changes in rules for health

policy_analyser/analyse.py

@@ -11,6 +11,7 @@ from datetime import datetime
 from policy_analyser import PROMPTS_DIR, DATA_DIR
 from policy_analyser.ocr import PyMuPDF4LLMOCR
 from policy_analyser.llm import call_openai
+from policy_analyser.utils import markdown_table_to_json
 
 class LOB:
     def __init__(self, ocr_engine = 'open-source/pymupdf4llm'):
@@ -90,8 +91,10 @@ class Health(LOB):
             self.rules = f.read()
         with open(os.path.join(PROMPTS_DIR, 'health', 'suggest.txt'), 'r') as f:
             self.suggest_prompt = f.read()
-        with open(os.path.join(DATA_DIR, 'health.md'), 'r') as f:
+        with open(os.path.join(DATA_DIR, 'health_policy.md'), 'r') as f:
             self.acko_policy = f.read()
+        with open(os.path.join(DATA_DIR, 'health_super_topup.md'), 'r') as f:
+            self.acko_super_topup = f.read()
 
     def _analyse(self, **kwargs):
         text = kwargs.get('text')
@@ -106,7 +109,15 @@ class Health(LOB):
     def _suggest(self, **kwargs):
         analysis = kwargs.get('analysis')
         if len(analysis) > 0:
-            prompt = self.suggest_prompt + "\nCustomer Policy Analysis : " + analysis + "\nAcko's Policy : " + self.acko_policy
+            bad_factors = markdown_table_to_json(analysis.split(f'<BAD>')[-1].split(f'</BAD>')[0].replace('## Bad Factors', ''))
+            bad_factor_names = [factor['Factor'] for factor in bad_factors]
+            avg_factors = markdown_table_to_json(analysis.split(f'<AVERAGE>')[-1].split(f'</AVERAGE>')[0].replace('## Average Factors', ''))
+            avg_factor_names = [factor['Factor'] for factor in bad_factors]
+            if len(bad_factors) < 3 and any(['sum insured' in factor.lower() for factor in bad_factor_names]) \
+                or len(avg_factors) < 3 and any(['sum insured' in factor.lower() for factor in avg_factor_names]):
+                prompt = self.suggest_prompt + "\nCustomer Policy Analysis : " + analysis + "\nAcko's Policy : " + self.acko_super_topup
+            else:
+                prompt = self.suggest_prompt + "\nCustomer Policy Analysis : " + analysis + "\nAcko's Super Top up Policy : " + self.acko_policy + '\nNote : Super Top up is an additional policy the customer can buy to enhance the benefits along with their current policy'
             response = call_openai(prompt)
             if len(response) > 0:
                 return response
@@ -126,8 +137,8 @@ if __name__ == '__main__':
     for filepath in tqdm(filepaths):
         # if os.path.isfile(filepath.replace('.pdf', '.analysis.json')):
             # continue
-        if '.analysis' in filepath or '.e2e-analysis' in filepath:
-            continue
+        # if '.analysis' in filepath or '.e2e-analysis' in filepath:
+        #     continue
         print(filepath)
         if filepath.endswith('.pdf'):
             file_bytes = open(filepath, 'rb').read()
@@ -137,11 +148,11 @@ if __name__ == '__main__':
         analysis = health(file_bytes)
         # print(analysis)
         basepath = os.path.splitext(filepath)[0]
-        if not end2end:
-            with open(os.path.splitext(filepath)[0] + '.analysis.json', 'w') as f:
-                json.dump(analysis, f, indent = 4)
-        else:
-            with open(os.path.splitext(filepath)[0] + '.e2e-analysis.json', 'w') as f:
-                json.dump(analysis, f, indent = 4)
-            with open(os.path.splitext(filepath)[0] + '.e2e-analysis.md', 'w') as f:
-                f.write(analysis[1]['response'])
+        # if not end2end:
+        #     with open(os.path.splitext(filepath)[0] + '.analysis.json', 'w') as f:
+        #         json.dump(analysis, f, indent = 4)
+        # else:
+        #     with open(os.path.splitext(filepath)[0] + '.o1-mini.e2e-analysis.json', 'w') as f:
+        #         json.dump(analysis, f, indent = 4)
+        #     with open(os.path.splitext(filepath)[0] + '.o1-mini.e2e-analysis.md', 'w') as f:
+        #         f.write(analysis[1]['response'])

policy_analyser/data/auto_policy_entities.json

@@ -0,0 +1,122 @@
+[
+    {
+        "entityId": 0,
+        "entityName": "policy_start_date",
+        "entityDesc": "Start date of the policy",
+        "expectedOutputFormat": "dd/mm/yyyy"
+    },
+    {
+        "entityId": 1,
+        "entityName": "policy_end_date",
+        "entityDesc": "End date of the policy",
+        "expectedOutputFormat": "dd/mm/yyyy"
+    },
+    {
+        "entityId": 2,
+        "entityName": "base_cover_ncb",
+        "entityDesc": "No claim bonus discount %age",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 3,
+        "entityName": "transmission_type",
+        "entityDesc": "Transmission type of car, one of the two : automatic, manual",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 4,
+        "entityName": "previous_insurer",
+        "entityDesc": "Previous insurance company",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 5,
+        "entityName": "registration_month",
+        "entityDesc": "Month of vehicle registration",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 6,
+        "entityName": "registration_year",
+        "entityDesc": "Year of vehicle registration",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 7,
+        "entityName": "registration_number",
+        "entityDesc": "vehicle registration number",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 8,
+        "entityName": "phone_number",
+        "entityDesc": "Customer's contact number",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 9,
+        "entityName": "customer_name",
+        "entityDesc": "Customer's name",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 10,
+        "entityName": "model",
+        "entityDesc": "Vehicle model name",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 11,
+        "entityName": "fuel_type",
+        "entityDesc": "Fuel type of the vehicle",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 12,
+        "entityName": "make",
+        "entityDesc": "Make of the vehicle",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 13,
+        "entityName": "variant",
+        "entityDesc": "Variant of the vehicle model",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 14,
+        "entityName": "cc",
+        "entityDesc": "CC of vehicle",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 15,
+        "entityName": "pincode",
+        "entityDesc": "Pincode of the customer's address",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 16,
+        "entityName": "Product_Type",
+        "entityDesc": "Type of insurance policy plan",
+        "expectedOutputFormat": "string"
+    },
+    {
+        "entityId": 17,
+        "entityName": "ex_showroom_price",
+        "entityDesc": "Ex showroom price of the vehicle",
+        "expectedOutputFormat": "integer"
+    },
+    {
+        "entityId": 18,
+        "entityName": "add_ons",
+        "entityDesc": "Add-ons purchased with the policy",
+        "expectedOutputFormat": "JSON list"
+    },
+    {
+        "entityId": 19,
+        "entityName": "not_covered",
+        "entityDesc": "Items that are not covered in the policy",
+        "expectedOutputFormat": "JSON list"
+    }
+]

