This document ("Agreement"), together with any specific declarations or information provided by You ("You/Your"), sets out the basis on which You may avail the healthcare and wellness features under Your "InsurMonthly Plan", a service that is provided to You by Trufedu Budgetary Education Private Limited Private Limited ("Company/We/Us/Our"), having its corporate office at  The Executive Centre, Level 3B,DLF Centre, Sansad Marg, Connaught Place New Delhi Central Delhi 110001

INTRODUCTION:

We help You access various healthcare and wellness services to improve Your health and well-being and InsurMonthly situations leading up to any hospitalisation ("Managed Care”). Our doctors and in-house specialists, as approved or empanelled with Us (“InsurMonthly Doctors”), will provide best-in-class curated programmes, teleconsultations and video consultations.

You have subscribed to the InsurMonthly Plan and its services are available to You on Our website and Our mobile application (“InsurMonthly App”) if You have paid the applicable monthly/yearly subscription ("Membership Fees").

OUR SERVICES

1.1 Your InsurMonthly Plan will commence on the date on which this Agreement is sent to You (“Effective Date”) and will be valid for the period of the advance payment, if any, or until cancelled.

1. 1.2  Managed Care: The Managed Care features of Your InsurMonthly Plan will provide You access to medical consultations to improve Your health and well-being and InsurMonthly situations leading up to any hospitalisation. The Managed Care facility is available to all the InsurMonthly Plan members
2. 1.4  IPD: If You are an InsurMonthly member then along with the Managed Care and OPD cover, You will also receive health cover for treatments requiring hospitalisation and day care services from Our Insurance Partner. IPD and day care services provided to You under Your InsurMonthlyPlan will include cashless hospitalisation facility from a wide network of doctors and hospitals in India and certain day-care procedures (which do not need You to stay at the hospital overnight) from Healthcare Partners.

INSURANCE COVER

1. The sum insured for the insurance is available on a sharing basis for any one or all (for Trufedu Budgetary Education Private Limited members who are in the same account) for all claims arising during the coverage period (i.e. it is a “floater”), and is not issued to You exclusively on a per individual basis.
2. 1.6  In the InsurMonthly that any document or information is required from You in processing any claim under the group insurance policy by the Healthcare Partner or the Insurance Partner, You shall co-operate and provide the same to Us.
3. 1.7  While we provide You access to the insurance cover, by acting as a group administrator, We do not underwrite the same or assume any risk thereunder. Claims under the group insurance policy may be intimated to Us for coordination, but all claim processing and decision will be by the Insurance Partner directly.
4. 1.8  The premium amount payable towards such insurance cover is determined by the Insurance Partner,and is included in the cost of Your InsurMonthly membership. You may view the premium amount paid by You, and passed on to the Insurance Partner by Us, on the payment page during your InsurMonthly onboarding process.
5. 1.9  Any dispute or query related to any claim or terms of the insurance policy will be addressed by Our Insurance Partner and We will not be liable to You in this regard.

PROCESS AND PROCEDURES

1. 1.10  For availing the Managed Care services under Your InsurMonthly Plan, You are required to have access to the InsurMonthly App. Upon subscribing, You will be able to log into Your InsurMonthly Plan account which can be accessed on the InsurMonthly Website and App and be used to avail Managed Care services.
2. 1.11  For availing the insurance benefits, InsurMonthly members will need their Certificate of Insurance, or alternatively, their group insurance details available on the InsurMonthly Website or App.
3. 1.12  Normally, all services under Your InsurMonthly Plan will be available in a cashless manner at the concerned facility and may be accessed through the InsurMonthly App (for Managed Care and OPD services) or the TPA/insurance desk (for IPD services), as available at such Healthcare Partner’s facility. In case of InsurMonthly members, where services are not available on a cashless basis, You may claim a reimbursement upon providing supporting documentation to Us and Our Insurance Partner. This may typically be due to:
1. (a)  A medical emergency faced by You, which may be included under Your InsurMonthly Plan once InsurMonthly Doctors are able to assess the treatment taken;
2. (b)  Us/Insurance Partner needing to further assess Your request;
3. (c)  Technical reasons faced by Us, Insurance Partner or the TPA.

Please note that if a reimbursement is requested without having first sought pre-approval, through InsurMonthly, by InsurMonthly's Insurance Partner, and not for one of the reasons above, the reimbursement request may be denied.

1. 1.13  The broad procedure for availing any features under Your InsurMonthly Plan is as follows:

Step 1: You are required to book a consultation with InsurMonthly Doctors on the InsurMonthly App or Website for their preliminary advice/prescription. In accordance with Your medical condition, symptoms and the InsurMonthly Plan taken by You, InsurMonthly Doctors will recommend You for a relevant Managed Care service or OPD/IPD service.

Step 2: Upon receiving such recommendation,

1. (a)  InsurMonthly members, will avail teleconsultation covered under the Managed Care from recommended InsurMonthly Doctor.
2. (b)  InsurMonthly members may additionally avail OPD/IPD services from the Healthcare Partner recommended by Us or Our Insurance Partner.

Step 3: For availing OPD/IPD service at the approved Healthcare Partner. You may avail the treatment by visiting the selected facility and approach the TPA/insurance desk and provide supporting documentation in case of IPD services, or, in case of OPD services and where pre-approval is granted, initiate claim settlement through the InsurMonthly App. Before using any further OPD/IPD services, You shall be required to submit all required proofs, consultation etc, on the InsurMonthly App or directly to the Insurance Partner. It is recommended to always coordinate with InsurMonthly prior to any medical procedure or claim in order to simplify the claims process and the communication with the Healthcare and Insurance Partners.

