HDFC ERGO General Insurance Company Limited

Sil

2825100207112402000

MR VIPIN KUMAR
77 Tf Mu-2 Block A Affordable House Greater Noida
GHAZIABAD, 201310
UTTAR PRADESH
Contact No : 9911602984

Date : 12/06/2019

We have secured your health last year and we are happy to have the privilege of serving you again this year as well.

Your Health insurance policy reference no 2825100207112402000 has been renewed successfully.

For your convenience we have implemented a Lifetime Validity Health Card. For you,this simply means that the Health card issued at the time of first
policy purchase is valid throughout and as long as your policy is active with us.

We look forward to serving you in future and wish you a safe and secure year ahead.

For HDFC ERGO General Insurance Company Ltd.

Ankur Bahorey
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited

Dear Vipin Kumar,

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 ` 15,518.00 (RUPEES FIFTEEN THOUSAND FIVE HUNDRED EIGHTEEN AND ZERO PAISE Only)
towards premium for Health Suraksha Insurance Policy, policy no. 2825100207112402000 issued to VIPIN KUMAR for the period 12/06/2019 to 11/06/2020.

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.
For HDFC ERGO General Insurance Company Ltd.
Date : 12/06/2019
Policy Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) UIN : HDFHLIP10001V020910 | IRDAI Reg No.146 | CIN : U66030MH2007PLC177117
Registered & Corporate Office: Customer Service Address: Customer Service no : 022 - 6234 6234 / 0120 - 6234 6234
1st Floor, HDFC House, 165/166 Backbay Reclamation, D 301, 3rd Floor, Eastern Business District (Magnet Mall), Telephone: 022 6638 3600 Fax : 022 6638 3699
H.T.Parekh Marg, Mumbai - 400 020 LBS Marg, Bhandup (West), Mumbai - 400 078 Email : care@hdfcergo.com
HDFC ERGO General Insurance Company Limited 2825100207112402000
POLICY SCHEDULE Health Suraksha Policy
SILVER PLAN

Policy Details
Policy No. 2825 1002 0711 2402 000 Premium Frequency Yearly
Period of From 12/06/2019 10:20 hrs Policy Type Family Floater
Insurance To 11/06/2020 Midnight PAN BGEPK0186L 0

2825100207112402000 Issuance Date 12/06/2019

MR VIPIN KUMAR Customer Id:1016426733030001
77 Tf Mu-2 Block A Affordable House Greater Noida Proposer Name MR VIPIN KUMAR
GHAZIABAD
UTTAR PRADESH, 201310
Contact No : 9911602984
Email ID : VIPIN2010SHARMA@GMAIL.COM

Insured Person’s Details & Sum Insured

Insured's Name Relation with Gender Date of Nominee Name Nominee 1st Policy Sum Insured CB Amount Pre Existing
policy holder Birth Relationship Inception (`) (`) Disease
Om Praksh Sharma Father Male 01/01/1964 VIPIN KUMAR Child 12/06/2017 300000 60000 NA
Kanti Devi Mother Female 01/01/1968 12/06/2017 NA

Coverage Details
Coverage Details Coverage Details
In-Patient Treatment Covered Pre-hospitalization (days) 60
Post-hospitalization (days) 90 Day Care Procedures Covered
Domiciliary Treatment Covered Organ Donor Covered
Emergency Ambulance Limit per hospitalisation Upto Rs. 2000 Ayurveda/Unani/Sidha/Homeopathy Covered
Health Check Up Per Family (Post 4 Claims Free Upto 1% Sum Insured,Maximum 10% of Sum Insured; Maximum
Enhanced Cumulative Bonus
Years) Upto Rs 5000 100%
Regain Benefit 100% of basic Sum Insured
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 (`)

Basic Premium 11121.00
Enhanced Cumulative Bonus(Loading) 278.03
Regain Benefit(Loading) 556.05
Total Premium excluding Taxes 11955.08
Loading 1195.51
Integrated Tax 18% 2367.00
Total Premium 15518.00

Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1906007294 11/06/2019 HDFC BANK LTD

Special Conditions
Age proof/identity proof will be collected in event of claim under the policy.
PED for Mrs Kanti Devi- Dyslipidaemia & related complications

Invoice No. 100207112402000 HSN Code 9971

For Claim Services Phone 022 - 6234 6234 / 0120 - 6234 6234 Fax no 1860 2000 600 Email healthclaims@hdfcergo.com
Processing Centre HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.
For any other query call 022 - 6234 6234 / 0120 - 6234 6234 (Accessible from India only) or email us at care@hdfcergo.com or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
" The stamp duty of ` 0.50 paid by Demand Draft, vide Receipt/Challan no. CSD/36/2019/2289/19 dated 27/05/2019 as prescribed in Government of Maharashtra Order
No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". . Goods & Services Tax Registration No: 27AABCL5045N1Z8. Goods and Services Tax for this invoice is
not payable under reverse charge basis.
Branch :LEELA BUSINESS PARK, 6TH FLR, ANDHERI - KURLA RD, MUMBAI, 400059. Phone No. :+91-22-66383600
*1* *1*