policy_analyser/data/health_policy.md

@@ -0,0 +1,810 @@
+y
+
+**Acko Personal Health Insurancert**
+
+**Policy Wordings**  
+
+ACKO promises to cover you basis the declarations you’ve made with us when purchasing health insurance from us. Note: If any of your declarations are found to be untrue, incorrect or inaccurate in any way, ACKO can reevaluate the Benefits applicable for the remainder of the Policy Period. Depending on the severity of misrepresentation or non-disclosure, the policy can also be voided, so please answer truthfully to the best of your knowledge\! And if you don’t know, feel free to ask or offer your best understanding when disclosing medical information to us. 
+
+**Definitions of terms when purchasing health insurance from ACKO**
+
+1\. **Accident** means sudden, unforeseen and involuntary event caused by external, visible and violent means.  
+
+2\. **Illness** means continuous period of illness and includes relapse within 45 days from the date of last consultation with the Hospital/Nursing Home where treatment was taken.  
+
+3\. **AYUSH Hospital** is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising  of any of the following:  
+
+a) Central or State Government AYUSH Hospital; or 
+
+b) Teaching hospital attached to AYUSH College recognized by the Central  Government/Central Council of Indian Medicine/Central Council for Homeopathy; or  
+
+4\. **AYUSH Day Care Centre** are Community Health Centre (CHC), Primary  Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre
+
+5\. **Cashless facility** means the customer payments for treatment costs are directly made to the Network Provider by the insurer  
+
+7\. **Congenital Anomaly** means a condition present since birth, and which is abnormal with reference to form, structure or position.
+
+a) Internal Congenital Anomaly- Congenital anomaly which is not in the visible and accessible parts of the body.  
+
+b) External Congenital Anomaly- Congenital anomaly which is in the visible and  accessible parts of the body  
+
+8\. **Co-Payment (or Copay)** means a cost-sharing feature under health insurance where the policyholder/insured member is required to pay a percentage of the total claims amount.
+
+9\. **Cumulative Bonus:** Cumulative Bonus means any increase or addition in the Sum Insured  granted by the insurer. This does not increase the premium. Note: ACKO does not offer this feature for health insurance.
+
+10\. **Day Care Centre** means any institution established for Day Care Treatment of illness or injuries 11\. **Day Care Treatment** means a treatment or surgery undertaken under General or Local Anesthesia in a hospital/Day Care Centre in less than 24 hrs. This is different from out-patient treatment.
+
+12\. **Deductible:** Generally chosen by customers who already are insured upto a certain amount (eg. if they have a pre-existing topup) or if a customer willing wants a cheaper plan at the cost of needing to pay the deductible from their pocket if a claim arises in that year. 
+
+13\. **Dental Treatment** means a treatment related to teeth such as examinations, fillings, crowns, extractions and surgery.   
+15\. **Domiciliary Hospitalization** means treatment for an illness/disease/injury which is done at home
+
+16\. **Emergency Care** is immediate medical attention given to a person to prevent death or serious long term impairment of the insured person’s health. 
+
+17\. **Grace Period** is a specific period of time after the premium payment deadline, during which a payment can be made to renew or continue a policy. There will be no gap or break in benefits such as waiting periods and coverage of pre-existing diseases.
+
+18\. **Hospital** means any institution established for in-patient care and Day Care Treatment of illness and/or injuries.
+
+19\. **Hospitalization** means admission to a Hospital for more than 24 hours
+
+20\. **Illness** could mean any sickness, disease or condition that impairs a person’s well-being and requires medical treatment. There are two types of Illnesses:
+
+a) **Acute condition** \- Conditions that can be treated which leads to immediate recovery and don’t recur
+
+b) **Chronic condition**  include recurring pain, illnesses or symptoms that require ongoing or long-term monitoring to control symptoms. This can also include long-term rehabilitation which the patient has to continue indefinitely
+
+21\. Injury means accidental physical bodily harm which may have been caused by external or violent means
+
+22\. Inpatient care: the insured person has to stay in a hospital for more than 24 hours
+
+23\. Intensive care unit (ICU): a section, ward or wing of a hospital which is equipped for the continuous monitoring and treatment of patients in a critical condition or require life support facilities
+
+24\. ICU Charges: these generally include charges for bed and general medical support such as monitoring devices, critical care nursing.  
+
+25\. ACKO does not offer Maternity coverage. Maternity expenses are usually medical expenses traceable to childbirth (including complicated deliveries and caesarean sections) as well as abortions
+
+26\. Medical Advice: any consultation or advice from a Medical Practitioner. This includes any issued prescriptions.
+
+27\. Medical Expenses: expenses that a patient has actually for medical treatment on account of Illness or Accident 
+
+28\. Medical Practitioner means a person who holds a valid registration from the Medical Council  of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government
+
+29\. Medically Necessary Treatment means any treatment, tests, medication, or hospital stay which is required for medically managing an illness
+
+30\. Migration involves changing to a different plan within ACKO itself
+
+31\. Network Provider means hospitals or health care providers enlisted by an insurer, TPA or  jointly by an Insurer and TPA to provide medical services to an insured by a Cashless facility.  
+
+32\. New Born: ACKO only covers new born babies 90 days after birth.  New Born Baby means baby born during the Policy Period. They can be added as a new member under the "Edit" section after accessing your ACKO health policy on the acko app
+
+33\. Non-Network means any hospital, day care centre or other provider that is not part of the network of hospitals published by ACKO
+
+34\. Notification of Claim means the process of intimating a claim to the insurer or TPA (Third Party Administrator) through  any of the recognized modes of communication.  
+
+35\. OPD treatment: The insured person only visits a clinic / hospital or associated  facility like a consultation room for diagnosis and treatment. Note: The Insured is not admitted as a day care or in-patient.
+
+36\. Pre-Existing Disease means any existing condition, ailment, injury or disease the user may already have 
+
+37\. Pre-hospitalization Medical Expenses means medical expenses incurred before hospitalisation of the insured person
+
+38\. Portability means the policyholder can transfer transfer any credit gained for pre-existing conditions or waiting periods from an existing insurer to ACKO which directly offers zero waiting period for eligible users based on medical tests
+
+39\. Post-hospitalization Medical Expenses means medical expenses incurred by the insured person after being discharged from the hospital 
+
+40\. Qualified nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India. 
+
+42\. Renewal: ACKO's health insurance policy can be renewed continuing their health insurance coverage. This also helps insured members gain waiting period credits for pre-existing diseases or any other time-bound exclusions on ACKO's standard or platinum plan
+
+43\. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses
+
+44\. Surgery or Surgical Procedure means operations required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of  diseases, relief from suffering and prolongation of life
+
+45\. Unproven/Experimental treatment means the treatment including drug experimental  therapy which is not based on established medical practice in India or may be unproven
+
+**Specific Definitions** 
+
+1\. **Age or Aged** means the age as on last birthday.  
+2\. **Admission** means Your admission in a Hospital as an in-patient for the purpose of medical treatment of an Injury and/ or Illness.  
+
+3\. **Ambulance** means a road vehicle operated by a licenced/authorised service provider and equipped for the transport and paramedical treatment of the person requiring medical  attention. 
+
+5\. **Annual Renewal Date** means the day on which the existing health insurance policy expires and can be renewed  
+7\. **Base Sum Insured:** the amount of money to be used by the insurer on claiming their health insurance   
+8\. **Break in Policy:** This occurs when the payment for the health insurance policy is not done within 30 days of policy expiry
+
+10\. **Claim:** a request raised by the policyholder or insured members to the insurer to pay for medical Expenses or avail any benefits
+
+11\. **Commencement Date:** Commencement Date means the start date of the Policy
+
+12\. **Covered In-patient Medical Expenses** shall include Room Rent, ICU/CCU/HDU charges,  nursing charges, operation theatre charges, Surgical Appliance and/or Medical Appliance  cost, fees of Medical Practitioner/ surgeon / anaesthetist / Specialist / radiologist / pathologist  and diagnostic tests conducted within the same Hospital where the Insured Person has been  admitted.  
