Terms and Conditions

1. Introduction and Scope

These Terms and Conditions govern access to and use of the digital platforms, websites, mobile applications, customer portals, WhatsApp servicing channels, chatbots, AI-enabled tools, microsites, application programming interfaces, web applications and other customer-facing digital interfaces made available by Prudential HCL Health Insurance Limited, a company incorporated in India having CIN: U65120MH2025FLC457866 and registered office at Suite 6, 48th Floor, Commerz III, International Business Park, Oberoi Garden City, Off Western Express Highway, Goregaon (East), Mumbai - 400063, referred to in these Terms as “PHI”, “we”, “us” or “our”. By accessing or using any PHI Digital Platform, you agree to be bound by these Terms, the applicable product terms, proposal form, policy wording, benefit illustration, customer information sheet, privacy notice, consent notices, payment terms and any additional terms displayed or accepted through the relevant channel.

These Terms apply to PHI’s corporate website, Buy Online insurance purchase journey, PruServices customer self-service portal, PHI mobile application or health app, PHI WhatsApp servicing platform, AI-enabled chatbot, virtual assistant and automated digital assistance tools, and any present or future digital channel introduced by PHI. If there is any inconsistency between these Terms and the terms of an issued insurance policy, the policy wording, schedule, endorsements and applicable regulatory requirements will prevail for matters relating to insurance coverage, benefits, exclusions, waiting periods, claims and policyholder rights.

2. Regulatory and Legal Context

PHI is a health insurer operating in India and its digital services are intended to be used in accordance with applicable Indian laws, including insurance, data protection, information technology, consumer protection, contract, anti-money laundering, cybersecurity and sectoral regulatory requirements. PHI may update its processes, disclosures, platform features and customer journeys from time to time to reflect changes in law, regulatory guidance, technology, business operations, risk controls and customer servicing requirements.

3. Definitions

In these Terms, unless the context requires otherwise: “Account” means a user profile or login created or used to access PHI Digital Platforms. “Digital Platforms” means all customer-facing digital channels operated, enabled or made available by PHI. “Policy” means an insurance policy issued by PHI. “User”, “you” or “your” means any person accessing or using the Digital Platforms, including prospects, applicants, policyholders, insured persons, nominees, beneficiaries, customers, agents where applicable, authorised representatives and guest users. “AI Systems” means AI-enabled chatbots, WhatsApp AI chatbots, conversational AI tools, generative AI systems, virtual assistants, automated recommendation engines, intelligent search tools, decision-support tools and other automated digital assistance features deployed by or for PHI. “Third Party Services” means services, platforms, devices, integrations, payment gateways, banking channels, hospitals, TPAs, health partners, analytics tools, communication providers, cloud services or other third-party systems used in connection with the Digital Platforms.

4. Acceptance, Eligibility and User Responsibility

By accessing, browsing, registering, logging in, submitting information, making a payment, accepting an electronic communication, using OTP authentication, using any AI-enabled chatbot or virtual assistant, raising a service request or otherwise using a PHI Digital Platform, you confirm that you have read, understood and accepted these Terms. You must be legally competent to contract under Indian law. If you act on behalf of another person, you represent that you are duly authorised to do so and that the information you provide is true, complete and accurate.

Only persons who are legally competent to enter into a binding contract under applicable law may register for, access, use or transact on PHI Digital Platforms, including to apply for, purchase or obtain insurance products. Where any person on whose behalf the Digital Platform is used, including an intended insured person, beneficiary, life assured or user, is a minor or is otherwise not legally capable of acting independently under applicable law, all registrations, applications, declarations, consents, acknowledgements, acceptances of these Terms and purchases of insurance products must be made by such person’s parent, legal guardian or other duly authorised representative acting on their behalf. This clause applies only where the relevant person does not have legal capacity to undertake such actions independently under applicable law and should not be read as implying that all persons with disabilities lack legal capacity.

