HDFC ERGO General Insurance Company Limited

2952202863303900000
MS SHIVANI PATEL
CHILLOD BANKHEDI,461990
DISTRICT- HOSHANGABAD
MADHYA PRADESH
Contact No : 8120963354

Date : 10/07/2024

Dear Ms Shivani Patel

Thank you for choosing HDFC ERGO as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2952202863303900000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.

We value your relationship with us and assure you our best services at all times and we look forward to serve you.

Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
For HDFC ERGO General Insurance Company Ltd.

Ankur Bahorey
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited 2952202863303900000

Dear MS SHIVANI PATEL

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986

This i s to certify that we have received an amount of` 27413.76 (RUPEES TWENTY SEVEN THOUSAND FOUR HUNDRED THIRTEEN AND SEVENTY SIX PAISE Only)
towards premium for Health Suraksha Policy , Policy No. 2952202863303900000 issued to Shivani Patel for the period 10/07/2024 to 09/07/2025.

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.
Date : 10/07/2024 For HDFC ERGO General Insurance Company Ltd.

Policy Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) 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 : [email protected]
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE
Health Suraksha Policy
SILVER PLAN

Policy Details
Policy No. 2952 2028 6330 3900 000 Premium Frequency Single
0

Period of From 10/07/2024 19:22 hrs Policy Type Individual

Insurance To 09/07/2025 Midnight PAN EUWPP0601J
2952202863303900000 Issuance Date 10/07/2024
Customer Id : 1016426733030001
MS SHIVANI PATEL
CHILLOD BANKHEDI,461990 Proposer Name MS SHIVANI PATEL
DISTRICT- HOSHANGABAD
MADHYA PRADESH
Contact No : 8120963354

Email ID : [email protected]
Insured Person’s Details & Sum Insured
Insured's Name Relationship Date of Birth Member ID 1st Policy Portability Pre Existing
Inception Sum Insured (`) Disease

SHIVANI PATEL Self 20/01/1998 10/10/2021 NO

Sum Insured (`) 400,000.00 CB Amount (`) 0.00

In case of increase in the Sum Insured at renewal, waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.

Nominee Name SHUBHAM PATEL Relationship Sibling

The nominee must be an immediate relative of the Insured Person. For all other insured person(s), the Policyholder shall be the nominee.

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 Expenses Covered
Emergency Ambulance Charges (Limit per Ayurvedic /Unani/Sidha/ Homeopathic
Upto Rs. 2000 Covered
hospitalisation)
Health Check up per family (Post 4 Claims free Upto 1% Sum Insured,Maximum Upto Rs Enhanced Cumulative Bonus 10% of Sum Insured; Maximum
years) 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 23,232.00
Loadings 0.00
GST 18% : Central Tax 9% ( ` 2090.88 ) + State Tax 9% `( 2090.88) 4181.76
Total Premium 27,413.76

Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
ERGO_CC_10072019 10/07/2024 HDFC Bank Ltd

Invoice No. 2028633039000001 HSN Code 9971

For Claim Services Phone 022 - 6234 6234 / 0120 - 6234 6234 Fax no. 1860 2000 600 E-mail [email protected]
Address 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 [email protected] or log on to www.hdfcergo.com
If the premium is not realised the policy shall be void from inception.
Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan no CSD/36/2019/2289/19 dated 27/05/2019 as prescribed in Government Notification Revenue and Forest
Department No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004. , Goods & Services Tax Registration No: 24AABCL5045N1ZE. Goods and Services Tax for this invoice is not payable under reverse charge
basis.
Branch :AHMEDABAD - 206, SECOND FLOOR,SHOPPER PLAZA IV,OPP. BSNL TELEPHONE EXCHANGE ROAD, NAVARANGPURA,AHMEDABAD - 380006 AHMEDABAD, 380006.Phone No.
:+91-79-39883600
Write to us : [email protected]

For HDFC ERGO General Insurance Company Ltd.

Agent Name :HDFC BANK LTD

Agent Code :201587086428 Tel No. : 91-22-61606161
Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) 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 : [email protected]
HDFC ERGO General Insurance Company Limited

Customer
Section Transcript
Response
A Introduction:
Good Morning Sir / Madam, Am I speaking to Mr/ Ms.SHIVANI PATEL on Phone no 8120963354? This is [shital.gadekar and Emp.Code=152753]
calling from HDFC ERGO General Insurance Co ltd. This call is regarding the Health Suraksha Silver with Regain and enhanced cumulative bonus rider Insurance
Policy for which you have shown interest in buying through HDFC Bank credit card. ir HDFC Bank is the Corporate Agent having Corportae Agency code -CA0010.
Should we continue?
Sir/ Madam, we would like to inform you that your consent will be recorded for processing the issuance of policy and we shall be also sending the transcript of this
conversation along with the policy documents. The call recording is available wtih us for any future reference. OK