+
+13\. **Coverage Period:** Coverage Period is the amount of time for which a person is insured for their health insurance policy
+
+14\. **Date of Admission** means the date of the Insured Person’s first admission to a Hospital or  Day Care Centre 
+
+15\. **Dependent** means the Employee’s / Member’s parents, Spouse or child who have been  enrolled in the Policy.  
+
+16\. **Employee:** means any member of Your staff who is proposed or sponsored by You and  who becomes an Insured Person under this Policy
+
+17\.**Emergency:** An emergency is a sudden, serious medical issue that requires immediate professional treatment within 24 hours to prevent serious harm or long-term health problems. Once the condition is stabilized, it is no longer considered an emergency.
+
+19\. **Exclusions** mean specified coverage, hazards, services, conditions, and the like that are not provided for under ACKO’s Policy  
+
+21\. The "**Floater Benefit**" is the total insurance coverage amount that applies to your entire family under the policy. This is the maximum amount the insurance company will pay out for all your family members together during the policy period
+
+22\. **HDU (High Dependency Unit)**: This is a special area in the hospital, close to the Intensive Care Unit, where patients can receive more care than in a normal ward, but not as much as in the Intensive Care Unit.
+
+**Insured Person**: This refers to the main person covered by the insurance policy, as well as any dependents (like family members) named in the policy schedule, who are also covered as long as the appropriate premiums are paid.
+
+24\. **IRDAI** means the Insurance Regulatory and Development Authority of India.  
+
+26\. The "Nominee" is the person named in the policy schedule who will receive the insurance benefits if the insured person or their dependent passes away while the policy is still active. This nominee receives the payments according to the policy's terms and conditions.
+
+1. Out-Patient: Someone who gets treatment or stays less than 24 hours in the hospital.  
+2. Primary Insured: The main person covered by the insurance policy, who is employed by or a member of the organization.  
+3. Partner: The live-in partner who is also covered under the health insurance policy.  
+4. Policy: The complete insurance contract, including the proposal form, terms and conditions, schedules, and any changes made over time.  
+5. Policy Anniversary Date: The yearly date when the policy coverage period begins.  
+6. Policy Period: The duration of the policy, from the start date to the expiry date or cancellation date.  
+7. Policy Year: A 12-month period within the overall policy period, starting from the policy anniversary date.  
+8. Risk Commencement Date: The date when the policy coverage and our responsibility as the insurer begins.  
+9. Room Category: The type of hospital room and associated expenses covered, like private, shared, deluxe, etc.  
+10. Schedule: The part of the policy that lists the details of the insured persons, coverage amounts, policy period, and any special conditions.  
+11. Spouse: The proposer's legal husband or wife who is also covered under the policy.  
+12. Specialist Medical Practitioner: A doctor with advanced training in a specific medical field.  
+13. Sum Insured: The maximum amount the insurance company will pay out for any or all claims under the policy.  
+14. Surgical/Medical Appliance: Artificial devices or prosthetics required for surgery or medical treatment.  
+15. Sub-Limit: A limit on the amount covered for a specific type of claim.  
+16. TPA: A licensed third-party administrator who assists the insurance company in providing health services.  
+17. Treatment: Any relevant medical care provided by a doctor to cure or substantially relieve an illness or injury.  
+18. Waiting Period: A time period before certain conditions are covered by the policy.  
+19. **Schedule**: A policy schedule outlines what's included in the insurance coverage and any rules or limitations around the different benefits. It's an important part of the policy that details the specifics of the coverage you have.  
+20. **What is Sum Insured:** The policy's "Sum Insured" refers to the maximum coverage amount available for the different benefits. There is a single, shared coverage limit for all the insured people on the policy, for each benefit for the period of coverage. The total payout for all insured people's claims combined is limited to the single sum insured amount. Eg. If the sum insured is worth Rs. 1Crore, then 1 Crore is available for all three members. Now if a single family member makes a claim worth Rs. 10 Lakhs, then 90 Lakhs is left for all the family members covered under the plan.
+
+21. **Consequential Losses:** The insurance company is not responsible for any losses or damages that are caused by mistakes, errors or misrepresentations made by the network providers when you use the covered services.  
+22. **Reasonable and Customary Charges:** The insurance company will only pay for costs and expenses that are reasonable and commonly charged for that type of service or treatment.
+
+**Section 3: Benefits**
+
+**Basic Benefits** 
+
+All the benefits listed below are available to anyone insured by ACKO for their retail health policy
+
+**In-patient Hospitalization** 
+
+In the event of hospitalization, we will cover the following medical expenses for anyone insured  in the policy \- 
+
+● Hospital room rent 
+
+● ICU/CCU/HDU charges   
+● Operation room charges 
+
+● Medical practitioner / doctor fees
+
+● Medicines prescribed by the treating medical practitioner / doctor, used in the treatment ● Diagnostic tests directly related to the current hospitalization 
+
+● Surgical or medical appliance(s) prescribed by the treating medical practitioner/doctor  (e.g. a stent) 
+
+**Room Rent /ICU** 
+
+ACKO has no room rent limits\! If anyone insured under the policy is hospitalized, ACKO will cover the entire room rent charges for the  room category and ICU charges during hospitalization stay.
+
+**Day Care Treatment** 
+
+If anyone insured under the policy undertakes Day Care Treatment in a hospital, nursing home, or day care centre, we will cover the expenses of the day care treatment.
+
+**Pre or Post Hospitalization Medical Expenses**  
+
+ACKO will cover all the relevant medical expenses including consultations, investigations,  diagnostics and medicines that are incurred towards pre-hospitalization and post-hospitalization  of anyone insured under the policy.
+
+**Road Ambulance Limit** 
+
+The goal is to help cover the costs when you urgently need to get someone to receive immediate medical attention.
+
+This covers emergency transport to a hospital or day care facility
+
+ACKO will pay for the reasonable costs of the transportation
+
+This applies to anyone insured under the policy who needs emergency care
+
+**Domestic Emergency Evacuation Limit** 
+
+If anyone covered by the insurance policy has a serious medical emergency and the local hospitals can't provide the necessary care, the policy will cover the costs to transport that person to the nearest medical facility that can properly treat them.
+
+This could involve using a specialized medical aircraft, a commercial airline, a train, an ambulance, or an air ambulance \- whatever transportation method is best suited for the person's medical needs and availability. This emergency evacuation coverage is only valid within India.
+
+**Domiciliary Treatment**
+
+If anyone insured under the policy undergoes Domiciliary Hospitalization i.e. medical treatments  or procedures taken at home, we will cover the cost of such domiciliary hospitalization.
+
+
+**Organ Donor Expenses** 
+
+If anyone insured under the policy requires organ donation, we will cover all the in-patient  hospitalization expenses incurred by the person’s organ donor for harvesting of the organ.  
+
+**Second Opinion** 
+
+If anyone insured under the policy seeks a second opinion for an alternate evaluation of the  diagnosis or treatment, we will cover the expenses associated with seeking the second opinion. This is generally covered for consultation on an out-patient basis, or when the person is advised hospitalization or day care treatment in the first opinion 
+
+**Basic benefit options** 
+
+**Worldwide in-patient hospitalization**
+
+This benefit allows anyone insured under the policy to get covered for in-patient medical expenses anywhere outside India. Note that ACKO does not provide this coverage for their health insurance.
+
+**Unlimited Restore (ACKO Provides this)**  
+Consider the situation where you use up all your insurance coverage of Rs 1 Cr for a hospitalization or treatment. If you or a family member needs another treatment for a different medical issue, they may find themselves without insurance coverage. With "Unlimited restore" ACKO will re-fill your insurance coverage by another 1 Cr, so you are never short of funds when seeking new treatment. Note: This benefit is not applicable for an unlimited-sum insured plan
+
+**First Notification of Claim (FNOL)**