You are responsible for maintaining the confidentiality of your login credentials, device access, OTPs, passwords, registered mobile number, email account and authentication information. Any activity conducted through your credentials or registered device may be treated as authorised by you unless PHI is notified of unauthorised use in accordance with its prescribed process. You must not share OTPs, passwords or sensitive account information with any person claiming to represent PHI unless you have verified the authenticity of the request through official PHI channels.

You are responsible for making all arrangements necessary to access the Digital Platforms, including internet connectivity, compatible devices, software, security settings and telecommunications services. You are also responsible for ensuring that any person who accesses a PHI Digital Platform through your device, connection, credentials or account is aware of these Terms and complies with them.

5. Accuracy of Information, Proposal Submission and Misrepresentation

You must provide accurate, complete, current and truthful information when using PHI Digital Platforms, including while generating quotes, submitting proposal forms, completing KYC, making declarations, updating contact details, raising service requests, submitting claim-related information or using health and wellness features. Insurance contracts are based on disclosures made by the proposer, insured person and other relevant persons. Any suppression, misstatement, misrepresentation, impersonation, fraud, false declaration or failure to disclose material information may affect underwriting, policy issuance, premium calculation, claim assessment, policy servicing, cancellation, rejection of proposal, repudiation of claim or other remedies available to PHI under applicable law and policy terms.

6. Buy Online, Quotes, Premiums and Policy Issuance

The Buy Online journey may allow you to browse products, compare options, generate premium illustrations, obtain indicative quotations, submit proposal forms, complete KYC, provide declarations, make payments, receive policy documents and renew policies. Any quote, premium illustration or product comparison generated through a Digital Platform is indicative and subject to underwriting, eligibility, accurate disclosures, risk assessment, KYC, payment realisation, applicable taxes, product availability, policy terms, regulatory requirements and PHI’s internal processes.

Submission of a proposal form or payment of premium does not automatically result in policy issuance or coverage commencement. PHI may request additional information, medical records, declarations, verification, health checks or documents. PHI may accept the proposal, issue the policy with applicable terms, defer the decision, apply underwriting conditions, loadings or exclusions where permitted, or reject the proposal in accordance with applicable law and regulatory requirements. Coverage begins only from the effective date stated in the policy schedule or as otherwise expressly confirmed by PHI.

7. KYC, AML, Sanctions and Verification

You agree to provide all information and documents required for know-your-customer verification, anti-money laundering checks, sanctions screening, politically exposed person screening, fraud prevention, regulatory reporting and other due diligence requirements. PHI may verify your identity, contact details, payment information, declarations and documents through internal systems, third-party service providers, government databases, authorised agencies, payment partners or other lawful sources. PHI may suspend or restrict access, decline transactions, delay issuance or take other appropriate steps where verification is incomplete, inconsistent, suspicious or legally restricted.

8. Customer Servicing, Claims and Digital Records

PHI Digital Platforms may allow you to access policy documents, download certificates, renew policies, update contact details, raise service requests, track requests, submit claim-related information, communicate with PHI, access FAQs and receive notifications. Digital servicing features are provided for convenience and do not alter the terms of any policy, the claim process, documentation requirements, admissibility assessment, exclusions, sub-limits, waiting periods or other policy conditions. Claims are assessed strictly in accordance with the applicable policy wording, schedule, endorsements, regulatory requirements and information available to PHI.

Electronic records, timestamps, system logs, OTP validations, consent records, IP information, device information, payment confirmations, communication records and digital acceptance records maintained by PHI or its service providers may be used for verification, audit, compliance, dispute resolution, fraud prevention, customer servicing and evidentiary purposes, subject to applicable law.

9. WhatsApp, SMS, Email, Push Notifications and Contact Centre Communications

PHI may communicate with you through WhatsApp, SMS, email, push notifications, in-app messages, telephone calls, contact centre channels, chat interfaces and other electronic modes for service, transactional, regulatory, security, renewal, claim, payment, consent, grievance, educational, promotional or informational purposes, subject to applicable law and your communication preferences, including consent and opt-out choices where required. Communications sent to your registered contact details may be treated as delivered unless PHI receives a delivery failure or other contrary system indication.