RIGHTS AND DUTIES OF THE PARTIES

Please note that the Parties have the following rights and obligations under this Agreement:

1. 1.14  For the purpose of determining Your eligibility for the InsurMonthly Plan, We reserve the right to require You to undergo medical tests, and You shall extend all reasonable cooperation with Us in this regard.
2. 1.15  The final decision in relation to whether and where any specific OPD/IPD service may be available to You through Your InsurMonthly Plan, shall be made by Our Insurance Partner, per its sole discretion.
3. 1.16  At the time of availing the Managed Care services under Your InsurMonthly Plan, if You are not satisfied with the consultation of InsurMonthly primary care doctors, You are allowed to take second opinion from up to two super-specialists doctors for the same health issue without unnecessary repetition of same tests and prescription, provided InsurMonthly has full discretion to reject Your request for this purpose.
4. 1.17  We are not responsible for the outcome or result of any treatments, or the quality of care provided by any Healthcare Partner. Additionally, by way of this Agreement or otherwise, we do not assume or shall be deemed to assume any liability towards any loss or damage arising out of or in relation to any opinion, advice, prescription, procedure, actual or alleged errors, omissions and representations provided or made by any doctors or any other personnel at any Healthcare Partner, other than those of InsurMonthly Doctors.
5. 1.18  We do not have a principal agent relationship, partnership, joint venture relationship or any similar arrangements with any of the Healthcare Partners or with Our Insurance Partner.
6. 1.19  We reserve the right to revise the admission and renewal criteria and/or Membership Fees for the InsurMonthly Plan, as well as the choice of Insurance Partner, per Our sole discretion. We will provide You an advance notice of 30 days before implementing such a change. In such an InsurMonthly You may be required to undergo additional tests recommended by an InsurMonthly Doctor.
7. 1.20  We reserve the right to update, modify or remove any specific Managed Care service or OPD service or IPD service or Healthcare Partner available to You, at Our discretion.

MEMBERSHIP FEES

1. 1.21  You are required to pay Your Membership Fees (which includes the relevant group insurance premium for InsurMonthly members) for Your InsurMonthly Plan in advance. Details of the available payment schedules, prices, and payment options for any InsurMonthly Plan are specified on InsurMonthly.com
2. 1.22  The duration of any InsurMonthly Plan and cover under Our Insurance Partner's group insurance policy (for InsurMonthly Plan shall be limited to the period for which Membership Fees is received in advance, including by way of monthly instalments or otherwise.

CONFIDENTIALITY

1. 1.29  We agree to keep all Your information confidential, subject to the terms of this Agreement. We shall not, without obtaining Your written consent, disclose such information, including any medical information, to any third parties except Healthcare Partners and Our Insurance Partner and for any purposes other than for InsurMonthly’s internal research and scientific assessment and those contemplated under this Agreement. This obligation shall not extend to any information that is already in the public domain or which We are under an obligation to disclose pursuant to the applicable law or orders of any court or governmental or regulatory body.
2. 1.30  Our Insurance Partner and Healthcare Partners may use Your information, including Your medical information, for their clinical purposes, subject always to applicable law in force.

GENERAL TERMS & CONDITIONS

1.31 Dispute Resolution: This Agreement is subject to Indian law. The courts in Delhi shall have the exclusive jurisdiction over any disputes or differences arising under or in relation to this Agreement.

Terms & Conditions – InsurMonthly Membership

1. 1.32  Assignment: You shall not assign any of its rights and obligations under this Agreement, except with Our prior written consent.
2. 1.33  Notices: Any notice, request, demand, approval, consent, or other communication under this Agreement shall be delivered in writing.
3. 1.34  Force Majeure: Notwithstanding anything to the contrary in this Agreement, We or Our Healthcare Partners shall not be liable by reason of any failure or delay in the performance of any duties and obligations under this Agreement if such failure or delay is caused by natural disasters, strikes, lock-outs, embargoes, war, riots, civil commotion, any orders of governmental, quasi-governmental or local authorities, or any other similar cause beyond Our control and without any fault or negligence of Our own.
4. 1.35  We shall inform You and keep You updated in the InsurMonthly of any changes to Your InsurMonthly Plan, Our operations, or any other changes relevant to Your subscription of the InsurMonthly Plan. All up to date information about Our services can be accessed on the InsurMonthly App and Our website at InsurMonthly.com

DECLARATIONS

I hereby understand and agree that by consenting to purchase this InsurMonthly Plan, I have read and understood the contents of this Agreement, and freely provide the declarations below:

1. 1.36  All the information and declarations provided to Trufedu Budgetary Education Private Limited are true, accurate and complete to the best of my knowledge and information, and that I have read the terms of this Agreement and agree to be bound by them.
2. 1.37  By opting for the InsurMonthly Plan membership, I freely consent to Trufedu Budgetary Education Private Limited seeking and the relevant hospital or such similar provider, establishment, or clinic (who at anytime has attended to me in the past or present concerning anything which affects my physical and mental health) providing InsurMonthly with my medical information and records for the purpose of reviewing my eligibility to the InsurMonthly Plan and the provision of any services thereunder.
3. 1.38  I grant Trufedu Budgetary Education Private Limited permission to verify my identity through my Aadhaar number and other Government issued identification and obtain access to my credit score from any credit information company, in accordance with applicable law.
4. 1.39  I authorise Trufedu Budgetary Education Private Limited to process, use, store, disclose and transfer any information, including medical information, as is made available by me or the relevant hospital or such similar provider, establishment, or clinic, for the sole purpose of providing and improving its services, fulfilling its contractual obligations to me, billing, conducting background screening, investigations, claims assistance for my insurance, and carrying out any other activity related or incidental thereto, subject always to the requirements under the Information Technology Act 2000 or any other applicable law in force.

Trufedu Budgetary Education Private Limited