+
+This is an agreement to let the insurance company know within 48 hours of being admitted to the hospital or before being discharged (whichever comes first) if anyone covered needs inpatient hospitalization or day care treatment.
+
+Note: ACKO currently does not offer a specific discount on the premium on intimating first notification of loss.  
+
+**Preferred Providers Network** 
+
+Anyone covered under the policy agrees to only use hospitals only within the ACKO’s preferred provider network for inpatient hospitalizations or day care treatments. 
+
+**Waiver of non-payable medical expenses** 
+
+ACKO will cover certain medical expenses that are usually excluded or considered "non-medical" expenses.
+
+However, for ACKO to pay for these expenses, a few conditions apply:
+
+1. The expenses claimed must be reasonable and considered medically necessary for your treatment.  
+2. The insurance company must have already approved and admitted your claim for inpatient hospitalization, day care treatment, or domiciliary (at-home) treatment.
+
+**Preventive Health Check-up**  
+
+ACKO will provide the following preventive health check-ups to anyone insured under the policy if they are above 18 years of Age. The list of tests included in the check-ups are:
+
+1\. Complete Medical Examination by a Medical Practitioner  
+
+2\. Complete Blood Count (CBC)  
+
+3\. Erythrocyte sedimentation rate (ESR)  
+
+4\. Fasting Blood Sugar (FBS)  
+
+5\. Electrocardiogram (ECG)  
+
+6\. Serum Creatinine,  
+
+7\. Serum Gamma-Glutamyl Transferase (GGT)  
+
+8\. Serum Total Cholesterol (T Chol)  
+
+9\. Serum Triglyceride (S. Trig)  
+
+**Inflation Protect Sum Insured** 
+
+ACKO increases your coverage automatically to account for medical inflation, as long as you keep renewing your policy each year. This is to help your insurance coverage keep up with rising medical costs over time
+
+The Inflation Protect Sum Insured is calculated as a fixed percentage of your current policy year's base sum insured amount. For example, if your base sum insured is Rs. 5 lakhs and the inflation protection percentage is 10%, you'll get an extra Rs. 50,000 (10% of 5 lakhs) added to your total coverage for the next year.
+
+**Initial 30 days waiting period waiver** With this benefit, you get coverage from day one of the new policy instead of having to wait for 30 days before making any claims. Normally, there is an initial 30-day waiting period when you buy a new health insurance policy, meaning the insurance company will not cover any treatments or procedures that occur within the first 30 days of the policy start date. This benefit allows you to make a claim and it will be covered by the insurance, without having to wait for 30 day, even if you need medical treatment right after buying the policy. Note: ACKO covers new born babies only 90 days after birth.
+
+**24/7 Doctor-on-call:** ACKO can provide access to consult with a doctor or general medical practitioner anytime of the day or night. it's a convenient way to quickly get general medical guidance from a doctor remotely, 24/7. The consultation can happen through various options like:
+
+* Online portal (App, Website)  
+* Chat service  
+* Call-back service  
+* Voice call  
+* Video call  
+* Note: this does not replace proper in-person diagnosis and treatment from your regular doctor when required.
+
+**Family physician** 
+
+ACKO will assign a qualified general physician as your "Family Physician" who will be located near your residential area. You can easily visit this doctor in-person for consultations and routine medical needs without having to travel far:
+
+Some key points:
+
+* The assigned doctor will be a general physician, not a specialist for any specific disease.  
+* ACKO will try their best to provide at least one Family Physician option within 5 km of your current residential address.  
+* If no doctor is available within that radius, they will assign one outside that area or let you choose your own general physician.  
+* If you move residences, ACKO will re-assign a new Family Physician near your new address.
+
+**Out-Patient Department (OPD) Medical Services**
+
+Only ACKO’s corporate health insurance plan covers this benefit, and not their retail health insurance.
+
+Outpatient treatment refers to medical services that are provided to patients who do not need to stay overnight in a hospital. This could include doctor's visits, diagnostic tests, minor surgeries, and other medical procedures that can be performed in a clinic or outpatient facility.  
+The outpatient department benefit covers certain costs related to outpatient treatment. This includes:
+
+1. Physical Consultation: Visiting a doctor in person for medical advice.  
+2. Prescribed Diagnostics: Tests recommended by your doctor.  
+3. Prescribed Pharmacy: Discounts or coverage for prescribed medicines.  
+4. OPD Treatment: Minor medical procedures done at an outpatient facility.
+
+These services are only covered at specified network providers. However, ACKO’s retail won't cover costs for things like cosmetic treatments, routine check-ups, infertility treatments, experimental treatments, weight management programs, dental care (unless due to an accident), and more. 
+
+**3.4.6 Daily Hospital Cash (HospiCash)**  
+Daily Hospital Cash is a benefit where the insured receives a fixed amount of money for each day spent in the hospital due to illness or injury. This cash benefit is intended to help cover miscellaneous expenses incurred during the hospital stay, such as transportation, meals, and other incidental costs that may not be covered by the insurance plan. It provides financial assistance to policyholders to alleviate the financial burden associated with hospitalization.
+
+**3.4.7 Accidental Death or Disability Cover** 
+
+If you have this coverage, and if someone insured under the policy dies or becomes disabled due to an accident during the coverage period, the insurance will pay out. The payout depends on the severity of the injury and is a percentage of the sum insured. For example, if someone dies in an accident, the payout is 100% of the sum insured. If they lose both eyesight, both hands, or both feet, it's also 100%. There are different percentages for various injuries, like losing one eye or one hand, and even for specific finger or toe losses. The insurance also covers permanent disability that prevents the insured person from working.
+
+To get the payout for disability, the condition must last at least 180 days with no hope of improvement, confirmed by a medical certificate. If the disability isn't listed, medical advisors will assess it. The total payout cannot exceed the sum insured, and once it reaches 100%, the coverage ends for that person.
+
+Note: Limb means hand or foot; Physical separation means the limb is severed at or above the wrist or ankle.
+
+| Insured Event  | Percentage of the Sum Insured payable |
+| ----- | ----- |
+| 1\. Accidental death  | 100% |
+| 2\. Total and irrecoverable loss of sight in both eyes  | 100% |
+| 3\. Loss by physical separation or total and permanent loss of use of both hands or both feet  | 100% |
+| 4\. Loss by physical separation or total and permanent loss of use of one hand and one foot  | 100% |
+| 5\. Total and irrecoverable loss of sight in one eye and loss of a Limb  | 100% |
+
+| 6\. Total and irrecoverable loss of hearing in both ears and loss of one  Limb/ loss of sight in one eye  | 100% |
+| :---- | :---- |
+| 7\. Total and irrecoverable loss of hearing in both ears and loss of speech  | 100% |
+| 8\. Total and irrecoverable loss of speech and loss of one Limb/ loss of  sight in one eye  | 100% |
+| 9\. Permanent, total and absolute disability (not falling under any one the above) which results in the Insured Person being unable to engage  in any employment or occupation or business for remuneration or profit,  of any description whatsoever which results in Loss of Independent   | 100% |
+| 10\. Total and irrecoverable loss of sight in one eye  | 50% |
+| 11\. Loss of one hand or one foot  | 50% |
+| 12\. Loss of all toes \- any one foot  | 10% |
+| 13\. Loss of toe great \- any one foot  | 5% |
+| 14\. Loss of toes other than great, if more than one toe lost, each  | 2% |
+| 15\. Total and irrecoverable loss of hearing in both ears  | 50% |
+| 16\. Total and irrecoverable loss of hearing in one ear  | 15% |
+| 17\. Total and irrecoverable loss of speech  | 50% |
+| 18\. Loss of four fingers and thumb of one hand  | 40% |
+| 19\. Loss of four fingers  | 35% |
+| 20\. Loss of thumb- both phalanges  | 25% |
+| 21\. Loss of thumb- one phalanx  | 10% |
+| 22\. Loss of index finger-three phalanges  | 10% |
+| 23\. Loss of index finger-two phalanges  | 8% |
+| 24\. Loss of index finger-one phalanx  | 4% |
+| 25\. Loss of middle/ring/little finger-three phalanges  | 6% |
+| 26\. Loss of middle/ring/little finger-two phalanges  | 4% |
+| 27\. Loss of middle/ring/little finger-one phalanx  | 2% |
+
+3**.4.9 Value Added Services** 
+
+With this benefit, you'll get access to various health and wellness services to help you stay healthy. These include:
+
+1. e-Consultation: Chat or talk to a doctor online.  
+2. Wellness Coach: Get tips on weight management, fitness, nutrition, and more via email, blogs, or online platforms.  
