COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION CARD

ASSIST NO.
NAME : BIPLAB GOPE 110030801693

ADDRESS : VILLAGE - KENDA KENDA WEST BENGAL-713342 START DATE END DATE
21/06/2024 01/07/2024
ASSIST FEES : 711( INCL GST @ 18% )
SMART

You can now enjoy exclusive travel assistance including insurance benefits on your trip.
Kindly ensure to carry this document for a pleasant travel experience.

Travel hassle-free with...

TRAVEL ASSISTANCE TRAVEL INSURANCE

24x7 Medical Lifestyle Domestic Roadside Arranged with an IRDAI authorised underwriter -
Assistance Assistance Assistance Aditya Birla Capital Health Insurance Co. Ltd.

Travel Support Services

Emergency Assistance Expert Intensive Care & Consultation 24/7 Customer Helpline

Ask for help

Note: Assistance provided by ASEGO TRAVEL LLP, Insurance
24x7 helpline: +91 22 67872 037
underwritten by Aditya Birla Capital Health Insurance Co.
Ltd.
Assistance: customercare@asego.in
Claims: claims@asego.in Customer will bear any cost or expenses arising from
availing the assistance ser vices through a third party
ser vice provider.
Whatsapp message only for claims: +91 86478 34444

asego.in

Keep travelling, because the world is waiting for you and we are always by your side.

BON VOYAGE!

Click here or scan the QR code for detailed information about our assistance ser vices.
 Aditya Birla Health Insurance Company Limited, 7th floor, C building, Modi Business Centre, Kasarvadavali, Mumbai, Thane West – 400615
IRDA Regn. No.153
Certificate Of Insurance

Customer Details:

Insured Name: BIPLAB GOPE Date of Birth: 23/10/1999 Passport Number: R6929014
Address: VILLAGE - KENDA KENDA PASCHIM BARDHAMAN WEST BENGAL-713342

Group Active Travel Mobile no: 9903676563 Landline no:

E Mail: CR no:
Issue Date: 06/06/2024 Intermediary Code: 93 -21-00027-00-00
Certificate No: 30801693 Intermediary Name: Asego Insurance LLP

Overseas Travel Insurance

This Group Travel Insurance policy 74-23-9000001-000 & 74-23-9000002-000 dated 16-02-2024 has been issued at Mumbai by Aditya Birla Health
Insurance Company Ltd. to the master policy holder, ASEGO TRAVEL LLP and governed by the terms, conditions and exclusions therein contained or
otherwise expressed in the said policy, but not exceeding the Sum Insured as specified in the Schedule. The master policy holder, Aditya Birla Health
Insurance Co. Ltd. has received an amount of Rs. 219.92 (Incl GST @ 18%) towards covering the risk benefits, on behalf of the above mentioned
insured. This Certificate, represents the availability of benefit to the above mentioned Insured Person.

Insurance Details:

Commencement Date: From: 21/06/2024 End Date: 01/07/2024 No. of Days: 11

Plan Name: AB Single Trip : B-4 25000 Geographical Coverage: Asia Nominee Name: BANALATA GOPE
Relation: MOTHER
Pre-existing diseases excluded are: Exclusions :

Coverages Sum
Deductibles Coverages Sum Insured Deductibles
Insured
In-patient Care for Illness and Injury USD
USD 100 Medical Evacuation USD 15000 USD 100
with Day Care Treatment 25000
USD
Repatriation of Mortal Remains NA Out-patient Care USD 15000 USD 100
10000
USD Personal Accident
Dental Expenses USD 50 USD 10000 NA
300 (AD, PTD, PPD)
USD Delay of Checked-in
Loss of Checked-in Baggage NA USD 100 6 HRS
300 Baggage
USD
Loss of Passport USD 50 Personal Liability USD 100000 USD 100
300
USD
Missed connection 3 HRS Mugging Cover USD 200 NA
500
USD Automatic USD It ’s a part of medical
Compassionate Visit - Travel USD 100 NA
500 Extensions cover upto 7 days
Personal Accident (Common Carrier) - USD
NA Hotel Over Booking USD 500 USD 50
AD, PTD, PPD 1000
* Trip Cancellation (option 5) Trip USD
USD 100
Interruption Trip Curtailment 500
 Emergency Assistance Details:
FA LC K I N DI A PV T LT D
The Peac h tree, B l ock C, S ush ant Lo k – 1 , Se ctor – 43 G u rga on , Ha r yan a - 100 215 .
Rest O f Th e World (Cal l B ack Facil it y) + 91 12 4 4 498 7 8 2
E m ai l Add re ss : a di tya bir la in su ra nc e@ fa lck .com
Ge og ra p hi cal Coverage Wo rld wid e cove ra ge fo r M e dical & Travel re late d as si sta nc e
USA & Ca n a da Tol l F ree N u mb e r + 18 007 487 89 0

