Certificate of Insurance Group Policyholder Name COVERME TECHNOLOG PRIVATE LIMITED

Mr Sitesh Kumar Singh Group Policy No. 38652564

F-202 Palam Colony Palam Certificate of Insurance No 76461614
New Delhi Plan Name Group Care 360?(Coverme)-Topup
New Delhi 110077
Cover type Floater
Delhi 07
Policy Period - Start Date 00:00 hrs 22/Dec/2023
Policy Period - End Date Midnight 21/Dec/2024
Nominee Name (Relation) Bharti Singh (WIFE)

Premium Paid Rs. 2,228.00

Premium Rs 1888+CGST Rs 0.00+IGST Rs
339.84+SGST Rs 0.00+UGST Rs0.00
Premium Payment Mode ANNUAL PREMIUM

Details of Applicant

Policyholder Date Of Birth Client ID

Mr Sitesh Kumar Singh 27-Nov-1988 A6448251

Details of Insured Person

Insured with the

Name Client ID Date of Birth Relationship Pre-existing diseases since
Company (since)

Sitesh Kumar Singh A6448251 27-Nov-1988 MEMBER 22-Dec-2023 NONE

Bharti Singh A6448252 08-Apr-1988 SPOUSE 22-Dec-2023 NONE

Contact details for Claims & Policy Servicing

Care Health Insurance Limited, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43,
Correspondence address
Gurugram-122009 (Haryana)

E-mail ID for Claims [email protected]

Website www.careinsurance.com

Intermediary Details

Name Code Contact Details

SHIFT RISK INSURANCE BROKERS LIMITED 20049700 9702555550

Benefits
S No. Particulars Basis of Offering

1 Hospitalization Sum Insured (SI) in Rs. 2000000

2 In - patient care Up to SI
3 Day Care Treatment Up to SI
4 Pre-hospitalization Medical expenses 30 days
5 Post-hospitalization Medical expenses 60 days
6 Domestic Road Ambulance Up to Rs.2,000 per hospitalization
7 Wait Period,30 Days Yes (except for Injuries/Accident)
8 Named Ailment (as defined in Group Care 360 Product) 24 Months
9 Pre-existing diseases 24 Months
10 On Room rent Single Private Room
11 ICU charges No Limit
12 Aggregate Deductible 3 Lacs

Key Exclusions
The company shall not be liable to make payment for any claim directly or indirectly caused by, based on, arising out of howsoever
attributable to any of the following except covered by way of an extension: page3
l Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline
for which he is licensed or any kind of self-medication.
l Charges incurred (or Treatment undergone) in connection with routine eye examinations and ear examinations, dentures, artificial
teeth and all other similar external appliances and / or devices whether for diagnosis or treatment.
l Treatment of any external Congenital Anomaly or Illness or defects or anomalies or treatment relating to external birth defects.
l Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during
hospitalization)or expenses towards lawful medical termination of pregnancy during the policy period.
l Cosmetic surgery or plastic surgery or related treatment of any description, including any complication arising from these treatments, other
than as may be necessitated due to an Injury, cancer or burns
l Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured
Member with any criminal intent
l Act of self-destruction or self-inflicted Injury, attempted suicide or suicide while sane or insane
l Any Illness or Injury attributable to consumption, use, misuse or abuse of intoxicating drugs or alcohol or Tobacco (in any Form like cigarettes
or Gutka etc..)or any other hallucinogens drugs.
Note: This is an illustrative list of exclusions. Please refer Group Policy Terms and Conditions at our website www.careinsurance.com or Group
Policy T&C issued to the Group Master Policy Holder.

Portability/Renewability
S NO. Particulars

1. You can renew the policy only if Master Policy is renewed by Group Master Policyholder.

Care Health Insurance reserves the right to change premium/benefits of the Group Policy at the time of Renewal in consultation
2.
with Master Policy Holder.
You can migrate your existing Policy from this scheme to any Health Insurance retail product of Care Health Insurance. Policy
3.
Issuance subject to Underwriting guidelines of company on the date of migration.
Once the Group Care Health Insurance policy is migrated to retail product of Care Health Insurance, customer will have to pay
4.
premium as per the New product underwriting guidelines.

