HDFC ERGO General Insurance Company Limited

Sil
2828100075549200000

Date : 26/08/2015
Dear MR ARUN KHUSHAL GADE
MR. ARUN KHUSHAL GADE NEAR RAJIV GANDHI
Smarak makde nagar Dist. bhandara
BHANDARA, MAHARASHTRA, 441912
Contact No. 8390491340

We thank you for trusting HDFC ERGO General Insurance. Enclosed herewith is your insurance policy which has been confirmed on
the basis of the information and declaration given by you.
Product Name
Health Suraksha Policy

Policy No.

Sum Insured (`)

2828100075549200000

As per the attached policy

schedule

Premium (`)
(Inclusive of Service Tax)
5681

The insurance policy enclosed herewith represents a written agreement confirming the terms of the cover agreed as per the declaration
given by you.
To ensure seamless & hassle-free services, we request you to kindly check your contact and other details on your policy schedule on the
basis of which the insurance is issued. In case of any discrepancy please call our toll free 1800 2 700 700.
For any further assistance on your policy or to know more about our other products, please free to contact us. We once again thank you
for choosing HDFC ERGO and heartily welcome you to our growing family.
For HDFC ERGO General Insurance Company Ltd.

Karan Chopra
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited

Dear Arun Khushal Gade,

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 ` 5,681.00 (RUPEES FIVE THOUSAND SIX HUNDRED EIGHTY-ONE
AND ZERO PAISE Only) towards premium for Health Suraksha Insurance Policy, Policy No. 2828100075549200000 issued
to ARUN KHUSHAL GADE for the period 26/08/2015 to 25/08/2016.
Note:
1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this
declaration the liability shall be upon the policy holder.
Date : 26/08/2015

For HDFC ERGO General Insurance Company Ltd.

Policy Issuing Office: Mumbai

Duly Constituted Attorney

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri
(E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com

HDFC ERGO General Insurance Company Limited

2828100075549200000

POLICY SCHEDULE

Policy No. 2828 1000 7554 9200 000

Health Suraksha Policy
SILVER PLAN
Proposer Name
Correspondence
Address

MR. ARUN KHUSHAL GADE

MR. ARUN KHUSHAL GADE NEAR RAJIV GANDHI Smarak
makde nagar Dist. bhandara
BHANDARA,MAHARASHTRA,441912

Permanent
Address

Premium Frequency
Yearly
MR. ARUN KHUSHAL GADE NEAR RAJIV GANDHI Smarak
makde nagar Dist. bhandara
BHANDARA,MAHARASHTRA,441912

2828
0

Mobile

8390491340

Phone

Period of Insurance

E Mail

From Date & Time

AMJADSHARE@YAHOO.CO.IN

26/08/2015 20:39 hrs

Policy Type

To Date & Time

Individual
25/08/2016 Midnight

Insured Persons Details & Sum Insured

Insured's Name
Arun Khushal Gade
Sum Insured (`)

Relationship

Date of Birth

Self

01/07/1975

Member ID

Sum Insured (`)

400000

CB Amount (`)

400,000.00

CB Amount (`)

Pre Existing
Disease

0.00

In case of increase in the Sum Insured at renewal, waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.
Nominee Name

HEMALATA

Relationship to Policyholder

Spouse

The nominee must be an immediate relative of the Insured Person. For all other insured person(s), the Policyholder shall be the nominee.

Coverage Details
Coverage
In-Patient Treatment

Details
Covered

Pre-hospitalization (days)

60

Post-hospitalization (days)

90

Day Care Procedures

Covered

Domiciliary Treatment

Covered

Coverage
Organ Donor
Emergency Ambulance Limit per
hospitalisation
Ayurveda/Unani/Sidha/Homeopathy
Health Check Up Per Family (Post 4
Claims Free Years)

Details
Covered
Upto Rs. 2000
Covered
Upto 1% Sum Insured,Maximum Upto Rs
5000

The Policy Wording attached herewith includes all the standard coverages offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in
this Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our toll free number.
Subject to the conditions laid down in the Policy, on completion of each four consecutive policy years with us, the eligible Insured Person(s), included in each policy year is/are entitled for a medical checkup benefit
up to an amount equals to 1% of sum insured or Rs 5000/- whichever is less.

Premium Details (`)

Insured 1 - Arun Khushal Gade
Basic Premium
Loading
Service Tax
Total Premium (Including Service Tax)

4983.00
000.00
698.00
5681.00

Payment Details
Cheque No./DD/Fund Transfer
HI1508007685

Date

Bank Name

26/08/2015

BizDirect

Special Conditions

Exclusions

List of Endorsements
Endt No

Description

Effective Date

For Claim Services

Phone

Address

HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.

