HDFC ERGO General Insurance Company Limited

2828100075549200000

Date : 25/01/2024
Dear MS VISHAL BALU UGALE
AT.REVALKARWADI, PO.VISAPUR,
TAL.KHATAV, Dist.SATARA, MAHARASHTRA, 415502
Contact No. 9768152998
We thank you for trusting HDFC ERGO General Insurance. Enclosed herewith is your insurance policy which has been confirmed on
the basis of the information and declaration given by you.

Product Name Policy No. Sum Insured (`) Premium (`)

(Inclusive of Service Tax)
As per the attached policy
Health Suraksha Policy 2828100075549200000 25771
Schedule

The insurance policy enclosed herewith represents a written agreement confirming the terms of the cover agreed as per the
declaration given by you.

To ensure seamless & hassle-free services, we request you to kindly check your contact and other details on your policy schedule on the
basis of which the insurance is issued. In case of any discrepancy please call our toll free 1800 2 700 700.

For any further assistance on your policy or to know more about our other products, please free to contact us. We once again thank you
for choosing HDFC ERGO and heartily welcome you to our growing family.

For HDFC ERGO General Insurance Company Ltd.

Karan Chopra
Head - Retail Business Group

HDFC ERGO General Insurance Company Limited

Dear Vishal Balu Ugale,

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986*
This is to certify that we have received an amount of 25,771.00 ( RUPEES TWENTY F I V E THOUSAND S E V E N HUNDRED
SEVENTY-ONE AND ZERO PAISE Only) towards premium for Health Suraksha Insurance Policy, Policy No.
2828100075549200000 issued to PARUBAI BALU UGALE for the period 26/02/2024 to 25/02/2025.

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 : 25/01/2024 For HDFC ERGO General Insurance Company

Ltd. Policy Issuing Office: Mumbai

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE
Policy No. 2828 1000 7554 9200 000
Health Suraksha Policy
SILVER PLAN

Proposer Name MS. V I S H A L BALU UGALE Premium Frequency Yearly

Correspondence AT.REVALKARW ADI, PO.VISAPUR,TAL.KHATAV Permanent AT.REVALKARW ADI, PO.VISAPUR, TAL.KHATAV
Address Dist.SATARA,MAHARASHTRA,415502 Address Dist.SATARA,MAHARASHTRA,415502

Mobile 9768152998 Phone E Mail [email protected] Policy Type Individual

Period of Insurance From Date & Time 26/02/2024 20:39 hrs To Date & Time 25/02/2025 Midnight

Insured Person’s Details & Sum Insured

Insured's Name Relationship Date of Birth Member ID Sum Insured (`) CB Amount (`) Pre Existing
Disease

Parubai Balu Ugale Self 01/07/1968 750000 0

Sum Insured (`) 750,000.00 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 VISHAL UGALE Relationship to Policyholder Son

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 Organ Donor Covered
Emergency Ambulance Limit per
Pre-hospitalization (days) 60 Upto Rs. 2000
hospitalisation
Post-hospitalization (days) 90 Ayurveda/Unani/Sidha/Homeopathy Covered
Health Check Up Per Family (Post 4 Upto 1% Sum Insured,Maximum Upto Rs
Day Care Procedures Covered
Claims Free Years) 5000
Domiciliary Treatment Covered

The Policy Wording attached herewith includes all the standard coverages offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits as 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 (`)

Insured 1 - Parubai Balu Ugale
Basic Premium 21132.22
Loading 000.00
GST 4638.78
Total Premium (Including Service Tax) 25771.00

Payment Details
Cheque No./DD/Fund Transfer Date Bank Name
HI1508007685 25/01/2024 BizDirect

Special Conditions

Exclusions

List of Endorsements
Endt No Description Effective Date

For Claim Services Phone 1860 2000 700 / 1800 2001 999 Fax no. 1860 2000 600 E-mail [email protected]
Address HDFC ERGO General Insurance Company Ltd., Arenja Corner, 211, 2nd floor, Sector 17, Vashi, Navi Mumbai, Maharashtra 400705.
For any other query call toll-free 1800 2 700 700 or email us at [email protected] or log on to www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE
Policy No. 2828 1000 7554 9200 000
Health Suraksha Policy
SILVER PLAN

Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

 -
HDFC ERGO General Insurance Company Limited

-
This card is for identification purpose only.