+3. Lab Services (Home Collection): Have samples collected from home for tests.  
+4. Pharmacy (Home Delivery): Get prescribed medications delivered to your door.  
+5. Vital/Physical Activity Monitoring Services: Connect health devices to track your health online.  
+6. Reminder Notifications: Receive reminders for medical appointments and medication.  
+7. Medical Wallet: Store medical reports online securely.  
+8. Report Aggregation: Get analysis of your health reports.  
+9. Home Care Services: Access nursing, physiotherapy, and more at home if needed.  
+10. Ambulance Arrangement Services: Arrange for ambulance transport when needed.  
+11. Pick-up and Drop Services for Consultation: Get transportation to medical facilities.  
+12. Prioritizing Appointments: Get urgent appointments with healthcare providers.
+
+Remember, you might need to pay for some services and it's always best to consult your own doctor before using these services.
+
+**Standard Exclusions**  
+
+We shall not be liable to make any payment under this Policy caused by, arising out of or  attributable to any of the following. 
+
+**Pre-Existing Diseases (PED):**
+
+a. Treatment expenses for pre-existing diseases are excluded until a specified number of months of continuous coverage after the policy starts.
+
+b. If you increase the sum insured, the exclusion applies again for the increased portion.
+
+c. Continuous coverage reduces the waiting period as per IRDAI portability norms.
+
+d. Coverage after the waiting period is subject to declaration and acceptance of pre-existing diseases.
+
+**Specified Disease/Procedure Waiting Period:**
+
+a. Treatment for listed conditions is excluded for a specified number of months after the policy starts, unless due to an accident.
+
+b. Sum insured increase resets the waiting period.
+
+c. Longer waiting period between PED and specified diseases applies.  
+d. Waiting period applies even if the condition is declared later.
+
+**30-Day Waiting Period:**
+
+a. Treatment for any illness within 30 days of policy start is excluded for certain plans, except for accidents, unless continuous coverage exceeds twelve months.  
+b. This waiting period applies to the enhanced sum insured too.
+
+**Investigation & Evaluation:**
+
+a. Diagnostic admissions are excluded.  
+b. Only diagnostic expenses related to current treatment are covered.
+
+**Rest Cure, Rehabilitation, and Respite Care:**  
+a. Expenses for enforced bed rest, custodial care, and terminal illness care are excluded.
+
+**Obesity/Weight Control:**  
+Expenses for surgical treatment of obesity are covered only under specific conditions.
+
+**Change-of-Gender Treatments:**  
+Expenses for treatments to change characteristics of the body to the opposite sex are excluded.
+
+**Cosmetic or Plastic Surgery:**  
+Cosmetic surgeries are excluded unless for reconstruction following an accident, burn, or cancer.
+
+**Excluded Providers:**  
+Treatment from excluded providers is not covered, except for life-threatening situations or accidents up to stabilization.
+
+**Excluded Establishments:** Treatments in health hydros, nature cure clinics, and spas are excluded.
+
+**Dietary Supplements:**  
+Expenses for over-the-counter supplements are excluded unless prescribed as part of hospitalization.
+
+**Refractive Error:**  
+Treatment for refractive errors less than 7.5 dioptres is excluded.
+
+**Sterility and Infertility**  
+Expenses for contraception, assisted reproduction, gestational surrogacy, and sterilization reversal are excluded.
+
+**Maternity:**Treatment expenses related to childbirth, miscarriage, and lawful termination are excluded.
+
+**Specific Exclusions** 
+
+**Permanent Exclusions Set 1 (Can be Waived)**  
+
+1. Self-Inflicted Injury: No coverage for injuries caused deliberately by the insured person.  
+2. Breach of Law: Treatment costs from illegal activities are not covered.  
+3. HIV and AIDS: Treatment for HIV and AIDS is excluded.  
+4. Other Sexually Transmitted Diseases: Treatment for other STDs is not covered.  
+5. Hazardous or Adventure Sports: Costs related to professional participation in risky sports are excluded.  
+6. Unproven and Experimental Treatment: Expenses for treatments lacking medical evidence or approval are not covered.  
+7. Treatment Outside India: Except for specific cases, treatment abroad is not covered.  
+8. External Congenital Anomaly or Defects: Treatment for congenital defects is excluded.  
+9. Non-Allopathic or AYUSH Treatment: Costs for treatments outside of allopathic or AYUSH systems are not covered.  
+10. Specific Treatments: Various specific treatments and procedures are excluded unless specifically covered.  
+11. Sleep Disorders: Treatment for sleep-related conditions like sleep apnea is not covered.  
+12. Substance Abuse and Addictions: Costs related to drug or alcohol abuse and addiction treatment are excluded.  
+13. OPD Treatment: Outpatient consultations and tests are not covered unless specified as an add-on benefit or part of admitted claims for inpatient or daycare treatment.
+
+**Permanent Exclusions Set 2 (Cannot be Waived)**  
+
+1. Suicide: No coverage for injuries or death resulting from suicide.  
+2. Dental Treatment: Costs for dental treatments are excluded unless due to an accident.  
+3. Medically Unnecessary Treatment: Circumcision and cosmetic treatments are not covered.  
+4. Prosthetics and Devices: External devices and cochlear implants are excluded unless due to an accident.  
+5. War and Hazardous Situations: Injuries or illnesses from war, terrorism, or exposure to hazardous substances are not covered.  
+6. Hormonal Therapies: Growth hormone and other hormone therapies are excluded.  
+   
+
+**Permanent Exclusions for Personal Accident Add-on Benefit** 
+
+1. Pre-existing Conditions: No coverage for injuries or disabilities related to existing health conditions.  
+2. Multiple Claims: Only one claim per policy period is covered, except for specific benefits like emergency ambulance cover.  
+3. Self-Inflicted Harm: Injuries from suicide attempts or intentional self-harm are not covered.  
+4. War and Military Activities: Injuries from war, military operations, or participation in armed forces activities are excluded.  
+5. Sexually Transmitted Diseases: Injuries from sexually transmitted diseases are not covered.  
+6. Congenital Defects: Birth defects or anomalies are excluded.  
+7. Bacterial Infections: Except for pyogenic infections from accidental cuts, bacterial infections are excluded.  
+8. Medical Treatment: Injuries from medical or surgical treatments unrelated to accidents are not covered.  
+9. Hernia: Injuries from hernias are excluded from coverage.  
+10. Change in Profession: Any increase in risk due to a change in profession must be endorsed by the insurer.  
+11. Illegal Activities: Injuries from criminal activities or breaches of law are not covered.  
+12. Substance Abuse: Injuries from substance abuse or addiction are excluded.  
+13. Pregnancy-related Issues: Disabilities or deaths related to childbirth or pregnancy are not covered.  
+14. Flying Activities: Injuries from certain flying activities are excluded, except for commercial airline travel.  
+15. Risky Recreational Activities: Injuries from high-risk recreational activities are not covered.  
+16. Hazardous Work: Injuries from hazardous occupations or activities are excluded.  
+17. Radiation Exposure: Injuries from radiation or nuclear incidents are not covered.  
+18. Chemical and Biological Attacks: Injuries from chemical or biological attacks are excluded.  
+19. Policy-Specific Exclusions: Any condition or treatment specifically excluded in the policy is not covered.
+
+**Standard General Terms and Clauses**   
+Here's a friendly summary of the standard general terms and clauses:
+
+1. Disclosure of Information: If you don't tell the insurance company important information when you apply, they can cancel your policy and keep your money.  
+2. Condition Precedent: You must follow all the rules in the policy for the insurance company to pay for any claims.  
+3. Material Change: If anything important changes about your health, you need to tell the insurance company, and they might adjust your coverage or cost.  
+4. Records to be Maintained: Keep all your medical records and let the insurance company check them if needed for a claim.  
+5. Complete Discharge: If the insurance company pays you or your hospital for a claim, that's the end of their responsibility for that claim.  
+6. Notice and Communication: All policy-related communication should be in writing, sent to the company's address, or through specified electronic modes.  
+7. Territorial Limit: Your medical treatments must happen in India for the insurance to cover them.  
+8. Multiple Policies: If you have more than one insurance policy, you can choose which one to use for a claim. You can also use this policy to cover what the others don't.  
+9. Fraud: If you lie or cheat to get benefits from the insurance, they can cancel your policy and ask for their money back. But if you can prove you didn't mean to lie, they can't cancel it.
+
+**Cancellation** 
+
+* You can cancel the policy by giving written notice 7 days before. The refund depends on how much of the coverage period is left.  