Sir Please let us know the preffered language i.e English, Hindi or local language
Sir / Madam - are you voluntarily enrolling yourself / your family to the policy without ANY OFFERS?".................If YES, then proceed.
Sir ,Commission from General Insurance - Health Insurance is 15%
B Product features:
This Insurance is 1 Years policy.
This policy is a combination of a "Health Suraksha Silver with Regain and enhanced cumulative bonus rider" provided exclusively for HDFC Bank customers.
1. Health Insurance of [Rs 400000] on individual basis, which gives you cashless mediclaim facility in more than 6000+ network hospitals all over India.Updated
network hospital list is available on our company's website : WWW.HDFCERGO.COM
If the treatment is undertaken in a non-network hospital, you get reimburesement of your hospitalization expenses within 10 Working days after submission of all
documents.
The policy also covers ayurvedic, homeopathic and Unani treatments in addition to allopathic treatments. Policy also covers Organ donor expenses.
This policy also includes Pre & Post Hospitalization expenses [60 days before hospitalisation and 90 days after hospitalisation] and emergency ambulance charges
upto Rs. 2000 per hospitalization.
This policy doesn't cover any pre-existing diseases which you or any of the family member is or has been suffering from until a waiting period of 48 months
This policy has a waiting period for 2 years for medical conditions like Hernia, Cataract, Piles, gall bladder stones & kidney stones This list is not exhaustive, the
complete list is mentioned in the policy document.
OK
Also please note that the policy will not cover any medical hospitalization for first 30 days, however Accidental hospitalization will be covered from day one.
Minimum 24 hours of hospitalization is required for all inpatient treatment
Maternity , dental & cosmetic surgery are not covered in this policy. Dental treatment and Cosmetic surgery arising out of accident is covered
If the first benefit is clear, can I explain next benefit
2.Regain Benefit: Under this benefit your basic sum insured will be re-instated in case the basic sum insured inclusive of the no claim bonus has been exhausted
during the policy year. The basic sum insured will be re-instated only once in a policy year. The re-instated (Regain) sum insured can be used for only future claims
made and not against any illness/disease (including its complications) for which a claim has been paid in the current policy year
If the Second benefit is clear, can I explain next benefit
3.Enhanced Cumulative Bonus: Under this benefit the basic sum insured of your policy cover will increase by 10% for every claim free year up to 100% of basic
sum insured and will decrease by 10% in case of a claim
We also would like to inform you that we offer life long renewability on this product
C Family details:
We would like to confirm the details of the insured persons covered under the Policy: OK
Name of Insured Relationship Date of Birth
SHIVANI PATEL Self 20/01/1998

Name of Nominee Relationship with Insured

SHUBHAM PATEL Sibling

D Pre-existing declaration :
Has any of the person proposed for insurance cover ever suffered or is currently suffering from any disease, ailments, - medical conditions/illnesses, accident or
.
injury?
Whether the given insured is suffering from Diabetes ? NO

Whether the given insured is suffering from Hypertension ? NO

Sir / Madam hope all the above information is true to the best of your knowledge, since any miss representation of facts can lead to rejection at the time of claims OK
Dear Sir/Madam If our underwriter refers you for any Pre Policy Checkup then the entire cost for check ups will be borne by us & if Diagnostic center offers Home
OK
visit service then the same will also not be charged.
E Authorisation:
Dear Sir/Madam, The Company will confidentially retain personal information and health details provided by you. However, to assess and underwrite the risk, YES
issuance of policy and claim settlement, the Company may disseminate the same with insurance intermediaries like TPA or Insurance repositories or and other
service provider(s). Yes/No :
The premium amount for your insurance policy is Rs. 13707 for 1 Years.
You can pay your premium amount on EMI basis in 24 EMI. this option is being provided by your credit card provider “HDFC Bank”. This option is not associated
with insurance coverage neither related to insurance policy’s terms and conditions.Please note that the ROI on EMI and the DAE processing fee will be applicable
as informed to you by Bank team.
Should we debit this amount and issue the policy?
I hope you are aware about the fees to be charged by HDFC Bank, details of which are available on HDFC Bank website. Should we instruct HDFC Bank to debit
the premium amount and the processing fee from your account.Premiums are based on the age of the insured. In case of a family floater, the premium is as per the
eldest insured of the family. Any change in the premium will be as per the premium tables approved by IRDA.There will not be any refund of policy premium amount
post expiry of the policy.Kindly note, in case of cancellation request during policy period, termination clause mentioned in the policy clause will be applicable.
Thank you Sir/Madam, we will issue your policy and the premium will reflect in your HDFC Bank statement. Request you to please maintain the Credit Card limit
upto premium of Rs.13707 Premium in your HDFC Bank Credit Card amount so that your request can be processed. Incase there is no sufficient balance on your
HDFC Bank Credit Card, request your OK for TEMPORARY LIMIT enhancement to process the payment
You will be entitled for a Free Look period of 30 days from the date of receipt of the policy to review its terms and conditions. In case you disagree with or object to
any terms or conditions of the Policy, you have an option to request for cancellation of the policy stating the reasons for cancellation. The premium paid by you will
be refunded after deducting the expenses incurred by HDFC ERGO on medical check - up, stamp duty charges and proportionate risk premium.
Please note that your insurance cover starts from the date of debit of the premium amount from your Credit Card,it is 1 Years policy to be renewed after every
1 Years to enjoy the benefits.
Please note that the premium will be debited from account.