WhatsApp and other third-party communication channels involve external platforms and telecommunication networks. Responses on WhatsApp, chat interfaces or similar channels may be automated, AI-assisted or generated through chatbot or virtual assistant tools. You acknowledge that messages may be subject to network delays, platform limitations, device settings, internet availability, message previews, shared device risks and third-party terms. You should not use WhatsApp, chat or similar channels for emergencies or urgent medical assistance.

10. Health App, Wellness and Fitness Features

The PHI health app may include wellness features, fitness tracking, step counting, health challenges, BMI calculators, health scores, educational content, preventive health information, goal tracking, reward mechanisms, wellness journeys, Google Fit integration, Apple Health or Apple Fitness integration, wearable integrations, guest access and future health management capabilities. These features are provided for general wellness, engagement and informational purposes only. They do not constitute medical advice, clinical advice, diagnosis, treatment, prescription, healthcare recommendation, emergency assistance or a substitute for consultation with qualified healthcare professionals.

Health scores, BMI values, step counts, activity data, goals, rewards and similar outputs may depend on user inputs, device sensors, third-party platforms, wearable accuracy, software versions, internet connectivity, permissions and data synchronisation. PHI does not guarantee that such outputs are complete, accurate, medically validated, suitable for your health condition or available at all times. You should consult a qualified healthcare professional before making any health, fitness, diet, treatment or lifestyle decision, especially if you have a medical condition, are pregnant, are undergoing treatment or experience symptoms.

11. Rewards, Challenges and Engagement Programmes

PHI may introduce rewards, wellness points, engagement programmes, challenges, badges, incentives, discounts, vouchers or similar benefits. Such programmes may be subject to additional terms, eligibility criteria, validity periods, usage conditions, partner availability, regulatory requirements and PHI’s discretion. Rewards are not guaranteed unless expressly confirmed by PHI and may be modified, withdrawn, suspended or discontinued. Participation in a wellness or rewards programme does not guarantee policy issuance, claim approval, premium reduction, medical benefit or health outcome.

12. AI-Enabled Chatbots, Virtual Assistants and Automated Digital Assistance

PHI may deploy AI-enabled chatbots, WhatsApp AI chatbots, conversational AI tools, generative AI systems, virtual servicing assistants, automated recommendation engines, decision-support tools, intelligent search tools and other automated digital assistance features. You acknowledge that certain responses, summaries, prompts, recommendations or outputs may be generated automatically using artificial intelligence and may not always be complete, accurate, current or suitable for your specific circumstances.

AI outputs do not constitute medical advice, clinical advice, healthcare advice, insurance advice, underwriting decisions, claim decisions, financial advice, legal advice or any binding commitment by PHI. AI outputs, chatbot responses or virtual assistant responses are provided for general assistance only and do not override the policy wording, policy schedule, endorsements, benefit illustration, customer information sheet, proposal form, official communications issued by PHI, or any decision formally communicated by PHI. You should independently verify important information through official PHI documents, authorised representatives or qualified professionals before acting on it. PHI may monitor, review, record, analyse and improve AI interactions for service quality, safety, compliance, fraud prevention, analytics, model tuning, customer experience and system improvement, subject to applicable law, privacy obligations and consent requirements where applicable.

PHI may modify, restrict, suspend or discontinue AI features at any time. You must not input unnecessary sensitive information, confidential third-party information, unlawful content, abusive content, medical emergencies or instructions intended to manipulate, test, reverse engineer or misuse AI Systems. PHI may use permitted information, de-identified data, aggregated data, feedback and interaction metadata for quality monitoring, analytics, safety testing and service improvement in accordance with applicable law and its privacy notices.

13. Website Content, Educational Material and No Professional Advice

Content on PHI Digital Platforms may include product information, FAQs, educational articles, wellness content, calculators, promotional material, advertisements, blog posts, explainers and general information. Some content may be provided by or based on information received from third parties. Such content is provided for convenience and awareness only, may be changed or updated without notice, and should not be treated as medical, clinical, legal, tax, financial, investment, insurance or other professional advice. While PHI takes reasonable care in making information available, PHI does not guarantee its accuracy, completeness, timeliness or suitability. You should independently verify important information before acting on it. Product benefits, exclusions, premiums, waiting periods, claim conditions and policyholder rights are governed by the applicable policy documents and regulatory requirements.