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) UIN : HDFHLIP10001V020910 | IRDAI Reg No.146 | CIN : U66030MH2007PLC177117
Registered & Corporate Office: Customer Service Address: Customer Service no : 022 - 6234 6234 / 0120 - 6234 6234
1st Floor, HDFC House, 165/166 Backbay Reclamation, D 301, 3rd Floor, Eastern Business District (Magnet Mall), Telephone: 022 6638 3600 Fax : 022 6638 3699
H.T.Parekh Marg, Mumbai - 400 020 LBS Marg, Bhandup (West), Mumbai - 400 078 Email : care@hdfcergo.com
 HDFC ERGO General Insurance Company Limited 2
Policy No.:2825100207112402000 This card is for identification purpose only.
Valid From: 12/06/2019 Renewal Date: 11 June
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
Insured Name Date Of Birth Gender
with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
Om Praksh Sharma 01/01/1964 Male call our call centre. This card is valid till the time policy is active.

Kanti Devi 01/01/1968 Female

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
Fax Number : 1860 2000 600
Email : healthclaims@hdfcergo.com
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

Frequently Asked Question's (FAQ's) - Health Suraksha Policy

WHAT IS THIS PLAN ALL ABOUT
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.
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.
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.
WHAT IS NOT COVERED IN THE HEALTH SURAKSHA POLICY
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.
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)?

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, Android, iPhone, Windows (version 8 & above)
DO I GET INCOME TAX BENEFIT?
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
HOW TO REGISTER/ TRACK MY CLAIM STATUS?
CORRECTIONS IN MY POLICY
You can track your claim status from any of the below options: 1.You can send duly signed request via any of the below options:
¡ Call toll free : 1800 2 700 700 (Accessible from India only) ¡ Fax : 022-66383669
¡ Fax : 1860 2000 600 ¡ Email : care@hdfcergo.com
¡ Email : healthclaims@hdfcergo.com ¡ Visit our nearest branch in your city
¡ Visit IPO: Login into online Insurance Portfolio Organiser (IPO) on the home page of ¡ Post/courier : Customer service office at Andheri (East) in Mumbai.
our website, www.hdfcergo.com 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
Kindly mention your claim number and/ or policy/ reference number in the correspondence. and contact numbers in the communication.
Above numbers can be dialed for queries pertaining to hospitalisation, critical illness, Note: Supporting documents may be asked for such corrections whereby change of premium
cashless facility and authentication of health cards. amount is involved or otherwise in the policy on case to case basis.
WHOM SHOULD I SEND THE CLAIM DOCUMENTS TO? WHAT IS MEANT BY NETWORK HOSPITALS?
Duly signed claim form (available on website) with necessary supporting documents and These hospitals are empanelled by company to provide cashless hospitalization facility to
original bills are to be sent to the below address via courier. the insured under given Health Insurance Policy. The company directly reimburses all the
HDFC ERGO General Insurance Company Limited admissible expenses to the hospital. For a complete list of network hospitals, visit our
Stellar IT Park Tower - 1, 5th Floor, C - 25, Sector - 62, Noida - 201 301, Uttar Pradesh. website, www.hdfcergo.com.

WOULD I RECEIVE ANY CONFIRMATION ON THE CHANGES DONE IN MY POLICY?

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.

HOW DO I RENEW MY POLICY? WHAT IS THE RENEWAL BENEFIT FOR

HEALTH SURAKSHA POLICY?
You can renew your policy via any of the below options: 1. On every claim free year, a cumulative bonus of 5% of the Basic Sum Insured is applied to
a) Visit www.hdfcergo.com to renew instantly online the policy (upto a maximum of 50% of the basic sum insured). This doubles up when
b) SMS "RENEW <POLICY NUMBER>" to 9999 700700 (from your registered enhanced cumulative bonus rider is opted in the policy i.e., cumulative bonus applied is
mobile number) 10% of the basic sum insured on every claim free year, upto a maximum of 100% of the
c) Visit our nearest branch or contact your agent basic sum insured.
d) Send a copy of the renewal notice along with premium cheque to our branch office 2. After every continuous (without a break) 4 claim free years; in every fifth year a free
or Customer service office health check-up upto a cost of 1% of the Basic Sum Insured (not exceeding Rs. 5000)
e) Call toll free 1800 2 700 700 (Accessible from India only) shall be offered as a renewal benefit.
f) Email to care@hdfcergo.com

Convenience at your fingertips

On the Customer Support section of our website, you can:
Ver.AUG17

Get Policy Copy/ Make Changes Track Claim Update Contact

` 80D Tax Certificate on Policy Status Details
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.