

The due observance and fulfillment of the terms, conditions and endorsements of thispolity by you or your nominated person in so far as they relate to anything to be done orcomplied with by him and the truth of the statements and answers in the proposal formand any subsequent declarations shall be conditions precedent to any liability of us tomake any payment under this policy.

9. Forfeiture

lf the claim be in any respect fraudulent, or if any false declaration be made or used insupport thereof or if any fraudulent means or devices are used by you or anyone acting onyour behalf to obtain any benefit under this polity or if the injury / illness be occasionedby the willful act or with connivance of you all benefits under this policy shall beforfeited.

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