14. No Emergency Services

PHI Digital Platforms, including the health app, WhatsApp services, AI-enabled chatbots and virtual assistance tools, are not emergency medical services. If you believe you are experiencing a medical emergency, you should immediately contact emergency services, visit the nearest hospital or consult a qualified medical practitioner. PHI is not responsible for delays, errors or consequences arising from reliance on Digital Platforms for emergency assistance.

15. Payments, Refunds and Third-Party Payment Gateways

Premium payments, renewals and other permitted payments may be processed through banks, card networks, UPI, wallets, payment aggregators, payment gateways, payment orchestration service providers or other authorised payment systems. Payments are subject to successful authorisation, settlement, reconciliation, applicable taxes, payment partner terms and PHI’s confirmation. Third-party payment and payment orchestration providers may have their own terms, privacy notices, refund processes, dispute processes, security practices and transaction limits, which you should review and comply with where applicable. PHI is not responsible for failures, delays, reversals, declines, duplicate debits or technical issues attributable to banks, payment systems, networks or third-party providers, though PHI may assist in reconciliation where reasonably possible.

Refunds, cancellations, free-look cancellations, premium adjustments and charge reversals will be handled in accordance with applicable law, policy terms, regulatory requirements, payment partner processes and PHI’s internal procedures.

16. Privacy Policy, Cookies and Data Protection

PHI processes personal data in accordance with applicable data protection laws, consent notices, privacy notices and PHI’s separate Privacy Policy, which also incorporates PHI’s cookie-related disclosures and practices. The Privacy Policy explains how PHI collects, uses, stores, shares, protects and otherwise processes personal data, including in connection with Digital Platforms, cookies, tracking technologies, analytics, platform security, customer communications, wellness features and AI-enabled services.

Please refer to PHI’s Privacy Policy here: Privacy Policy Your use of the Digital Platforms may also be subject to specific consent notices, privacy notices or preference choices presented at the relevant point of collection or use.

Nothing in these Terms limits any rights you may have under applicable data protection laws or PHI’s Privacy Policy. If you withdraw consent or exercise other privacy rights, PHI’s ability to provide certain Digital Platform features, policy servicing, claims support, communications or other services may be affected where the relevant processing is necessary.

17. Third-Party Platforms, Partners and External Links

PHI may use or integrate with third-party platforms and service providers, including payment gateways, payment orchestration service providers, banks, card networks, UPI providers, TPAs, hospitals, diagnostic providers, wellness partners, cloud providers, communication service providers, messaging platforms, analytics providers, identity verification providers, Google Fit, Apple Health or Apple Fitness, wearable device providers and other technology partners. Third Party Services may be governed by their own separate terms, privacy notices, cookie notices, acceptable use policies, permissions, technical requirements and operating procedures. You should review and understand the applicable third-party terms and policies before using such services or authorising access through them. PHI does not control all third-party systems and is not responsible for their independent acts, omissions, downtime, accuracy, availability, security incidents or content except to the extent required under applicable law or contractual obligations.

Links to external websites or third-party resources are provided for convenience only and do not imply endorsement unless expressly stated. You should review the applicable terms and privacy notices before using third-party platforms or sharing information with them.

18. Prohibited Activities

You must not misuse PHI Digital Platforms. Prohibited activities include unauthorised access, impersonation, fraud, false declarations, submission of forged documents, interference with platform security, reverse engineering, scraping, automated extraction, malware introduction, denial-of-service activity, unauthorised use of APIs, infringement of intellectual property, uploading or sharing content that belongs to another person without authority, unlawful content, obscene, sexually explicit, indecent or otherwise inappropriate content, content harmful to minors, abusive or harassing content, phishing, social engineering, attempts to bypass authentication, misuse of AI Systems, or any activity that violates applicable law, PHI policies or third-party rights.