1860 2000 700 / 1800 2001 999

Fax no.

1860 2000 600

For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to

E-mail

healthclaims@hdfcergo.com

www.hdfcergo.com

If the premium is not realised the policy shall be void from inception.
Consolidatedstamp duty for this Insurance Policy i s paid by Demand Draft, vide Receipt/Challan no 1275186201516 dated 02/07/2015 as prescribed in Government Notification Revenue and Forest Department
No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004.

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri
(E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com

HDFC ERGO General Insurance Company Limited

POLICY SCHEDULE

2828100075549200000

Policy No. 2828 1000 7554 9200 000

Health Suraksha Policy
SILVER PLAN
Policy Issuing Office: Mumbai

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri
(E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com

HDFC ERGO ID : 2828100075549200000

DOB

: 01/07/1975

Valid From

: 26/08/2015 to 25/08/2016

Gender : Male

---------------------------------Fold Here------------------------------

Member Name : Arun Khushal Gade

HDFC ERGO General Insurance Company Limited

This card is for identification purpose only.
Card has to be presented to the Network Service Provider at the time of admission availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
with the policy terms & conditions. Card does not guarantee cashless hospitalization o r any other
services. For more details and updated list of network service provider please refer our website o r
call our call center.
Phone Number : 1860 2000 700 / 1800 2001 999
Fax Number : 1860 2000 600
: HDFC ERGO General Insurance Company Ltd. 5th floor, Tower
Address
1, Steller IT Park, C-25, Sector-62,Noida-201301.
: www.hdfcergo.com
Website

HDFC ERGO General Insurance Company Limited

Frequently Asked Question's (FAQ's) - Health Suraksha Policy
WHAT IS THIS PLAN ALL ABOUT

WHAT IS NOT COVERED IN THE HEALTH SURAKSHA POLICY

HDFC ERGO Health Suraksha is a comprehensive health insurance plan which covers your
medical expenses incurred due to hospitalization involving more than 24 hours. The plan also
covers your pre and post hospitalization expenses, day care procedures, domiciliary treatment,
organ donor expenses, emergency ambulance and non-allopathic treatments.

Exclusions valid for the first 30 Days

Any illness contracted within 30 days of the inception date of the Policy, except those that are
incurred as a result of an accident. This clause is not applicable on the subsequent renewals.

WHY DO I NEED HEALTH CARD?

The health card is an identification of a valid policy holder of the company. To avail cashless claim
service at network hospitals you need to present this health card at the time of hospitalization. You
need to register your claim by calling the contact numbers as mentioned on health card. You can
also call these numbers for queries, clarifications and for seeking any kind of assistance
pertaining to disease or related hospitalization.
Note: Even under family floater plan each member will be issued an individual health card which
will be a part of the policy dispatch kit. You must carry a photo id proof of the patient while
hospitalizing enabling authentication of health card.
HOW DO I INCREASE MY COVERAGE i.e. SUM INSURED?
You can increase the Sum Insured at the time of renewal. Such request has to be placed atleast 15
days in advance of policy expiry. We are sorry to inform you that mid term changes in the Sum
Insured are not possible.
HOW DO I STOP AUTO RENEWAL OF MY POLICY?
Please SMS ''STOP<policy number>'' to 9999700700 from your registered mobile number. You
will receive a confirmatory communication from us once the request is processed.

Exclusions valid for the first 2 years (waiting period)#

Cataract; fissuers &/or fistula in anus, hemorrhoids/piles; hernia, hydrocele; gastric and duodenal
erosions & ulcers; deviated nasal septum; all types of skin and all internal tumors/ cysts/ nodules/
polyps of any kind, including breast lumps, unless malignant; joint replacement, unless due to
accident; sinusitis and related disorders; stone in the urinary and biliary systems; surgery on
tonsils, adenoids and sinuses; dialysis required for chronic renal failure; benign prostatic
hypertrophy; arthritis, gout, rheumatism and spinal disorders; varicose veins/ varicose ulcers etc.
If the policy is renewed with us for two consecutive years, the above diseases/ illness/ ailments
will be covered from the third year, unless pre-existing.
Exclusions valid for the first 4 years (Pre-existing disease/ injury)
Any illness/ disease/ injury existing before the inception of the policy. However, this exclusion
ceases to apply if the policy is renewed with the Company for 4 consecutive years.
General exclusions
Pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related
treatment; expenses arising from hiv or aids and related diseases, use or misuse of liquor
intoxicating substances or drugs as well as intentional self injury; war, civil war or breach of law;
naturopathy treatment, acupressure, acupuncture, magnetic and other such therapies; treatment
taken outside the country; vaccination including inoculation and immunizations; experimental,
investigational or unproven treatments; external congenital disease etc.
# for details, kindly refer to policy wordings.