+* If you cancel because of a misrepresentation or fraud, you won't get a refund.  
+* The insurance company can also cancel the policy with written notice if there's misrepresentation or fraud, with no refund.  
+* This table shows the refund percentages based on when you cancel the policy:  
+* If you cancel within the first 25% of the coverage period, you get back 60% of the premium.  
+* Cancelling between 25% and 50% of the coverage period gets you 40% back.  
+* For cancellations between 50% and 75% of the coverage period, you get 20% back.  
+* If you cancel after 75% of the coverage period, you won't receive any refund.
+
+**Automatic Change in Coverage:**
+
+* If someone covered by the policy passes away, their coverage ends, but others covered can still renew.  
+* If the sum insured and bonus are used up, the policy ends, but you can renew it.
+
+**Territorial Jurisdiction:**
+
+* Any disputes about the policy will be handled by Indian courts and Indian law.
+
+**Arbitration:**
+
+* If there's a disagreement about how much the insurance should pay, it can go to arbitration.  
+* The arbitration decision is necessary before taking legal action against the insurance company.
+
+**Migration:** You can switch this policy to another offered by the same company, with benefits like reduced waiting periods based on your previous coverage.
+
+1. **Renewal of Policy:** Your policy can usually be renewed unless there's been fraud or misrepresentation. You need to request renewal and pay before the policy ends. If you miss the renewal date, you have a grace period of 30 days, but coverage won't be active during this time.  
+2. **Premium Payment in Instalments:** If you're paying premiums in installments, you have a 15-day grace period to pay. Coverage won't be active during this grace period. If you don't pay within the grace period, the policy will be canceled.  
+3. **Possibility of Revision of Terms:** The insurance company can change policy terms and premium rates with approval, and they must notify you three months before any changes take effect.  
+4. **Free Look Period:** When you first get the policy, you have 30 days to review it. If you return it during this time and haven't made any claims, you'll get a refund.  
+5. **Endorsements (Changes or edits in Policy)**: Only the insurance company can modify the policy, and any changes will be documented. The policyholder can only be changed at renewal, except in cases of death or moving out of India.  
+6. **Change of Sum Insured**: You can change your sum insured at renewal or anytime with the company's approval. If you increase the sum insured, the waiting period starts again for the increased amount.  
+7. **Terms and Conditions of the Policy**: All terms and conditions in the policy document and schedule are part of the policy and should be read together.  
+8. **Nomination:** You need to nominate someone to receive the claim amount if you pass away. Any changes to the nomination must be communicated to the company in writing.
+
+**Specific Terms and Clauses** 
+
+1. Policy Changes: Any changes to the policy must be approved in writing by the insurance company by having a user wanting to edit policies consciously  
+2. Providing Information: You need to give all necessary written information to calculate premiums and process claims. You should also inform the insurer of any changes in insured persons.  
+3. Geographical Scope: The policy covers events in India unless specified otherwise. Premiums may vary based on your city of residence.  
+4. Premium Payment: Premium amount is specified in the schedule. You can pay it monthly, quarterly, half-yearly, or yearly.  
+5. Policy Parties: The policy involves you and the insurer only.  
+6. Currency: All payments under the policy will be in Indian Rupees.  
+   
+
+**Adding or Removing People from the Policy:**
+
+Adding: You can add someone to your insurance anytime during the policy year \- if we approve their application, they pay the premium, and we issue a new policy confirming their inclusion.
+
+Removing: You currently cannot remove someone from your insurance in the middle of your policy tenure currently. You have to wait upto 60 days before policy renewal to remove an individual where we will deduct it from your future premium payments, or else if you are within the 30-day free look period, you can cancel the policy to receive a full refund and repurchase it by excluding a member.
+
+**No Constructive Notice**  
+
+We won't consider any information ACKO or our officials have about you or the insured person as an official notice. This means just because we know something doesn't mean we'll act on it unless you tell us directly. You still need to disclose all relevant information, even if we already know about it.
+
+**5.2.9 Endorsements**  
+
+During the policy year, you can request changes to your policy, called endorsements. These changes can be either non-financial, meaning they don't affect the premium, or financial, which can alter the premium you pay. 
+
+Non-financial endorsements include correcting personal details like name, gender, or date of birth, updating contact information, or changing nominee details. 
+
+Financial endorsements involve actions like adding or removing insured persons, changing age or date of birth, or updating addresses that may affect the premium. Our underwriting team will review all endorsement requests, and they may ask for more information if needed.
+
+**Grace Period & Renewal:** You can renew the policy by paying the renewal premium before the coverage ends or within 30 days after expiry (grace period).
+
+**Our Right of Termination:** We can end the policy immediately if there's fraud or non-disclosure of important information by you. We'll notify you in writing. If you don't cooperate or pay premiums within the grace period, we may end the policy. In such cases, any ongoing treatment won't be covered, but we'll cover treatments that started before the policy ended. Cover for an individual will end if they stop paying premiums, the policy ends, they pass away, or they're no longer a dependent.
+
+**Portability**  
+
+You can move your health insurance to another company. If you've had continuous coverage without any breaks under a health insurance plan in India, you'll keep benefits like reduced waiting periods. When you leave your job or group, you can switch to a similar policy we offer, maintaining your benefits. You need to apply for this switch at least 30 days before switching. 
+
+**Underwriting Loadings & Discounts:** We might adjust your premium based on your health status and medical history declared at enrollment. These adjustments start from the beginning of your policy and apply to renewals too. We'll let you know about any changes, and you'll have seven working days to respond. If you don't, we'll cancel your application and refund your premium.
+
+**Operation of Policy & Policy Schedule:** Your policy lasts for the duration mentioned in the schedule. It starts on the Risk Commencement Date and ends on the coverage expiry date.
+
+**Other Terms And Conditions** 
+
+Claims Procedure: You have two options for making a claim,
+
+1. Reimbursement Claim: You have to payout of your own pocket first, post which you can submit your expenses directly to ACKO for reimbursement.  
+2. Cashless Claim:  This allows your insurance company to pay the hospital directly instead of you having to pay first and then get reimbursed. You can use your policy at any of our network hospitals for cashless treatment. You can find the list of network hospitals on our app, website, or by contacting customer service.
+
+Claims Conditions:
+
+* Submit all required documents on time to receive your payout.  
+* If you miss the deadline, we might not be able to pay your claim, but exceptions can be made if you had a valid reason.  
+* You agree to cooperate with us and allow our representatives to review your medical records.  
+* In some cases, a medical examination may be required before we approve your claim, and we'll cover the cost.
+
+Claim Registration process:
+
+* Notify ACKO directly through the app, email, or call center, or through our partners (TPA) at the hospital cashless desk.  
+* Inform us about planned hospitalizations at least 3 days in advance or within 48 hours of emergency hospitalization to avoid claim denial.  
+* When opting for cashless treatment, provide your policy card, photo ID proof, and address proof.  
+* When filing a claim, provide details like your policy number, insured person's name, hospital details, and nature of the medical issue.
+
+
+**6.1.3 Cashless claims process**  
+
+Cashless Claims Process: This allows your insurance company to pay the hospital directly instead of you having to pay first and then get reimbursed. Here's how it works:
+
+Pre-Authorization Process:
+
+* Planned Hospitalization: Notify the network hospital at least 3 days before admission. They'll send a pre-authorization request to your insurer.  
+* Emergency Hospitalization: Notify the hospital within 48 hours of admission. The hospital may start treatment while awaiting approval.  
+* If the treatment cost exceeds the authorized limit, the hospital can request an increase.  