Grievance Redressal/Complaints
In case of any grievance the Insured Person may contact the Company through
Website/link:https://www.careinsurance.com/contact-us.html
Mobile App : Care Health- Customer App
Toll free (WhatsApp Number): 8860402452
Courier: Any of Company's Branch Office or Corporate Office
Insured Person may also approach the grievance cell at any of the Company's branches with the details of grievance.
If Insured Person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the
grievance officer at Branch Office or corporate office.
For updated details of grievance officer, kindly refer the link- https://www.careinsurance.com/customer-grievance-redressal.html
If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach the
office of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance Ombudsman Rules 2017. The
details of insurance ombudsman offices may be referred in the annexure shared along with the Master policy document.
Grievance may also be lodged at IRDAI integrated Grievance Management System -https://bimabharosa.irdai.gov.in/
For Care Health Insurance Limited

Authorized Signatory

Date of Issue : 21/Dec/2023

Place of Issue : Gurgaon, Haryana
Service Branch : Synergy Business Park Office no 702 & 703 7th Floor Off Aarey Branch Contact No. 9289454793
Road Goregaon East Mumbai Maharashtra :
400063Mumbai,Maharashtra,400063

Consolidated Stamp Duty paid vide E-Challan GRN no. 0107464159 dated 21 Sep 2023, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State
GSTIN No.: 27AADCR6281N1ZS
UIN :RHIHLGP20126V011920
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 to the Group Administrator. In case
you find any discrepancy in the same, please contact us immediately.
3- This Certificate of Insurance is governed by and is subject to the Terms and Conditions of the referred Group Policy.
Premium Acknowledgement
Policy No. 76461614
Client ID A6448251
Policyholder Mr Sitesh Kumar Singh
Address F-202 Palam Colony Palam
New Delhi
New Delhi 110077
Delhi 07

Policy Period 22/Dec/2023 to 21/Dec/2024

Premium Details
Particulars Amount (in Rs.)

Gross Premium
Group Care 360? 1,888.00
Goods & Services Tax (GST) 339.84
Total 2,228.00
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.
Effective from Assessment year 2019-20, in cases where health insurance premium for multiple years is paid in one
year, it will be eligible for proportionate deduction in the years in which the health insurance continues to be
effective.

Signature Not Verified

For Care Health Insurance Limited
Digitally signed by Manish Dodeja
Date: 20231222204235
Reason: I'm the author
Location: India

Authorized Signatory
Date of Issue : 21/Dec/2023
Place of Issue : Gurgaon, Haryana
Note:
1) In case of any discrepancy, the Policyholder is requested to contact the Company 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 the Company in case of Cancellation of the Policy or for the issuance of a fresh
certificate in the case of any alteration in the Policy.
4)This Policy is issued subject to realization of the premium amount. In case the instrument given towards the premium
amount is dishonored, then the cover provided under this Policy shall automatically get cancelled. In the given scenario, if
any amount has been paid by the Company in respect of a claim or due to any other reason than the amount so advanced
by the Company shall be refunded to the Company forthwith.
5) We may credit upto Rs. 1/- to your account for validation, before remitting any further payment.
 No physical Health Cards will be dispatched. The electronic version of the card below will be accepted across all network providers.

www.careinsurance.com
Policy No.

76461614

Member ID DOB NAME

A6448251 27-Nov-1988 Sitesh Kumar Singh
A6448252 08-Apr-1988 Bharti Singh
Submit Your Queries/Requests: www.careinsurance.com/contact-us.html
Disclaimer
1. This card is not transferable
2. Use of this card is governed by the policy terms & conditions
3. To avail cashless facility.this card needs to be produced along with photo ID proof
4. Valid upto policy period end date or cancellation date,whichever is earlier

IRDAI Registration No.148