PHI may suspend, restrict or terminate access to Digital Platforms, decline transactions, investigate activity, report suspected misconduct to authorities, preserve records or take legal action where it reasonably believes that a user has violated these Terms, applicable law, platform security requirements or PHI’s legitimate business interests.

19. Availability, Maintenance and Cybersecurity

PHI will endeavour to maintain reasonable availability, security and functionality of its Digital Platforms. However, platforms may be unavailable, delayed, interrupted, degraded or restricted due to scheduled maintenance, emergency maintenance, system upgrades, technical failures, bugs, viruses, cyber incidents, internet outages, third-party downtime, force majeure events, regulatory directions, security controls or operational reasons. PHI does not guarantee uninterrupted, error-free, virus-free or fully secure access to Digital Platforms.

You are responsible for using updated devices, secure networks, genuine software, anti-malware tools and safe digital practices. PHI is not responsible for losses arising from compromised devices, shared devices, weak passwords, user negligence, phishing, unauthorised disclosure of OTPs, insecure networks or third-party malware.

You must not knowingly introduce viruses, trojans, worms, logic bombs, malicious code or technologically harmful material, attempt to gain unauthorised access to any PHI system, server, database or connected system, or attack any Digital Platform through a denial-of-service or distributed denial-of-service attack. PHI may report suspected cyber misuse, unlawful access or technology offences to appropriate law enforcement or regulatory authorities and may cooperate with such authorities in accordance with applicable law. In such cases, your right to access or use the relevant Digital Platform may cease immediately.

20. Intellectual Property and User Content

All rights in PHI Digital Platforms, content, design, software, text, graphics, logos, marks, trade names, product names, interfaces, databases, workflows, documentation, AI prompts, outputs curated by PHI and other materials are owned by or licensed to PHI and are protected by applicable intellectual property laws. You are granted a limited, revocable, non-exclusive, non-transferable licence to access and use the Digital Platforms for lawful personal or authorised purposes in accordance with these Terms. Unless expressly prohibited by PHI, you may print or download reasonable portions of website content for your personal, non-commercial use, provided that all proprietary notices, disclaimers and restrictions are retained. All other use, reproduction, modification, distribution or commercial exploitation is prohibited without prior written permission.

If you submit feedback, suggestions, ideas, reviews, comments, documents, images or other content through a Digital Platform, you represent that you have the right to do so and grant PHI a lawful, worldwide, royalty-free licence to use, reproduce, process, store, analyse, display, adapt and act upon such content for servicing, operations, compliance, analytics, platform improvement, dispute resolution and other lawful business purposes, subject to applicable privacy obligations.

21. Disclaimers and Limitation of Liability

To the maximum extent permitted by applicable law, PHI Digital Platforms are provided on an “as is” and “as available” basis. PHI disclaims all warranties not expressly provided by law or contract, including implied warranties of accuracy, completeness, merchantability, fitness for a particular purpose, uninterrupted availability, non-infringement and error-free operation. PHI does not warrant that digital content, AI outputs, wellness data, device integrations, third-party data, calculators, premium illustrations or platform results will be complete, accurate, current, reliable or suitable for your personal circumstances.

To the maximum extent permitted by law, PHI will not be liable for indirect, incidental, special, punitive, exemplary, remote or consequential damages, loss of profit, loss of opportunity, loss of data, loss of goodwill, business interruption, device damage, third-party failure, unauthorised access due to user negligence, or reliance on non-binding digital content, wellness outputs or AI-generated responses. Nothing in these Terms excludes or limits liability for fraud, fraudulent misrepresentation, death or personal injury caused by negligence, any liability that cannot be excluded or limited under applicable law, or statutory rights of policyholders under applicable insurance regulations.

22. Indemnity

You agree to indemnify and hold harmless PHI, its directors, officers, employees, agents, affiliates, service providers and representatives from and against claims, losses, liabilities, damages, penalties, costs and expenses arising from your breach of these Terms, misuse of Digital Platforms, reliance on health-related, wellness or educational content contrary to these Terms, unauthorised access, fraud, misrepresentation, violation of law, infringement of third-party rights, misuse of AI Systems, submission of false or unlawful content, or unauthorised actions taken through your account, device or credentials.