+* Any changes during hospitalization require a fresh authorization.
+
+Discharge Process:
+
+* At discharge, the hospital sends the final bill and discharge summary to the insurer.  
+* After receiving final authorization, you can leave the hospital.
+
+Submission of Claim Documents:
+
+* The hospital sends all claim documents to the insurer within 15 days of discharge.  
+* Required documents include pre-authorization request, approval letter, and others specified by the insurer.
+
+Notes:
+
+* Cashless facility covers only medical expenses for covered illnesses or injuries at network hospitals.  
+* You may still have to pay for non-admissible expenses, expenses above specified limits, co-payments, or deductibles directly to the hospital.  
+* If cashless facility is denied, you'll need to pay for treatment and then submit a reimbursement claim.  
+    
+  **6.1.4 Claim Reimbursement Process**  
+
+If you've opted for reimbursement of medical expenses, here's what you need to do:
+
+1\. Gather Documents:
+
+* Fill out and sign the claim form.  
+* Provide original discharge summary and original hospital bill with a detailed breakdown of charges.  
+* Include original payment receipts for hospital and pharmacy expenses.  
+* Attach copies of all laboratory and test reports, medical prescriptions, and any FIR/MLC certificate for accident claims.  
+* Complete the NEFT Mandate form for reimbursement.  
+* Provide a copy of your Aadhaar card or any other government photo ID and PAN Card.  
+* Depending on the type of claim, additional documents may be required, such as a certificate from the treating doctor for domiciliary treatment claims.
+
+2\. Submit Documents:
+
+* Send all the necessary claim documents to our branch or head office within 15 days of discharge from the hospital.  
+* You can obtain the claim form from any of our branch offices or download it from our website.
+
+Additional Notes:
+
+* For Accidental Death or Disability Cover claims, additional documents like an attested copy of the death certificate, FIR/Panchanama, post-mortem report, and disability certificate may be required.  
+* We may request additional documents or information if needed for further investigation.  
+* If there's a delay in notifying or submitting the claim, provide a written explanation for the delay. We'll consider condoning the delay if it's beyond your control.
+
+Here below is a simplified breakdown of how we handle claims once they are submitted to us:
+
+Scrutiny of Claim Documents:
+
+* We'll review your claim form and documents.  
+* If any documents are missing or incomplete, we'll inform you and provide reminders.  
+* In some cases, we may deduct the claim amount for incomplete documents and settle the claim if it's otherwise valid.  
+* For reimbursement claims received after pre-authorization, we'll check if the pre-authorization has been utilized and if all dues are settled with the hospital.
+
+Claim Assessment:
+
+* We'll pay fixed or indemnity amounts as specified in the policy.  
+* Claims will be assessed based on any applicable sub-limits, deductibles, and co-payments.  
+* Payment will be made according to the type of claim and benefits covered under the policy.
+
+Claims Investigation:
+
+* We'll settle or reject claims within 30 days of receiving all necessary documents.  
+* Claims requiring investigation will be settled within 30 days from the start of the investigation.  
+* Pre and post-hospitalization expenses will be covered based on the merit of the claim.
+
+Pre and Post-Hospitalization Claims:
+
+* Submit post-hospitalization claim documents within 15 days of completion.  
+* Claims for pre and post-hospitalization will be processed based on received documents.
+
+Settlement and Repudiation:
+
+* Claims will be settled within 30 days of receiving all necessary documents.  
+* In case of delay, interest will be paid at a specified rate.  
+* You can represent a rejected claim for reconsideration within 15 days.
+
+Claim Payment Terms:
+
+* Claims will not be paid once the applicable sum insured is exhausted.  
+* Payments will be made in India and in Indian rupees.  
+* Sum insured will be reduced by the amount paid under the policy.  
+* Relapse within 45 days of discharge will be considered part of the same claim.
+
+For cashless claims, payment goes directly to the network provider. For reimbursements, payment is made to the insured person or nominee in case of death.
+
+**6.2 Discounts**   
+Existing Customer Discount:
+
+We offer a discount on the policy premium to our existing customers as a discretionary benefit. The discount amount is specified in the policy schedule.
+
+Note:
+
+* The definition of existing customers.  
+* The extent of discount offered.  
+* The ongoing continuation of discount at renewal.
+
+These aspects are subject to periodic revisions at Acko's discretion.
+
+**Grievance Redressal Mechanism**
+
+1) If you or the insured person specifically want to raise a grievance formally, you can reach out to us through:  
+* Website: [www.acko.com](http://www.acko.com/)  
+* Email: [email protected]  
+* Toll-Free Number: 1860 266 2256  
+* Courier: Any of our branch offices or corporate office during business hours. You can also approach the grievance cell at any of ACKO’s branches from Monday to Friday.
+
+2) If you're not satisfied ACKO’s response, you can escalate the matter to our Grievance Officer:  
+   Grievance Redressal Officer  
+   Acko General Insurance Limited  
+   2nd Floor, \#36/5, Hustlehub One East, Somasandrapalya,  
+   27th Main Rd, Sector 2, HSR Layout,  
+   Bengaluru, Karnataka \- 560102  
+   [email protected]  
+3) If the response from the Grievance Officer is still unsatisfactory, you may register a complaint with the Integrated Grievance Management System (IGMS) of the IRDAI.
+
+4) If the grievance still remains unresolved, you may approach the Insurance Ombudsman. Details of the Insurance Ombudsman for different regions are available below:
+
+1. Ahmedabad:  
+   Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad – 380 001\.  
+   Tel.: 079 \- 25501201/02/05/06  
+   Email: [email protected]  
+2. Bengaluru:  
+   Jeevan Soudha Building, PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078\.  
+   Tel.: 080 \- 26652048 / 26652049  
+   Email: [email protected]  
+3. Bhopal:  
+   Janak Vihar Complex, 6, Malviya Nagar, Bhopal(M.P.)-462 003\.  
+   Tel.: 0755-2769201/9202  
+   Fax: 0755-2769203  
+   Email: [email protected]  
+4. Bhubaneshwar:  
+   62, Forest Park, Bhubaneshwar 751 009\.  
+   Tel.: 0674 \- 2596461 / 2596455  
+   Fax: 0674-2596429  
+   Email: [email protected]  
+5. Chandigarh:  
+   S.C.O. No.101-103, 2nd Floor, Batra Building, Sector 17-D, Chandigarh-160017.  
+   Tel.: 0172-2706468/2706196  
+   Fax: 0172-2708274  
+   Email: [email protected]  
+6. Chennai:  
+   Fathima Akhtar Court, 4th Floor, 453 (old 312), Anna Salai, Teynampet, Chennai-600 018\.  
+   Tel.: 044-24333668 / 24335284  
+   Fax: 044-24333664  
+   Email: [email protected]  
+7. Delhi:  
+   2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi-110 002\.  
+   Tel.: 011 \- 23232481 / 23213504  
+   Fax: 011-23230858  
+   Email: [email protected]  
+8. Guwahati:  
+   "Jeevan Nivesh", 5th Floor, S.S. Road, Guwahati-781 001\.  
+   Tel.: 0361-2132204/5  
+   Fax : 0361-2732937  
+   Email: [email protected]  
+9. Hyderabad:  
+   6-2-46, 1st Floor, Moin Court, A.C. Guards, Lakdi-Ka-Pool, Hyderabad-500 004\.  
+   Tel: 040-65504123/23312122  
+   Fax: 040-23376599  
+   Email: [email protected]  
+10. Jaipur:  
+    Ground Floor, Jeevan Nidhi II, Bhawani Singh Road, Jaipur – 302005  
+    Tel: 0141-2740363  
+    Email: [email protected]  
+11. Ernakulam:  
+    2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M.G. Road, Ernakulam-682 015\.  
+    Tel: 0484-2358759/2359338  
+    Fax: 0484-2359336  
+    Email: [email protected]  
+12. Kolkata:  
+    Hindustan Building. Annexe, 4th Floor, C.R. Avenue, Kolkata-700 072\.  
+    Tel.: 033 \- 22124339 / 22124340  
+    Fax: 033-22124341  
+    Email: [email protected]  
+13. Lucknow:  
+    6th Floor, Jeevan Bhawan, Phase-2, Nawal Kishore Road, Hazaratganj, Lucknow-226 001\.  
+    Tel: 0522 \-2231331/2231330  
+    Fax: 0522-2231310  
+    Email: [email protected]  
+14. Mumbai:  
+    3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W), Mumbai 400054\.  
+    Tel: 022-26106960/26106552  
+    Fax: 022-26106052  
+    Email: [email protected]  
+15. Pune:  
+    3rd Floor, Jeevan Darshan Bldg, C.T.S. No.s. 195 to 198, N.C. Kelkar Road,Narayanpeth, Pune – 411030\.  
+    Tel: 020-41312555  
+    Email: [email protected]  
+16. Noida:  
+    4th Floor, Bhagwan Sahai Palace,Main Road, Naya Bans, Sector-15, Distt: Gautam Buddh Nagar – 201301\.  
+    Tel: 0120- 2514250/52/53  
+    Email: [email protected]  
+17. Patna:  
+    1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna – 800006\.  
+    Tel No: 0612-2680952  
+    Email: [email protected]
+
+You can find the updated details of Insurance Ombudsman offices on the IRDAI website [www.irdai.gov.in](http://www.irdai.gov.in/), or on the website of the Governing Body of Insurance Council [www.ecoi.co.in](http://www.ecoi.co.in/), or on our company's website at [www.acko.com](http://www.acko.com/).  

