My: Optima Secure

HDFC ERGO General Insurance Company Limited
2856101374817000001
my: Optima Secure
2856101374817000001
2856
MR KIRAN RAJ R
MINI NIVAS
House No66 Vattiyoorkavu PO
THIRUVANANTHAPURAM, KERALA, 695013
Contact No. 90XXXXXXX2
Date :06/10/2023
Dear MR KIRAN RAJ R
Thank you for choosing HDFC ERGO GENERAL INSURANCE COMPANY LTD. as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2856101374817000001 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!!
As per recent directive by Insurance Regulator IRDAI, KYC verification has been mandated for all existing & new insurance customers.
To ensure that we comply with this guidelines, we are retrieving your KYC documents (Address proof and Photo) updated with Pan No from CERSAI portal. Rest assured, your
KYC details will be verified or retrieved for KYC purpose only.
Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.
Soft copy of the policy is valid for all purposes including claims.
For HDFC ERGO General Insurance Company Ltd.
Duly Constituted Attorney
Dear MR KIRAN RAJ R,
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 ` 1644 towards premium from MR KIRAN RAJ R for my: Optima Secure, Policy No. 2856101374817000001
issued to MR KIRAN RAJ R for the period 01/10/2023 to 31/10/2023.
Member wise premium break up is as follows:

Insured Person’s Premium Details
Name of Insured Person Relation with policy Gender Date of Birth Premium Goods & Services Total Premium including
holder Tax (GST) GST
Kiran Raj R Self Male 18/04/1998 696.67 125.4 822.07
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 : 06/10/2023
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP23123V022223. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
2856101374817000001
Policy Schedule - Endorsed Copy
my: Optima Secure
Optima Secure
2856101374817000001
Policy Number : 2856 1013 7481 7000 001 Issuance Date : 06/10/2023
Period of Insurance : From 01/09/2023 13:57 hrs To 31/08/2024 Midnight
Invoice No. : 101374817000001 Premium Frequency : Monthly
Policyholder Name : Mr Kiran Raj R Policy Type : INDIVIDUAL
MR KIRAN RAJ R HSN Code : 997133 Premium Tier : Tier2
MINI NIVAS House No66 Vattiyoorkavu PO Place of supply : KERALA Previous Policy
THIRUVANANTHAPURAM, KERALA-695013 Customer Id : 100781138003 Renewal : No
Contact No : 90XXXXXXX2
EIA No. : Not provided
PAN : HEHPK5187J
Email ID : [email protected]
Intermediary Name Intermediary Code Intermediary Contact Number
HE DIRECT_DBG DIRECT_10137 200278133519 91-22-66383600
Insured Person’s Details and Sum Insured - Optima Secure

Insured Person’s Relation with Gender Date of Nominee Name Relationship First Policy Base Sum Aggregate Plus Benefit Unlimited Overseas
Name policy holder Birth with Nominee Inception Insured Deductible Restore Add Travel
date (`) (`) on(Y/N) Secure
Kiran Raj R Self Male 18/04/1998 Anitha Kumari R Mother 01/09/2023 500000 0 0 No No
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Unlimited Restore UIN No: HDFHLIA22188V012122 Optima Wellbeing UIN No:HDFHLIA24099V012324
Insured Person’s Details and Sum Insured – Add On Covers
Optima Well my: health Critical illness Add
IPA Rider my: health Hospital Cash Benefit Add on
Being on
Insured Person’s Name Sum Plan Sum Insured Hospital Cash Hospital Cash Companio Hospital Hospital Cash
Insured Benefit - Normal Benefit - ICU n Benefit Cash Global - Global
Room Opted
Special Conditions/ Exclusions

Name of Insured Person Exclusion/Exclusion Wavier Loading Reason Special Condition / Declared Pre-existing
Disease
Renewal Continuity Benefits

Sum Insured (`) Waiting Periods Remaining Waiting Periods Remaining Waiting Periods Remaining: (30
Name of Insured Person
(Pre-existing Diseases) (Specific Waiting Period) Days Waiting Period)
Portability Continuity Benefits