23. Changes to Services, Future Functionality and Beta Features

PHI may introduce, modify, enhance, restrict, suspend, migrate or discontinue any Digital Platform, product journey, servicing feature, wellness capability, AI feature, integration, communication channel, API, mobile app feature or beta functionality at any time. Future or beta features may be experimental, limited, incomplete, subject to change and governed by additional terms. Continued use of the relevant platform after changes are published or notified constitutes acceptance of the updated terms, unless a separate consent or acceptance is required by law.

PHI reserves the right to vary, amend or replace these Terms at any time by publishing the updated version on the relevant Digital Platform or otherwise notifying users where required. You are advised to review these Terms periodically. Your continued access to or use of any Digital Platform after updated Terms are published or notified will be treated as acceptance of the updated Terms, unless a separate consent or acceptance is required by applicable law.

24. Prudential Name and Brand Disclaimer

Prudential HCL Health Insurance Limited is a joint venture company owned in part by an indirect subsidiary of Prudential plc of the United Kingdom. Prudential HCL Health Insurance Limited and Prudential plc are not affiliated in any manner with Prudential Financial, Inc., a company whose principal place of business is in the United States of America, or with The Prudential Assurance Company Limited, a subsidiary of M&G plc, a company incorporated in the United Kingdom.

25. HCL Name and Brand Disclaimer

Prudential HCL Health Insurance Limited uses the “HCL” name and related brand references pursuant to appropriate rights, permissions or arrangements. Unless expressly stated otherwise, any reference to “HCL” in connection with PHI is intended only to identify PHI’s association with the HCL group as a shareholder, promoter, joint venture participant or strategic partner, as applicable. PHI is a separate legal entity and is solely responsible for its insurance products, digital platforms, customer services, policy servicing, claims processes and obligations. No HCL group company, affiliate, associate, promoter entity, director, officer or employee shall be deemed to be an insurer, insurance intermediary, guarantor, underwriter or provider of PHI’s insurance products or services solely by reason of the use of the HCL name, brand or association, unless expressly required under applicable law or specifically stated in writing.

26. Grievance Redressal and Complaints

You may raise service complaints, policy-related complaints, claims grievances, digital platform issues, privacy complaints or concerns relating to AI-enabled chatbot or virtual assistance features through the grievance channels specified by PHI on its official website, policy documents, privacy notices or customer communications. PHI may designate grievance officers, nodal officers, data protection contacts or other responsible personnel as required under applicable law. If you are dissatisfied with PHI’s response, you may use escalation mechanisms available under applicable insurance, consumer protection or data protection frameworks, including relevant regulatory complaint channels where applicable.

27. Force Majeure

PHI will not be responsible for failure or delay in performance caused by events beyond its reasonable control, including natural disasters, epidemics, pandemics, acts of government, regulatory directions, war, terrorism, civil unrest, labour disruptions, power failures, internet outages, cyberattacks, third-party platform failures, payment network disruptions, cloud service outages or other force majeure events.

28. Governing Law and Jurisdiction

These Terms are governed by the laws of India. Subject to applicable statutory remedies and regulatory complaint mechanisms available to policyholders and customers, the courts at Mumbai, Maharashtra shall have jurisdiction over disputes arising from or relating to these Terms, PHI Digital Platforms or related digital services.

29. Severability, Entire Agreement and Survival

If any provision of these Terms is found invalid, unlawful or unenforceable, the remaining provisions will continue in effect to the maximum extent permitted by law. These Terms, together with applicable policy documents, product terms, proposal forms, privacy notices, consent notices and additional channel-specific terms, constitute the agreement governing your use of PHI Digital Platforms. Provisions relating to intellectual property, privacy, records, disclaimers, limitation of liability, indemnity, governing law, jurisdiction and dispute resolution will survive termination or discontinuation of access.