THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

New India Floater Mediclaim Policy

UIN : NIAHLIP21278V042021

Policy Schedule

Current Policy No 32160034222800000825 Current Policy Period From:15/12/2022 12:00:01 AM

To:14/12/2023 11:59:59 PM
Previous Policy No 32160034212800000855 Previous Policy Period 15-DEC-21 to 14-DEC-22
Policyholder's Details
Policyholder Name MR ARUN KUMAR TRIPATHI Customer ID H3234067
PAN Card No ADPPT1965M
Mobile No/Phone No XXXXXX6191
Policyholder's B - 407 Email id mailtoaruntripathi@gmail.com,
address AJNARA INTEGRITY RAJ
NAGAR EXTENSION
RAJ NAGAR EXTENSION
Ghaziabad ,UTTAR PRADESH,
201017
Name of the Nominee NUPUR TRIPATHI
Relation with the Policy Spouse
holder
GSTIN NA
Policy Issuing Office and Intermediary Details
Office Name and Code GHAZIABAD (321600) Office Contact No 2790515 / 2793822 / 9837239571
Office Email Id nia.321600@newindia.co.in Development Officer GULSHAN BAWEJA (1D7842472)
Name of the Mr. MR. KRISHNA KANHAIYA PANDEY
Agent/Intermediary (NIA1D7840818)
Office Address R-1/89, 1ST FLOOR, RDC-RAJ NAGAR, Contact No. of 2820066, 09810812808 / 01202790991,
NEAR BSNL TELEPHONE EXCHANGE Agent/Intermediary 01122912739, 9891240254
,201002
E-mail id of Intermediary lickkpandey@gmail.com,
gulshan.baweja@newindia.co.in,
gulshanbaweja123@gmail.com
Regional Office DRO (320000) GSTIN 09AAACN4165C4ZM
Regional Contact No 22404101 SAC 997133 (Accident and health insurance
services)
Details Of TPA (Notice or Communication to be given in respect of claim)
Name of the TPA HEALTH INSURANCE TPA OF INDIA
LIMITED
Email-id of the TPA Address of the TPA MAJESTIC OMNIA BUILDING,2ND
customerservice@hitpa.co.in FLOOR,,A-110, SECTOR – 4,
NOIDA,NOIDA

Toll Free / Contact No of 18001803600

the TPA 18001023600 /
Fax of TPA 01204765799

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.
* Cataract claims, up to 10% of Sum Insured or ` 50,000 whichever
less, for each eye.
* 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.
* For specified diseases waiting period is 24 months as per clause 4.3.1
of the policy document.
* Please refer to policy document for detailed terms and conditions.

Signature Not
Verified
Digitally signed
by JAGATJAYEE
PANIGRAHI
Date: 2022.12.05 Policy No. : 32160034222800000825Document generated by CUST663685 at 05/12/2022 06:58:36 Hours.
06:58:39 IST
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 1 of 5
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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 MR ARUN 17/03/1977(45) M SELF 03/12/2009 NA
KUMAR
TRIPATHI(H3234
067)
2 MRS NUPUR 08/08/1978(44) F SPOUSE 03/12/2009 NA
TRIPATHI(H3319
747)
3 MASTER AKSHAT 14/11/2006(16) M CHILD 03/12/2009 NA
TRIPATHI(H3266
731)

Floater Sum Insured 1500000 Floater Cumulative Bonus 750000

Cumulative Bonus Details

S. No Sum Insured CB percentage CB Amount
1 1500000 50 750000

Optional Cover Table

Policy Level - Optional Not Opted
Cover - 1
(No Proportionate
Deduction)
Member Level - Optional Not Opted Member Level - Optional Cover - III Not Opted
Cover - II (Revision in Cataract Limit)
(Maternity Benefit)

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 MR ARUN 8852 0 0 0 886 7966
KUMAR
TRIPATHI
2 MRS NUPUR 8852 0 0 0 886 7966
TRIPATHI
3 MASTER 3509 0 0 0 351 3158
AKSHAT
TRIPATHI

Previous Year Policy Details

Sl. No. Previous Policy Name of From Date To Date Sum Insured Pre-existing Claim Amount
No Insured Diseases
1 321600342028 MR ARUN 15/12/2020 14/12/2021 1500000 N 0
00000888 KUMAR
TRIPATHI
2 321600342028 MRS NUPUR 15/12/2020 14/12/2021 0 N 0
00000888 TRIPATHI

Policy No. : 32160034222800000825Document generated by CUST663685 at 05/12/2022 06:58:36 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 2 of 5
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

3 321600342028 MASTER 15/12/2020 14/12/2021 0 N 0

00000888 AKSHAT
TRIPATHI
4 321600342128 MR ARUN 15/12/2021 14/12/2022 1500000 N 0
00000855 KUMAR
TRIPATHI
5 321600342128 MRS NUPUR 15/12/2021 14/12/2022 1500000 N 0
00000855 TRIPATHI
6 321600342128 MASTER 15/12/2021 14/12/2022 1500000 N 0
00000855 AKSHAT
TRIPATHI
Total Gross 19090
Premium(Without
GST)
CGST(@9%) 1718
SGST(@9%) 1718
Net Premium in Words(RUPEES TWENTY-TWO THOUSAND FIVE HUNDRED TWENTY-SIX ONLY) IGST 0
Total GST 3436
Net Premium(With 22526
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 15th day of December 2022.

Date of Issue: 05/12/2022

( )
[]

FOR AND ON BEHALF OF

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

Policy No. : 32160034222800000825Document generated by CUST663685 at 05/12/2022 06:58:36 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 3 of 5
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Insurer Office Code : GHAZIABAD (321600)

Address : R-1/89, 1ST FLOOR, RDC-RAJ NAGAR,
NEAR BSNL TELEPHONE EXCHANGE
,201002
Telephone : 2790515 / 2793822 / 9837239571
Fax : 01202790722

New India Floater Mediclaim

PREMIUM CERTIFICATE FOR THE PURPOSE OF DEDUCTION UNDER SECTION 80 D OF INCOME TAX ( AMENDMENT ) ACT 1986

This is to certify that Mr./Mrs. MR ARUN KUMAR TRIPATHI has paid ` 22526 towards premium for New India Floater Mediclaim
for the period 15/12/2022 12:00:01 AM to 14/12/2023 11:59:59 PM

Policy no. : 32160034222800000825

Receipt no. & date : 10000089221200086692
05/12/2022

Date of Issue: 05/12/2022

( )
[]
Authorized Signatory For and on behalf of
The New India Assurance Company
Limited
(Note: This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation
of the policy or any alteration in the Insurance affecting the premium)

Policy No. : 32160034222800000825Document generated by CUST663685 at 05/12/2022 06:58:36 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 4 of 5
 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 Regulation 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.

Beware of spurious calls offering alluring benefits. Never share any policy details with unknown callers.
Call 1800-209-1415 for any enquiry or contact the nearest operating office of New India Assurance Co Ltd.

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 32160022E0009437

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 32160034222800000825Document generated by CUST663685 at 05/12/2022 06:58:36 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 5 of 5