policy_analyser/data/health_super_topup.md

@@ -0,0 +1,5 @@
+**Super Top-up** 
+
+A super top-up plan provides additional coverage on top of your existing health insurance policy. It acts as a safety net against high medical costs without having to pay a hefty premium for very high coverage under your main policy.
+
+It has a deductible limit, let's say Rs. 5 lakhs. If your total medical expenses in a year exceed this deductible, which your main policy covers, the super top-up kicks in to cover the remaining expenses. For example, if your medical bills are Rs. 8 lakhs and your main policy covers Rs. 5 lakhs, the super top-up will cover the additional Rs. 3 lakhs.

policy_analyser/data/policy_analyser_entities.csv

@@ -0,0 +1,31 @@
+entityId,entityName,entityDesc,expectedOutputFormat
+0,Sum Insured (SI),"Total amount insured, if any, upto which the policy covers the customer. Extract if mentioned or present in document.",float
+1,Pre-existing diseases (PED) Waiting period ,"Period after which pre existing diseases are covered by the insurer for the given customer. Consider today's date mentioned previously to evaluate the period left. If the waiting period is exhausted considering today's date, specify its value as 0. Extract if mentioned or present in document.",number of months in float
+2,30-Day Waiting Period,Is the customer insured in the first 30 days after policy start date? Consider today's date mentioned previously to evaluate whether the period is valid or not. Extract if mentioned or present in document.,true/false
+3,Specific Illness Waiting Period,Period after which specific illnesses are insured by the policy for the given customer. Consider today's date mentioned previously to evaluate the period left. Extract if mentioned or present in document.,number of months in float
+4,Maternity waiting period,Period after which the given customer can claim insurance for maternity treatments and reasons like pregnancy. Consider today's date mentioned previously to evaluate the period left. Extract if mentioned or present in document.,number of months in float
+5,Exclusions,Certain diseases and conditions that are not covered by the insurer for the given customer. Separate the several exclusions with comma in a JSON list. Extract if mentioned or present in document.,string
+6,Maternity benefits,Does the given customer get any benefits from the insurance policy for maternity related procedures and illnesses? Extract if mentioned or present in document.,true/false
+7,OPD,"Amount that covers outpatient consultations like physician visits, medicines, etc for the customer. Extract if mentioned or present in document.",float
+8,Copay,Percentage of total bill that the customer would have to pay themselves. Extract if mentioned or present in document.,float
+9,Deductible,Amount above which the Sum Insured can be claimed in case of super topup. Extract if mentioned or present in document.,float
+10,Daycare treatment,Daycare treatments and procedures where hospitalization may be required for <24 hours. Separate multiple treatments with comma in a JSON list. Extract if mentioned or present in document.,string
+11,Free Health checkup,Are full body health checkups consisting of certain pathology tests covered? Extract if mentioned or present in document.,true/false
+12,Restoration benefit,Is Sum Insured restored after it gets exhausted for the given customer? Extract if mentioned or present in document.,true/false
+13,Sublimits,"Max limit of total coverage amount that is mandated to be claimed for certain diseases to the given customer. Extract all sublimits as JSON list of dictionaries of following schema: [{""Sublimit Name"": ""Name of disease"", ""Sublimit Value"": Value of sublimit in float}].
+Extract if mentioned or present in document.",float
+14,Room rent limit (proportionate deduction),"The upper limit in percentage of total sum insured, on the hospital room rent (proportionate deduction if applicable based on room rent eligibility). Extract if mentioned or present in document.",float or string
+15,Pre & Post Hospitalization,Are medical expenses leading to and after hospitalization covered by insurer for given customer? Extract if mentioned or present in document.,true/false
+16,Domiciliary Cover,Is home treatment is covered by the insurer for the given customer? Extract if mentioned or present in document.,true/false
+17,No claim bonus,Increase in Sum Insured as bonus if the customer has not claimed any insurance in the past. Extract if mentioned or present in document.,float
+18,Ambulance cover,Amount covered for ambulance transport. Extract if mentioned or present in document.,float
+19,International coverage,Are treatments administered outside India covered by insurer for the given customer? Extract if mentioned or present in document.,true/false
+20,Dental treatment,Amount covered for dental treatments and procedures. Extract if mentioned or present in document.,float
+21,AYUSH treatment,"Are Ayurvedic, Homeopathic or other alternative treatments covered by insurer for given customer? Extract if mentioned or present in document.",true/false
+22,Health incentives,Are benefits for healthy habits offered to the given customer? Extract if mentioned or present in document.,true/false
+23,Wellness Services,Are complementary services and benefits offered to the given customer? Extract if mentioned or present in document.,true/false
+24,Consumables/ Non medical expenses,"Are expenses related to consumables like syringes, bandages, etc in the course of treatment convered for the given customer? Extract if mentioned or present in document.",true/false
+25,Hospital Cash,Are amounts reimbursed to the customer that they have paid to the hospital? Extract if mentioned or present in document.,true/false
+26,Policy Holder's Details,"Details of primary policy holder as a JSON dictionary of the following schema : {""Name"": ""Name of primary policy holder as a string"", ""Age"": ""Age of primary policy holder in float"", ""Date of birth"": ""Date of birth of primary policy holder in dd/mm/yyyy format"", ""Address"": ""Residential address of primary policy holder"", ""Email Address"": ""Email address of primary policy holder"", ""Phone Number"": ""Phone number of primary policy holder in integer or string"", ""PAN Card Number"": ""Permanent Account Number (PAN Number) of primary policy holder"", ""City"": ""City of residence of primary policy holder""}",JSON dictionary
+27,Policy Details,"Details of the policy issued to customer as a JSON dictionary of the following schema : {""Insurance Company Name"": ""Name of the insurance company that has issued the given insurance policy"", ""Policy Name"": ""Name of the given insurance policy as string"", ""Policy Number"": ""Policy number of the given insurance policy"", ""Issue Date"": ""Date on which the policy was issued to the policy holder in dd/mm/yyy format"", ""Start Date"": ""Date on which policy activated in dd/mm/yyyy format"", ""Expiry Date"": ""Date on which policy expires in dd/mm/yyyy format"", ""Renewal Date"": ""Date on which policy was renewed in dd/mm/yyyy format""}",JSON dictionary
+28,Insured Persons details,"Details of insured persons as a JSON list of dictionaries of the following schema : [{""Name"": ""Name of Insured person"", ""Age"": ""Age of Insured person in float"", ""Date of birth"": ""Date of birth of Insured person in dd/mm/yyyy format"", ""Gender"": ""Gender of Insured person, one of [Male, Female, Other]"", ""Relation"": ""Relationship of Insured person with policy holder"", ""Pre-existing Diseases"": ""Pre-existing diseases that Insured person has. Separate several diseases with comma in JSON list""}]",JSON list

policy_analyser/prompts/analysis.txt

@@ -4,6 +4,7 @@ Apply the following rules enclosed in triple backticks on the policy to analyse
 Make sure you are consider values for analysis factors on basis of customer's selected insurance plan when multiple plans are described in the policy terms.
 Make sure all factors appear in one of Good, Average or Bad only. No factor should be repeated in more than 1 verdict table.
 Note : Top cities = [Mumbai, Delhi, Bangalore, Chennai, Hyderabad, Gurgaon, Pune]
+Parameters : ["Sum Insured", "Adults", "Children", "Is Top City", "Room Rent Limit", "Deductible", "Sublimits", "Copay", "PED Waiting Period", "Thirty Day Waiting Period", "Specific Illness Waiting Period", "Maternity Benefits"]
 ```
 {{rules}}
 ```

policy_analyser/prompts/health/rules.txt

@@ -1,3 +1,7 @@
+IF Insured_Address_City in Top_Cities:
+    Is_Top_City = true
+ELSE:
+    Is_Top_City = false
 IF Adults == 1:
     IF Is_Top_City:
         IF Sum_Insured >= 2500000: