THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

New India Floater Mediclaim Policy

UIN : NIAHLIP20105V031920

Policy Schedule

Current Policy No 17010034192800079342 Current Policy Period From:05/03/2020 12:00:01 AM

To:04/03/2021 11:59:59 PM
Previous Policy No 17010034189500004711 Previous Policy Period 05-MAR-19 to 04-MAR-20
Policyholder's Details
Policyholder Name PRADEEP K. GUPTE Customer ID 1H3403781
PAN Card No
Mobile No/Phone No 993340203365770,
271196533687066
Policyholder's ovQPVksXAUsHlgxdudbVdmSO Email id
address LmGqqTpYOPMYsplpHNUZiwG
NdAsTBLUAhXFMEhvOkEfeWjT
BqvvMjYcom

MUMBAI ,MAHARASHTRA,
400016
Name of the Nominee PRITI P GUPTE
Relation with the Policy Others
holder
Policy Issuing Office and Intermediary Details
Office Name and Code THE NEW INDIA ASSURANCE CO. LTD. Office Contact No 886992208 / 6568808199
(DO) (170100)
Office Email Id dfsd@fg.fsd Development Officer Mr. MR.S.V. DESHMUKH (2D5612664)
Name of the MR. SAMBHAJI PATIL (2D5612776)
Agent/Intermediary
Office Address DFGGF Contact No. of 837847258968667 / 785945700394140
Agent/Intermediary
,400001
E-mail id of Intermediary /
xPyrROZ`WZGHOusEygtCVKrVjDSjM
mZ,
Regional Office MUMBAI RO-V (170000) GSTIN 27AAACN4165C3ZP
Regional Contact No NA SAC 997139 (Other non-life insurance
services excl RI)
Details Of TPA (Notice or Communication to be given in respect of claim)
Name of the TPA HEALTHINDIA INSURANCE TPA
SERVICES PRIVATE LIMITED
Email-id of the TPA Address of the TPA YiKihwkEwtkvIXvkkrDFCJGHyWCayEP
kjhb@gmail.com SSwgJiHLoHPTHHapJVrsjVBFWFMIfAz
XOpQFrfHYsGXMJjvRTOuKUGUpXIppj
HjCxgZym,hOCcOEtFxXqTHSzGUNm
yGua,nqbpnw

Toll Free / Contact No of

the TPA 294565073217156 / 9874512365
Fax of TPA RJUvczDZDsg

Highlights of New India Floater Mediclaim Policy*

* Day one baby cover.
* Critical Care Benefit 10% of the Sum Insured.
* Room rent and ICU Charges at 1% and 2% of Sum Insured per day
respectively.
* Hospital Cash up to 1% of Sum Insured.
* Midterm inclusion of newly married spouse.
* Ayurvedic / Homoeopathic / Unani treatments are covered up to 25%
of the Sum Insured.
* Optional Cover I: No Proportionate Deduction.
* Optional Cover II: Maternity Expenses Benefit for Sum Insured 5
Lakhs and Above.
* Optional Cover III: Revision in Limit of Cataract (For 8 Lakhs & above
Sum Insured).
* For Pre Existing Diseases Waiting period is 48 Months as per clause
4.1 of the policy document.

Policy No. : 17010034192800079342Document generated by TCSSUBH at 19/02/2020 16:12:50 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 1 of 4
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

* Cataract claims, up to 10% of Sum Insured or ` 50,000 whichever * For specified diseases waiting period is 24 months as per clause 4.3.1
less, for each eye. of the policy document.
* Please refer to policy document for detailed terms and conditions.
Important
*1.Date of Inception of first policy is the date from which the policyholder has been continuously obtaining health insurance cover in
India from any of the insurers without break subject to portability guidelines.
2.Enhanced Sum Insured under the policy will be subject to policy clauses 4.1,4.2 and 4.3
3. PED and specified diseases waiting periods for each of the merged policy shall be reckoned as per its date of inception of first policy.
* Please visit https://www.newindia.co.in for the list of network hospitals providing cashless facility. If network hospital is not
available in your city/location, please contact the concerned TPA." You are also requested to share your policy details when
you visit the network hospital.

Insured Persons details

S. No Name of the insued Date of birth(Age) Sex Relation *Date of inception of Pre Existing Disease
(Member ID) first policy
1 PRADEEP K. 14/10/1952(67) M Self 05/03/2007 N
GUPTE(1H34037
81)
2 MRS. PRITI P. 21/08/1955(64) F Spouse 05/03/2007 N
GUPTE(1H34475
19)

Floater Sum Insured 300000 Floater Cumulative Bonus 0

Cumulative Bonus Details

S. No Sum Insured SI Effective Date CB percentage CB Amount
1 300000 19-FEB-20 0 0

Optional Cover Table

Policy Level - Optional Opted
Cover - 1
(No Proportionate
Deduction)
Member Level - Optional Opted Member Level - Optional Cover - III Opted
Cover - II (Revision in Cataract Limit)
(Maternity Benefit)
Member Wise - Optional Cover -II (Maternity Benefit)
S. No Name of the Insured (Opting Optional Cover - II) Date of Opting Optional Cover - II
1 Pradeep K. Gupte 01/01/1970
2 Mrs. Priti P. Gupte 01/01/1970
Member Wise - Optional Cover - III (Revision in Cataract Limit)
S. No Name of the Insured (Opting Optional Cover - II) Date of Opting Optional Cover - II
1 Pradeep K. Gupte NA
2 Mrs. Priti P. Gupte NA

Premium Details

S No Name of the Basic Premium Premium for Premium for Premium for Discount Gross Premium
Insured Optional Cover - I Optional Cover - Optional Cover -
II III
1 PRADEEP K. 16827 6355 0 0 842 22340
GUPTE
2 MRS. PRITI P. 16026 4434 0 0 802 19658
GUPTE

Total Gross 41998

Premium(Without
GST)
CGST(@9%) 3780
SGST(@9%) 3780
Net Premium in Words(RUPEES FORTY-NINE THOUSAND FIVE HUNDRED FIFTY-EIGHT ONLY) IGST 0

Policy No. : 17010034192800079342Document generated by TCSSUBH at 19/02/2020 16:12:50 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Total GST 7560

Net Premium(With 49558
GST)

*This Policy is subject to terms and conditions of New India Floater Mediclaim.

In WITNESS WHEREOF,the undersigned being duly authorized by the Insurers and on behalf of the Insurers has(have) hereunder set
his/her(their) hand(s) on this 5th day of March 2020.
at ______________ this _______________ day of _______________ 20

Date of Issue: 19/02/2020

FOR AND ON BEHALF OF

THE NEW INDIA ASSURANCE COMPANY LIMITED
DULY CONSTITUTED ATTORNEY(S)

Policy No. : 17010034192800079342Document generated by TCSSUBH at 19/02/2020 16:12:50 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMPORTANT

This policy is subject to the terms and conditions contained in the policy document (Clauses).

This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.

This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.

This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.

Health Insurance Regulations 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.

Tax Invoice No : 17010019E0738094

IRDA Registration Number: 190

Policy No. : 17010034192800079342Document generated by TCSSUBH at 19/02/2020 16:12:50 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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