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    HDFC ERGO General Insurance Company Limited

    Uploaded by

    Dhanush Chauhan
    1) This document is a policy schedule from HDFC ERGO General Insurance Company confirming a Health Insurance policy for Mr. Karthick R with policy number 2825100780711201000. 2) The policy provides coverage for Mr. Karthick R, his wife Divya S, and son Jai Niithun K. It lists the basic sum insured, cumulative bonus amount, and tier level for each insured person. 3) The policy schedule outlines the sections covered, including hospitalization expenses, pre-and-post hospitalization costs, day care procedures, domiciliary treatment, and other optional covers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    HDFC ERGO General Insurance Company Limited

    Uploaded by

    Dhanush Chauhan
    90 views3 pages
    1) This document is a policy schedule from HDFC ERGO General Insurance Company confirming a Health Insurance policy for Mr. Karthick R with policy number 2825100780711201000. 2) The policy provides coverage for Mr. Karthick R, his wife Divya S, and son Jai Niithun K. It lists the basic sum insured, cumulative bonus amount, and tier level for each insured person. 3) The policy schedule outlines the sections covered, including hospitalization expenses, pre-and-post hospitalization costs, day care procedures, domiciliary treatment, and other optional covers.

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    Health insurance

    Original Title

    2825100780711201000

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    © © All Rights Reserved

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    1) This document is a policy schedule from HDFC ERGO General Insurance Company confirming a Health Insurance policy for Mr. Karthick R with policy number 2825100780711201000. 2) The policy provides coverage for Mr. Karthick R, his wife Divya S, and son Jai Niithun K. It lists the basic sum insured, cumulative bonus amount, and tier level for each insured person. 3) The policy schedule outlines the sections covered, including hospitalization expenses, pre-and-post hospitalization costs, day care procedures, domiciliary treatment, and other optional covers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    90 views3 pages

    HDFC ERGO General Insurance Company Limited

    Uploaded by

    Dhanush Chauhan
    1) This document is a policy schedule from HDFC ERGO General Insurance Company confirming a Health Insurance policy for Mr. Karthick R with policy number 2825100780711201000. 2) The policy provides coverage for Mr. Karthick R, his wife Divya S, and son Jai Niithun K. It lists the basic sum insured, cumulative bonus amount, and tier level for each insured person. 3) The policy schedule outlines the sections covered, including hospitalization expenses, pre-and-post hospitalization costs, day care procedures, domiciliary treatment, and other optional covers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    HDFC ERGO General Insurance Company Limited 2825100780711201000

    2825100780711201000

    2825

    Dear Mr KARTHICK R
    DO NO 553 24TH STREET GKM.COLONY PERIYAR
    NAGA
    --
    CHENNAI, TAMIL NADU, 600082
    Contact No. 9941256856

    Date :11/05/2021

    Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
    Your Health insurance policy reference no 2825100780711201000 i s confirmed on the basis of the information and declaration given by you.The details of coverage are
    mentioned in the enclosed policy schedule of insurance.

    As a measure of our customer convenience we have implemented a Lifetime Validity Health Card. For you, this simply means that your Health Card is valid for all subsequent
    renewals and as long as your policy is active with us. Hence, you need not replace your health card every year.

    We value your relationship with us and assure you our best services at all times and we look forward to serve you.
    Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!"

    For HDFC ERGO General Insurance Company Ltd.

    Vivek Rasgotra
    Senior Vice President Operations and Services Group

    HDFC ERGO General Insurance Company Limited


    TAX CERTIFICATE

    Dear Karthick R,

    Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986

    This is to certify that we have received an amount of ` 12,766.00 towards premium for Policy No. 2825100780711201000 issued to KARTHICK R for the
    period 11/05/2021 to 10/05/2022.
    Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
    Deduction under Section 80D can be claimed only on payment of the premium. In case where all the installment are not paid, the deduction to be claimed under section 80D will be
    restricted to the proportion of the premium actually paid.In case of free look cancellation or otherwise, the benefit under this section would be nullified or prorated, as applicable.
    For HDFC ERGO General Insurance Company Ltd.