Name of Insured Person Previous Sum Insured inclusive Porting Benefits on Waiting Periods Waiting Periods Waiting Periods
Policy Year of Cumulative Bonus Sum Insured (`) Remaining (Pre-existing Remaining (Specific Remaining: (30 Days
(`) Diseases) Waiting Period) Waiting Period)
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 022 - 6234 6234 / 0120 - 6234 6234.
For declared and accepted pre-exiting medical conditions, waiting period (s) shall apply per policy terms and conditions from 1st policy inception date of the policy,
fresh waiting period (s) shall apply on enhanced sum insured.
Premium Details (`)
Particulars Kiran Raj R
Base Premium (A) 733.33
Optional Cover Premium (B) 0
Add on Cover Premium (C) 0
Loading (D) 0
Total Premium (E=A+B+C+D) 733.33
Aggregate Deductible Discount 0
Online Discount 36.67
Employee Discount 0
Loyalty Discount 0
Family Discount 0
Long term Policy Discount 0
Total Discount (F) 36.67
Total Premium excluding GST (E-F) 696.67
Integrated Tax 18% 125.4
Total Premium including GST 822.07
Payment Details
Instrument details 92620231006000115345 Date 06/10/2023 Bank Name HDFC BANK LTD
HDFC ERGO General Insurance Company Limited 2856101374817000001
Payment Schedule
Year 1 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Premium
01/09/2023 01/10/2023 01/11/2023 01/12/2023 01/01/2024 01/02/2024 01/03/2024 01/04/2024 01/05/2024 01/06/2024 01/07/2024 01/08/2024
Due Date
Total
Premium 822 822 822 822 822 822 822 822 822 822 822 822
(incl. GST)
Paid Status PAID PAID UNPAID UNPAID UNPAID UNPAID UNPAID UNPAID UNPAID UNPAID UNPAID UNPAID
Note for premium payment in instalments:
a. In the event of a claim, all subsequent premium instalments shall immediately become due and payable.
b. The Company has the right to recover and deduct all the pending instalments from the claim amount due under the policy.
List of Endorsements
Endt No Description Effective Date
001 EMI Collection Endorsement 06/10/2023
Processing Centre
HDFC ERGO General Insurance Co. Ltd. , Stellar IT Park, Tower-1, Fifth Floor, C - 25, Sector 62, Noida - 0120 398 8360
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make
changes/register & track claim.
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 noLOA/CSD/547/2022/5450/22 dated 22/12/2022 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th
January 2018. GST Registration No: 27AABCL5045N1Z8". GST for this invoice is not payable under reverse charge basis.
I/ 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
Branch :leela business park, 6th flr, andheri - kurla rd, mumbai
For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings
SCHEDULE OF BENEFITS
Section* Plans Optima Secure
All figures Geography
India Only
in (`)
2 Base Sum Insured per Insured Person per Policy
500000
Year (in Lakh)
1.1. Hospitalization Expenses Covered
1.1.a. Room Rent At Actuals
1.1.1.h. Road Ambulance Covered upto sum insured
1.1.1.i. Dental Treatment Covered upto sum insured
1.1.1.j. Plastic surgery Covered upto sum insured
1.1.1.k. Day Care Treatment Covered upto sum insured
1.2. Home Healthcare Covered upto sum insured
1.3. Domiciliary Hospitalization Covered upto sum insured
1.4. Ayush Treatment Covered upto sum insured
1.5. Pre-Hospitalization 60 days
1.6. Post-Hospitalization 180 days
1.7. Organ Donor Expenses Covered upto sum insured
2.1. Emergency Air Ambulance Covered Up to 500000
2.2. Daily Cash for choosing Shared Accommodation 800 per day max up to 4800
2.3. Protect Benefit Covered upto sum insured
2.4. Plus Benefit Bonus of 50% of the Base Sum Insured, maximum upto 100%.
2.5. Secure Benefit Equal to 100% of Base sum insured
2.6. Automatic Restore Benefit Equal to 100% of Base sum insured
2.7. Aggregate Deductible 0
2.8. E-Opinion for Critical Illness In India
Preventive Health Check-up
3. Sum Insured 5 Lakhs 500000
Individual Policy* 1500
*For Individual policy sum insured and limits mentioned in the table are applicable on per Insured Person per Policy Year basis and for Family Floater policy sum insured and limits
apply on per policy per Policy Year basis
*Claims shall be payable as per geography mentioned in the above table unless explicitly stated otherwise in a specific cover.
#Aggregate Deductible & Overseas Travel Secure are not an inbuilt feature in any of the above Plans. However, these cover can be separately opted at inception of the Policy or at
subsequent Renewals. Aggregate Deductible if opted, shall apply only for claims arising in India. However, a Per Claim Deductible of Rs. 10,000 will apply separately for each and
every claim arising out of India in Global plans
*Preventive Health Check-up benefit will not be available under the policy if Aggregate Deductible of INR 5 Lakhs or more is in force

Policy No.:2856101374817000001 This card is for identification purpose only.
Valid From: 01/09/2023 Renewal Date: 31 August
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Insured Name Member ID Date Of Birth Gender with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
Kiran Raj R 2023310031412788 18/04/1998 Male call our call centre. This card is valid till the time policy is active.
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

Email : [email protected]
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com

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HDFC ERGO General Insurance Company Limited

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited

Dear MR KIRAN RAJ R,

Member wise premium break up is as follows:

For HDFC ERGO General Insurance Company Ltd.

Insured Person’s Details and Sum Insured - Optima Secure

Special Conditions/ Exclusions

Renewal Continuity Benefits

Portability Continuity Benefits

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited 1

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

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