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Certificate of Insurance

Mr Gadipally Mahesh Group Policyholder Name
Group Policy No.
Certificate of Insurance No.
C/O Ramulu H. No 13-42 Chinthala Basthi Aler
Plan Name
Alair Cover Start Date
Cover End Date
Alair Nominee Name (Relationship)
Premium Paid
Alair 508101
Telangana 36 Premium Payment Mode
Shriram City Union Finance Ltd
10623477
62324667
Group Care(Scheme for SCUF)
00:00 hrs 22-Feb-2023
Midnight 21-Feb-2024
Gadipally Radhika (WIFE)
Rs. 2662
(Premium Rs 2256 + CGST Rs 203.04 + IGST
Rs 0 + SGST/UGST Rs 203.04)
Single Premium

Applicant Date Of Birth Client ID

Gadipally Mahesh 30-Jan-1993 16886668

1

Details of Insured
Insured with
Name Client ID Date of Birth Relationship the Company Pre-existing diseases
(since)
Gadipally Mahesh 16886668 30-Jan-1993 Member 22-Feb-2023 None

Details of Cover

S No. Particulars Details

1 Sum Insured Rs. 1,00,000

1
Intermediary Details
Name Code Contact Number
Shriram City Union Finance
20182494 044-25341413
Ltd
12
0 Benefits

S No. Particulars Basis of Offering (On Annual Basis)

1 In-patient Care up to SI

2 Day Care treatment up to SI

3 Pre-hospitalization medical expenses 30 days

4 Post-hospitalization medical expenses 60 days

5 Health Check-up Once every year

6 Second Opinion Available

7 Organ Donor up to SI

8 Domiciliary Hospitalization Up to 20% SI

9 AYUSH Treatment Up to 20% SI

10 Ambulance Up to Rs. 2,500

11 Room Rent 1.5% of Sum Insured

12 ICU 2.5% of Sum Insured

Key Exclusions
The Company shall not be liable to make payment for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any
of the following except covered by way of an extension:
• Claim for any Medical Expenses incurred for treatment of any Illness during the first 30 days of the Cover Start Date shall not be admissible, except
those Medical Expenses incurred as a result of an Injury.
• Any Claim for or arising out of any of the following Illnesses or Surgical Procedures shall not be admissible during the first 24 consecutive months from
he Cover Start date: Arthritis, if non-infective, gout, rheumatism and spinal disorders, joint replacement surgery/Benign ear, nose and throat (ENT)
disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty), nasal septum deviation,
sinusitis and related disorders/Benign prostatic hypertrophy/Cataract/Dilatation and curettage/Fissure / fistula in anus, hemorrhoids/piles, pilonidal
sinus, gastric and duodenal ulcers/Surgery of genito urinary system unless necessitated by malignancy/All types of hernia, hydrocele/Hysterectomy for
menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy/Internal tumors, cysts, nodules, polyps including breast lumps
(each of any kind) unless malignant/Kidney stone/ureteric stone/lithotripsy/gall bladder/Myomectomy for fibroids/Skin tumors unless
malignant/Varicose veins and varicose ulcers.
• Any Claims for Medical Expenses incurred for diagnosis or treatment of any Pre-existing Disease shall not be admissible until the completion of first 36
months of continuous insurance coverage from the first Cover Start Date under the first Policy with Us.
• Maternity expenses
• Genetic disorders, External Congenital Ailments, Dental Treatments(other than accidents), Infertility/Impotency treatments, HIV & Related
complications.
• Any condition directly or indirectly caused by or associated with any sexually transmitted disease.
• Out - Patient Treatment
• Any Non allopathic treatment
Note: This is an indicative list of exclusions and not exhaustive. For the entire list of exclusions, please refer to the Group Policy Terms and Conditions
issued to the Group Policyholder.

0 Portability/Renewability
S No. Particulars
1 Renewal under the scheme is subject to continuation of this scheme by Group Policyholder
2 You can port from this scheme to Insurer’s individual health policy, subject to underwriting guidelines of such individual health policy under
following conditions:
a) Group Policyholder chooses not to continue this scheme
b) If you choose not to continue the enrollment under this scheme
3 The premium payable under this scheme shall be reviewed on annual basis and may subject to revision
After enrolment under the scheme, if you find it unsuitable you can cancel and return the Certificate of Insurance to the Insurer within 15 days
4 from the date of receipt of Certificate of Insurance.