-
Card has to be presented to the Net work Service Provider at the ti me of ad mission
availing cashless hospitalization or any other services. Insurance claim will be processed in
accordance with the policy terms & conditions. Card does not guarantee cashless hospitalization

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or any other services. For more details and updated list of network service provider please refer

- Fold Here
Member Name : Parubai Balu Ugale
our website or call our call center.
HDFC ERGO ID : 2828100075549200000
Phone Number : 1860 2000 700 / 1800 2001 999
Fax Number 1860 2000 600
DOB : 01/07/1968 Gender: F
Address : HDFC ERGO General Insurance Company Ltd., Arenja Corner,

-
211, 2nd floor, Sector 17, Vashi, Navi Mumbai, Maharashtra
Valid From : 26/02/2024 to 25/02/2025 400705.

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Website : www.hdfcergo.com

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 HDFC ERGO General Insurance Company Limited
Frequently Asked Question's (FAQ's) - Health Suraksha Policy

WHAT IS THIS PLAN ALL ABOUT WHAT IS NOT COVERED IN THE HEALTH SURAKSHA POLICY
HDFC ERGO Health Suraksha is a comprehensive health insurance plan which covers Exclusions valid for the first 30 Days
your medical expenses incurred due to hospitalization involving more than 24 hours. The plan Any illness contracted within 30 days of the inception date of the Policy, except those that are
also covers your pre and post hospitalization expenses, day care procedures, domiciliary incurred as a result of an accident. This clause is not applicable on the subsequent renewals.
treatment, organ donor expenses, emergency ambulance and non-allopathic treatments.
Exclusions valid for the first 2 years (waiting period)#
WHY DO I NEED HEALTH CARD? Cataract; fissuers &/or fistula in anus, hemorrhoids/piles; hernia, hydrocele; gastric and duodenal
The health card is an identification of a valid policy holder of the company. To avail cashless claim erosions & ulcers; deviated nasal septum; all types of skin and all internal tumors/ cysts/
service at network hospitals you need to present this health card at the time of hospitalization. You nodules/ polyps of any kind, including breast lumps, unless malignant; joint replacement, unless
need to register your claim by calling the contact numbers as mentioned on health card. You due to accident; sinusitis and related disorders; stone in the urinary and biliary systems;
can also call these numbers for queries, clarifications and for seeking any kind of surgery on tonsils, adenoids and sinuses; dialysis required for chronic renal failure; benign
assistance pertaining to disease or related hospitalization. pr ostatic hypertrophy; arthritis, gout, rheumatism and spinal disorders; varicose veins/ varicose
ulcers etc. If the policy is renewed with us for two consecutive years, the above diseases/ illness/
Note: Even under family floater plan each member will be issued an individual health card which ailments will be covered from the third year, unless pre-existing.
will be a part of the policy dispatch kit. You must carry a photo id proof of the patient while Exclusions valid for the first 4 years (Pre-existing disease/ injury)
hospitalizing enabling authentication of health card. Any illness/ disease/ injury existing before the inception of the policy. However, this exclusion
ceases to apply if the policy is renewed with the Company for 4 consecutive years.
HOW DO I INCREASE MY COVERAGE i.e. SUM INSURED?
General exclusions
You can increase the Sum Insured at the time of renewal. Such request has to be placed atleast 15 Pregnancy and childbirth related complications, cosmetic, aesthetic and obesity
days in advance of policy expiry. We are sorry to inform you that mid term changes in the Sum related treatment; expenses arising from hiv or aids and related diseases, use or misuse of
Insured are not possible. liquor intoxicating substances or drugs as well as intentional self injury; war, civil war or breach
of law; naturopathy treatment, acupressure, acupuncture, magnetic and other such therapies;
HOW DO I STOP AUTO RENEWAL OF MY POLICY? treatment taken outside the country; vaccination including inoculation and immunizations;
Please SMS ''STOP<policy number>'' to 9999700700 from your registered mobile number. You experimental, investigational or unproven treatments; external congenital disease etc.
will receive a confirmatory communication from us once the request is processed.
# for details, kindly refer to policy wordings.

