HEALTH INSURANCE POLICY

Double Wallet Plan

y
nl
O
se
r po
Pu

Hi, KARAN PURI!

It is wise of you to protect your biggest treasure,

your health!
te

Your Policy Number is D122304140

UIN: GODHLIP23073V012223
uo

Policy Start Date 30-Oct-2023 18:02:35

Policy Expiry Date 29-Oct-2024 23:59:59

Members Insured KARAN PURI, KARAN SPOUSE KARAN, KARAN CHILD 1 KARAN
Q
 Details of Policy Holder

Address Address, Indore, 452001

Mobile No. +917646852309 Email ID karan@salasarservices.com

SALASAR SERVICES
Partner Name INSURANCE BROKERS Partner Code 1056932
PRIVATE LIMITED

Partner Contact Partner Email ID manisha.roy@salasarservices.com

y
Policy Details

nl
First Policy Inception Date Policy Number D122304140

Policy Issue Date 01-Jan-0001 Policy Type Floater

O
Family Composition 2 Adult and 1 Child Policy Nature New Business

Premium Payment Zone ZONE 2 Plan Opted Double Wallet Plan

se
*Based on your city of residence, Zones have been classified into two as mentioned belo

Zone 1: Delhi/NCR, Mumbai including (Navi Mumbai, Thane, and Kalyan) and Greater Hyderabad Area. Zone 2: Rest of India apart from Zone 1.

As the treatment cost is different in different cities, there are certain conditions if you change your city of treatment:
po
1. At the time of claim, Insured needs to provide address proof as per the declaration in proposal form.

2. In the absence of Address proof provided which validates the pricing zone opted, and if the place of hospitalization belongs to
Higher Zone Category - then Co-pay of 10% would be applicable on admissible claim amount.

3. Zone based Co-Pay, as mentioned above, will not be applicable in case of Accidental Injury.
r
4. If address proof as per declaration in Proposal form and Address proof provided at the time of claim is same, Zone based Co-pay
will not be applicable.
Pu

5. In case of family floater policies, a single zone shall be applied to all the members covered under the policy.

Sum Insured(SI)
te

Additional Sum
Cumulative Cumulative Effective
Insured Name Base Sum Insured Insured
Bonus (%) Bonus* Sum Insured
(At Renewals)
uo

KARAN PURI

KARAN SPOUSE
KARAN 10,00,000 ` Ď 10,00,000

KARAN CHILD 1
Q

KARAN

*Cumulative Bonus will be applicable as per your opted plan. In case of an individual policy, cumulative bonus will not be
accumulated at the end of the year for all the new members added during the policy.
• In case of portability all the waiting period applicable under this policy shall be counted from First Policy Inception date
for each member for Sum Insured existing with the previous insurer.
• Fresh waiting periods will be applied on Enhanced Sum Insured opted with Go Digit at the time of porting the policy.

Policy Coverage Details

 Section Sum Insured (`)
No. of Limits Deductible/ Specific Terms &
Coverages
Policy (excluding cumulative Co-payments Conditions
Wordings bonus)

1 Hospitalization Cover ₹ 10,00,000 NA

No room rent
1.1 In-Patient Hospitalization Cover ₹ 10,00,000*
restrictions

1.2 Day Care Procedures* ₹ 10,00,000* NA

1.3 Pre-Hospitalization ₹ 10,00,000* 30 Days

1.4 Post-Hospitalization ₹ 10,00,000* 60 Days

y
1% of base Sum
1.5 Road Ambulance ₹ 10,000* Insured max upto

nl
INR 10,000
NA
1.6 Bariatric Surgery ₹ 10,00,000* NA

O
1.7 Psychiatric Illness ₹ 10,00,000* NA

0.25% of base
Sum Insured,
1.8 Health Check-up ₹ 1,000** max upto INR

se
1,000 after every
two year

1.9 Home (Domiciliary) Hospitalization ₹ 10,00,000* NA

2 Organ Donor Expenses ₹ 10,00,000* NA

po
Once in a policy
period, for related
6 Sum Insured Back-up ₹ 10,00,000 NA
and unrelated
illness
r
7 In-built Personal Accident ₹ 50,000** NA NA
Pu

*These Sum Insureds will be part of Section 1 - Hospitalization Cover Sum Insured
**These Sum Insured will be over and above Section 1 - Hospitalization Cover Sum Insured

Cumulative Bonus 10% of base Sum Insured for every claim free year, max up to 100%
te

Waiting Period Options - Year 1

uo

Initial
Waiting Pre-existing Worldwide Specific
Maternity Critical Illness
Member Period Disease Cover Disease
Waiting Waiting
Name and ID (excluding Waiting Waiting Waiting
Period Period
critical Period Period Period
Q

illness)

KARAN PURI - 30 Days Initial

30 Days 3 Years NA NA 2 Years
N9707718776 waiting period

KARAN SPOUSE
30 Days Initial
KARAN - 30 Days 3 Years NA NA 2 Years
waiting period
N6857261899

KARAN CHILD 1
30 Days Initial
KARAN - 30 Days 3 Years NA NA 2 Years
waiting period
N4526345362
 Premium Details

Description Amount (INR)

Base Premium 12852.00

Underwriting Loading NA

City Discount (-10%) -1285.20

Net Premium 11566.80

CGST @ 9% = (1041.00) + SGST/UTGST @9% =

2082.00
(1041.00)

y
Final Premium 13648.80

nl
*For policies issued via installment - In case the installment is not received by the due date, insured will have 5 days
grace period, but no claims shall be admissible during the grace period. If premium is not received within the grace

O
period also, policy will automatically be cancelled.

This quote is generated on the basis of basic information provided by you. Final premium under the policy will depend on the medical
and health related disclosures submitted by you in this proposal.

Disclaimer:

se
1. Year on year renewal premium indicated in this table is as per information given by you for this policy.

2. Premium may vary based on changes in medical or health related disclosures/ family composition/ sum insured and any changes in
premium rates as approved by IRDAI.

3. If a child has attained age of 25 years on date of policy renewal, a new and separate policy shall be issued for the child.
r po
You don’t have to fill these details again, just continue from where you left off.
Pu
te
uo
Q