WHAT IS IPO (INSURANCE PORTFOLIO ORGANIZER)?

DO I GET INCOME TAX BENEFIT?

IPO is an online insurance portfolio account of the customer. You can create your portfolio by
creating your login id and password under Insurance Portfolio Organizer section on our portal,
www.hdfcergo.com You can manage your insurance portfolio on your mobile phone also through
the IPO Mobile Application. The IPO Mobile Application is supported on the mobile platforms Blackberry (OS version 5, 6, 7 & 10), Android (version 2.3 & above), iPhone (iOS 5 & above),
Windows 7 & 8.

Yes, you can avail a tax benefit under Section 80D of Income Tax Act 1961 (Subject to change in
Income Tax law). Tax certificate is provided along with the policy copy. You can mail the same on
your registered email id through IPO, online insurance portfolio organizer.

WHOM DO I NEED TO CONTACT TO MAKE CHANGES OR

CORRECTIONS IN MY POLICY

HOW TO REGISTER/ TRACK MY CLAIM STATUS?

Kindly mention your claim number and/ or policy/ reference number in the correspondence.
Above numbers can be dialed for queries pertaining to hospitalisation, critical illness, cashless
facility and authentication of health cards.

1.You can send duly signed request via any of the below options:

Fax : 022-66383669

Email : care@hdfcergo.com

Visit our nearest branch in your city

Post/courier : Customer service office at Andheri (East) in Mumbai.

2.Call toll free 1800 2 700 700 (Accessible from India only) for assistance (from your registered
mobile number) Please mention your policy number, correspondence address and contact
numbers in the communication.
Note: Supporting documents may be asked for such corrections whereby change of premium
amount is involved or otherwise in the policy on case to case basis.
WOULD I RECEIVE ANY CONFIRMATION ON THE CHANGES DONE
IN MY POLICY?

WHOM SHOULD I SEND THE CLAIM DOCUMENTS TO?

Duly signed claim form (available on website) with necessary supporting documents and
original bills are to be sent to the below address via courier.
HDFC ERGO General Insurance Company Limited
Stellar IT Park Tower - 1, 5th Floor, C - 25, Sector - 62, Noida - 201 301, Uttar Pradesh.

You will receive an endorsed policy schedule reflecting the changes made in the policy details on
your correspondence address as provided & mentioned in the policy. Same would be captured in
the policy under the section List of Endorsements. You can view/print the endorsed policy
schedule on IPO, the online insurance portfolio organizer. Visit www.hdfcergo.com for the same.
WHAT IS THE RENEWAL BENEFIT FOR
HEALTH SURAKSHA POLICY?

HOW DO I RENEW MY POLICY?

You can renew your policy via any of the below options:
a. Visit www.hdfcergo.com to renew instantly online
b. SMS "RENEW <POLICY NO>" to 9999 700700 ( from your registered mobile number)
c. Visit our nearest branch or contact your agent
d. Send a copy of the renewal notice along with premium cheque to our branch office or
Customer service office
e. Call toll-free 1800 2 700 700 (Accessible from India only)
f. Email to care@hdfcergo.com

Manage Your Portfolio

@ hdfcergo.com /
Smartphones*

1. On every claim free year, a cumulative bonus of 5% of the Basic Sum Insured is applied to the
policy (upto a maximum of 50% of the basic sum insured)
2. After every continuous (without a break) 4 claim free years; in every fifth year a free health
check-up upto a cost of 1% of the Basic Sum Insured (not exceeding Rs. 5000) shall be offered
as a renewal benefit

Add/View your policies

Register motor / health claims

Track your claim status online

* supports smart phone based on Blackberry, iPhone, Windows 8 & Android platform.

Change your personal details on the go

Track your interactions on endorsement dispatch status

Find branches, garages and cashless network hospitals

Download IPO mobile application from IPO website post log in

This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.

Ver.Aug14

You can track your claim status from any of the below options:

Call toll free : 1800 2 700 700 (Accessible from India only)

Fax : 1860 2000 600

Email : healthclaims@hdfcergo.com

Visit IPO: Login into online Insurance Portfolio Organiser (IPO) on the home page of our
website, www.hdfcergo.com