Grievance Redressal/Complaints
The Company has developed proper procedures and effective mechanism to address of complaints by the customers. The Company is committed to
comply with the Regulations, standards which have been set forth in the Regulations, Circulars issued by the Authority (IRDAI) from time to time in this
regard.
(a) If the Policyholder / Insured Person has a grievance that the Policyholder / Insured Person wishes the Company to redress, the Policyholder / Insured
Person may contact the Company with the details of the grievance through:;
Website: www.careinsurance.com
Email: customerfirst@careinsurance.com
Contact No.:1800-102-6655
Courier: Any of Company’s Branch Office or corporate office
 The Policyholder/Insured Person may also approach the grievance cell at any of the Company’s branches with the details of his/her grievance during the
Company’s working hours from Monday to Friday.

Exclusively for Senior Citizens, the Company has a separate extension on the Customer Service Toll Free Number. This separate customer service
channel prioritizes and routes any kind of request / grievance raised by Senior Citizens through various fast track internal escalations leading to lesser
Turn-Around-Time (TAT) for request / grievance addressal.
(b) If the Policyholder / Insured Person is not satisfied with the Company's redressal of the Policyholder's / Insured Person’s grievance through one of the
above methods, the Policyholder / Insured Person may contact the Company’s Head of Customer Service at:
Head – Customer Services,
Care Health Insurance Limited

Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector – 43, Gurugram – 122009 (Haryana).
For Care Health Insurance Limited

Authorized Signatory Date of Issue : 21-Feb-2023 Place of Issue : Gurgaon, Haryana

Service Branch : CHIL, Shutters No. 3 & 4, 2Nd Floor, House No. 6-2-255 To 6-2-255, Pinjerla Street , Hanmankonda , Warangal , Telangana - 506002 Branch Contact No. : 1800-102-4488
Correspondence Address:
Care Health Insurance Limited
Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector – 43, Gurugram – 122009 (Haryana). Contact No : 1800-102-4488 Fax:1800-200-6677
Website : www.careinsurance.com Email : customerfirst@careinsurance.com
Consolidated Stamp Duty paid vide E-Challan GRN no. 92250132 dated 07 July 2022, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State GSTIN No.: 36AADCR6281N1ZT IRDA Registration Number - 148 UIN : RHIHLGP21404V022021

Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note:

1. Validity of this certificate is subject to terms and conditions of Group Policy issued to the Group Policyholder.
2. In event of non-receipt of Premium, this certificate of insurance automatically stands cancelled from inception, irrespective of whether a separate communication is sent or not. This policy is based
on the information provided by the Insured on your behalf in the proposal form. In case you find any discrepancy in the same, please contact us immediately.
3. Attached with this Certificate of Insurance are the Key Terms and Conditions. Please ensure that have been received, read and understood. If any of these documents, please email at
customerfirst@careinsurance.com or write to the Company. This Certificate of Insurance in original must be surrendered to the Company in case of cancellation of the Certificate of Insurance.
This Certificate of Insurance is governed by and is subject to the Terms and Conditions of the referred Group Policy.
 V 2,2

Premium Acknowledgement

Certificate of Insurance No. 62324667

Client ID 16886668
Applicant Mr Gadipally Mahesh
Address C/O Ramulu H. No 13-42 Chinthala Basthi Aler
Alair
Alair
Alair 508101, Telangana
Policy Period 22-Feb-2023 to 21-Feb-2024

Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Payment
1 A0719634 2,662.00 Payment Gateway
Gross Premium
Group Care 2,256.00

Goods & Services Tax (GST) 406.08

Total 2,662.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
The premium paid through any mode other than cash for this policy is eligible for Income tax benefits to the person making the
payment subject to the provisions of section 80D of the Income Tax Act, 1961 and amendments thereof.

For Care Health Insurance Limited

Authorized Signatory Date of Issue: 21-Feb-2023 Place of Issue: Gurgaon, Haryana

This Mr fro 225 towa
IRDA Registration Number - 148
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
CIN : U66000DL2007PLC161503

Note
1) In case of any discrepancy, you are requested to contact us immediately.
2) Any amount paid in cash towards the premium would not qualify for tax benefits as mentioned above.
3) This document must be surrendered to Us in case of Cancellation of the Certificate of Insurance or for the issuance of a fresh Certificate of Insurance in the case of any alteration. In event of
incorrect representation of this declaration this liability shall be upon the policy holder.
4) We may credit upto Rs. 1/- to your account for validation, before remitting any further payment.

Signature Not
Verified
Digitally signed by
MANISH DODEJA
Date: 2023.02.21
11:37:12 IST
Reason: I'm the author
Location: India