    Date : 06/05/2021
    Policy Issuing Office: Mumbai
    Duly Constituted Attorney

    HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN:HDFHLIP21473V052021. Customer Service Address: D 301, 3rd Floor,
    CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
    165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
    HDFC ERGO General Insurance Company Limited 2825100780711201000
    Policy Schedule
    my:health Suraksha Policy
    ( Silver Smart )

    2825100780711201000

    Policy No. : 2825 1007 8071 1201 000 Issuance Date : 06/05/2021
    Period of Insurance : From 11/05/2021 00:01 hrs To 10/05/2022 Midnight
    Invoice No. : 100780711201000 Premium Frequency : Single
    Proposer Name : Mr Karthick R Policy Type : Family
    Mr KARTHICK R HSN Code : 997133 PAN No.
    DO NO 553 24TH STREET GKM.COLONY PERIYAR NAGA - - Customer Id : 100931585122
    CHENNAI, TAMIL NADU- 600082
    Contact No : 9941256856

    EIA No. : Not provided


    Payment Details : 90221050692133 , Bank Name :BizDirect
    Email ID : [email protected]
    my:health Suraksha - Insured Person’s Details & Sum Insured
    Insured's Name Relation with Gender DOB Nominee Name Nominee 1st Policy Basic Sum Tier CB Amount Pre Existing
    policy holder Relationship Inception Insured (`) (`) Disease
    Karthick R Self Male 09/05/1989 Divya S SPOUSE 11/05/2020 400000 2 Tier 40000 No
    Divya S Wife Female 20/01/1990 Karthick R SPOUSE 11/05/2020 No
    Jai Niithun K Dependent Son Male 23/09/2015 Karthick R SPOUSE 11/05/2020 No
    Schedule of Coverage
    Section Covers Details/ Applicability of Sum Insured Limit
    Base Covers
    A Hospitalization Cover up to Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
    Medical Expenses Basic Sum Insured and CB
    1B Mental Healthcare Basic Sum Insured and CB
    2 Home Healthcare Basic Sum Insured and CB
    3 Domiciliary Hospitalization Basic Sum Insured and CB
    4 Pre-Hospitalization 60 Days
    5 Post-Hospitalization 180 Days
    6 Day Care Procedures Basic Sum Insured and CB
    7 Road Ambulance cover Sub limited within the Basic Sum Insured including SI 1 to 5 L -2,000
    Cumulative Bonus SI 6 to 50 L -3,500
    SI Above 50 L -15,000
    8 Organ Donor Expenses upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
    9 Alternative Treatment upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
    C1 Preventive Health Check Up -Booster over and above the Basic Sum Insured Covered Up to 1% of Basic Sum Insured max
    upto Rs 5,000, on every renewal
    C5 Recovery Benefit over and above the Basic Sum Insured 5000
    C6 Sum Insured Rebound over and above the Basic Sum Insured Upto 100% of Basic Sum Insured
    C11 Waiting Period Modification Option Reduction in the standard waiting period as opted for 3 Years
    Renewal Benefits
    1 Cumulative Bonus Applicable
    2 my:health Active Applicable
    Waiting Periods
    Sec E 1 i - General waiting period - 30 days from Policy inception date
    Section A Hospitalization Cover Sec E 1 ii - Listed illness & procedures - 24 Months
    Sec E 1 iii - Preexisting conditions - 36 Months
    Premium Details (`)
    Basic Premium 10819.10
    Medical U/W Loading + 0
    Total Premium (Insured) excluding Tax 10819.00
    Integrated Tax 18% 1947.00
    Total Premium (Including Taxes) 12766.00

    For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
    The policy is valid subject to payment received by us. If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft,
    vide Receipt/Challan noCSD/362/2020/1302 dated 20/03/2020 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018;. GST Registration No:
    27AABCL5045N1Z8 .GST for this invoice is not payable under reverse charge basis.

    Branch :leela business park, 6th flr, andheri - kurla rd, mumbai
    For HDFC ERGO General Insurance Company Ltd.

    Duly Constituted Attorney

    "For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

    HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN:HDFHLIP21473V052021. Customer Service Address: D 301, 3rd Floor,
    CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
    165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
    HDFC ERGO General Insurance Company Limited 2825100780711201000

    HDFC ERGO General Insurance Company Limited 3


    Policy No.:2825100780711201000 This card is for identification purpose only.
    Valid From: 11/05/2021 Renewal Date: 10 May
    Card has to be presented to the Network Service Provider at the time of admission/ availing
    Insured Name Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
    Karthick R 09/05/1989 Male with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
    Divya S 20/01/1990 Female service. For more details and updated list of Network Service Provider please refer our website or
    Jai Niithun K 23/09/2015 Male call our call centre. This card is valid till the time policy is active.

    Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234


    Fax Number : 1860 2000 600
    Email : [email protected]
    Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th floor,
    Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
    Website : www.hdfcergo.com

    HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN:HDFHLIP21473V052021. Customer Service Address: D 301, 3rd Floor,
    CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
    165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com

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