Dear Sir/Madam, Also Would like to inform you that there are no freebees provided along with this policy
F Closure :
Hope you are aware of similar insurance plans available in the market. Sir/Madam, can you please confirm if you have understood the terms and conditions under
OK AGREED
the policy? Please reconfirm that all the information provided are accurate enabling us to issue & dispatch the policy to you.
May I confirm your DOB details

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) 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 : [email protected]
HDFC ERGO General Insurance Company Limited

Thank you very much for re-confirming the details. You will receive your policy document within 15 working days by courier on your Credit Card mailing address. On
the basis of the information and confirmation given by you Health Suraksha Silver with Regain and enhanced cumulative bonus rider plus insurance policy detailing
the terms and conditions shall be issued to you in due course.We request you to please acknowledge the receipt of the same.Is there anything else you would like
us to assist you with? OK AGREED
Incase of any discrepancy, request you to get back to us on the toll free numbers 1800 2 700 700 or Customer Service Address:D-301, 3rd Floor, Eastern Business
District (Magnet Mall), LBS Marg, Bhandup (West),Mumbai - 400 078. Toll-free: 1800 2 700 700 (Accessible from India only) | Fax: +91 22 66383699 |
[email protected] | www.hdfcergo.com.
For further information about the policy, please refer policy terms and conditions sent with the policy schedule.You may also refer the policy terms and conditions
OK AGREED
available on the Company 's website.For more details on the risk factors, terms and conditions, please read the sales brochure before concluding the sale.
Is there anything else you would like us to assist you with? OK AGREED

Thank you & Have a nice day! OK

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) 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 : [email protected]
 FREE HEALTH CHECK UP COUPON
This coupon entitles a free health check up to the insured under the
Health Insurance Policy
■ Medical Examination ■ Urine Routine ■ Complete Blood Count ■ Fasting Blood Sugar
■ ECG ■ Total Cholesterol ■ Creatinine

Submit this coupon with Hospital / Nursing Home

Name of Insured: □ SHIVANI PATEL

Policy Number: 2952202863303900000 Policy Start Date: 10/07/2024

Health Check up Date:

Authorization Number:
Customer Contact: Valid upto:

Customer Signature : I am proposor (Hospital seal with sign)

Terms & Conditions

The Free Check Coupon is non-transferable and cannot be clubbed with any other offer from the Service Provider / Hospital / Nursing Home, The offer is valid only if the policy is
in force. HDFC ERGO General Insurance Co. Ltd. (“HDFC ERGO”) is entitled to refer the health check report. This Health Check Coupon can only be availed by any one insured
member under the health insurance policy of HDFC ERGO. The administration of this offer is brought to you by Health Claim Services. To avail this offer, the insured is required
to carry the policy copy along with this coupon while going for the health checkup. Coupon is valid up to 180 days from the below mentioned date on the coupons. In case of
cancellation of the health policies, where health coupons have been issued and also used by the insured, health coupons charges shall be deducted while refunding the premium.
HDFC ERGO is not responsible or liable for medical reports issued by the Service Provider / Hospital / Nursing Home.

Note:
■ Coupon cannot be clubbed with any other offer from the service provider or hospital/nursing home
■ Coupon is valid only if policy is in force
■ Coupon validity period is mentioned on the coupon
■ Tests are fixed for a particular coupon denomination
■ Coupon has one time use meaning it can be used in a single visit
■ Coupon can be used by a single insured

Call : 1800 - 2700 - 700 for your appointments

coupons will be valid for a period of 180 days from
the below mentioned date
25/08/2019

HDFC ERGO General Insurance Company Limited (Formerly HDFC General Insurance Limited) 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 : [email protected]