WHAT IS IPO (INSURANCE PORTFOLIO ORGANIZER)? DO I GET INCOME TAX BENEFIT?

IPO is an online insurance portfolio account of the customer. You can create your portfolio by
Yes, you can avail a tax benefit under Section 80D of Income Tax Act 1961 (Subject to change in
creating your login id and password under Insurance Portfolio Organizer section on our portal,
Income Tax law). Tax certificate is provided along with the policy copy. You can mail the same on
www.hdfcergo.com You can manage your insurance portfolio on your mobile phone also through
your registered email id through IPO, online insurance portfolio organizer.
the IPO Mobile Application. The IPO Mobile Application is supported on the mobile platforms -
Blackberry (OS version 5, 6, 7 & 10), Android (version 2.3 & above), iPhone (iOS 5 & above),
Windows 7 & 8.

HOW TO REGISTER/ TRACK MY CLAIM STATUS? WHOM DO I NEED TO CONTACT TO MAKE CHANGES
OR CORRECTIONS IN MY POLICY
You can track your claim status from any of the below options: 1.You can send duly signed request via any of the below options:
C◾all toll free : 1800 2 700 700 (Accessible fro m India only) ◾F a x : 022- 66383669
F◾ax : 1860 2000 600 ◾Email : [email protected]
E◾mail : [email protected] ◾V i s i t our nearest branch in your city
V◾i s i t IPO: Login into online Insurance Portfolio Organiser (IPO) on the home page of ◾Po st/courier : Customer service office at Andheri (East) in Mumbai.
our w ebsite, w ww .hdfcergo.com 2. Call toll free 1800 2 700 700 (Accessible from India only) for assistance (from your registered
mobile number) Please mention your policy number, correspondence address and contact
Kindly mention your claim number and/ or policy/ reference number in the numbers in the communication.
correspondence. Above numbers can be dialed for queries pertaining to hospitalisation, critical
Note: Supporting documents may be asked for such corrections whereby change of premium
illness, cash less facility and authentication of health cards.
amount is involved or otherwise in the policy on case to case basis.
WHOM WOULD
SHOULD I SEND THE CLAIM DOCUMENTS TO? I RECEIVE ANY CONFIRMATION ON THE CHANGES DONE

Duly signed claim form (available on website) with necessary supporting documents and You will receive an endorsed policy schedule reflecting the changes made in the policy details on
original bills are to be sent to the below address via courier. your correspondence address as provided & mentioned in the policy. Same would be captured in
HDFC ERGO General Insurance Company Limited the policy under the section “List of Endorsements’’. You can view/print the endorsed policy
Stellar IT Park Tower - 1, 5th Floor, C - 25, Sector - 62, Noida - 201 301, Uttar Pradesh. schedule on IPO, the online insurance portfolio organizer. Visit www.hdfcergo.com for the same.
HOW WHAT
DO I RENEW MY POLICY? IS THE RENEWAL BENEFIT FOR

You can renew your policy via any of the below options: 1. On every claim free year, a cumulative bonus of 5% of the Basic Sum Insured is applied to the
a. Visit www.hdfcergo.com to renew instantly online policy (upto a maximum of 50% of the basic sum insured)
b. SMS "RENEW <POLICY NO>" to 9999 700700 ( from your registered mobile number)
c. Visit our nearest branch or contact your agent 2. After every continuous (without a break) 4 claim free years; in every fifth year a free health
d. Send a copy of the renewal notice along with premium cheque to our branch office or check-up upto a cost of 1% of the Basic Sum Insured (not exceeding Rs. 5000) shall be offered
Customer service office as a renewal benefit
e. Call toll-free 1800 2 700 700 (Accessible from India only)
f. Email to [email protected]

Manage Your
◾A dd/View your policies ◾C hange your personal details on the go
Portfolio @ ◾R e g i s t er m ot or / health ◾T r a c k your interactions on endorsement dispatch stat us
Ver.Aug14

hdfcergo.com / claims ◾F i n d branches, g ar ag es and cashless network hospitals

Smartphones* ◾T r a c k your claim st atus
online
* supports smart phone based on Blackberry, iPhone, Windows 8 & Android platform. Download IPO mobile application from IPO website post log in

This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.