Stamp Duty:- The stamp duty of INR. 1/- paid vide MH003394929202122E dated 09/07/2021, 1, received from Stamp Duty Authorities vide Receipt
No./GRASS DEFACE NO 0001811011202122 dated 20/07/2021, , payment has been made vide Letter of Authorisation No. CSD/94/2021/2542 dated
26/07/2021 from Main Stamp Duty Office.

Other Terms & Conditions :

This policy covers Emergency Medical Expenses incurred due to sudden and unexpected injury or any acute Sickness including
COVID-19, arising when insured is outside the 'Republic of India' up to the limits as mentioned in the policy schedule.

● This Travel Insurance policy is only limited to customers of ASEGO TRAVEL LLP.
● Certificate is only valid to the customers who are travelling from India.
This policy covers the insured if travelling to any Schengen & its associate countries to a minimum of Euro 30000 minus deductibles
(if any).
● This policy consist of following coverage's which will be treated as benefit covers i.e. Personal Accident- Accidental Death
Permanent Total Disability (PTD) Permanent Partial Disability (PPD), Accidental Death-Common Carrier, Permanent Total Disability -
Common ,Permanent Partial Disability - Common carrier, Daily Allowance in case of Hospitalization, and Hijack Distress Allowance
subject to policy terms and conditions applicable to these sections.
Pre-existing condition(s) are excluded from the policy including but not limited to unforeseen emergency measures to save the
Insured/Insured person’s life. This exclusion will apply to the following sections: Emergency Medical Expenses, Emergency Medical
Evacuation, Dental Treatment Expenses, Daily Allowance in case of Hospitalization, Permanent Total Disability (PTD), Permanent
Partial Disability (PPD). This exclusion has been waived to the extent of USD 1500 per policy or upto 10% Sum Insured whichever is
lesser & limited to section i.e. Emergency Medical Expenses, Emergency Medical Evacuation, Dental Treatment Expenses, Daily
Allowance in case of Hospitalization, Permanent Total Disability (PTD), Permanent Partial Disability (PPD).
*This policy covers if the trip is unavoidably Cancelled/Interrupted or curtailed solely and directly results of following: Option 5 :-
Perils of Trip Cancellation/Interruption/Curtailment. Major industrial accident. Civil Unrest, Riot or Commotion resulting in
cancellation of scheduled Common Carrier services or relevant government warning against non-essential travel. War like situation
event leading to airspace or multiple airport closures. Mechanical breakdown of Common Carrier or Strike resulting in cancellation
of scheduled Common Carrier services. Act of Terrorism In the city of residence and or departing station or at the intended
destination as per travel itinerary. Curfew in home city/departing station or intended destination as per travel itinerary.
Hospitalization of Insured person / Immediate family member. Death of insured person / immediate family member. Termination of
employment or layoff of the Insured Person. Any theft, burglary, fire or allied perils at the insured’s place of residence or business.
Natural Calamity or Weather condition. Lockdown in city / state / country mentioned on the original itinerary due to a major
outbreak of Infectious disease. Insured person / immediate family member is admitted in hospital for treatment of pandemic.
Cancellation or Interruption of trip due to diagnosis of the insured’s Immediate Family Member (or relative) with any infectious or
contagious disease in the country intended to be visited and which is evident from the confirmed itinerary possessed by the
insured. Insured person / immediate family member requiring treatment on OPD basis. Epidemic or pandemic as declared by the
World Health Organization or Respective country / state Government and travel restrictions imposed by Central or State
Government.

● This policy does not cover any claim arising out of sporting activities in so far as they involve the training or participation in
competitions of professional or semi-professional sports persons, Adventure Sports unless declared beforehand and necessary
additional premium paid and mentioned in the policy schedule.

The certificate has been issued based on the information provided by you/your representative and the policy is not valid if any of
the information provided is incorrect, subject otherwise to the Terms, Conditions and Exclusions mentioned in the policy

Grievance Redressal :
In case of a grievance, the Insured Person/ Policyholder can contact Us with the details through our website: www.adityabirlacapital.com,
Email:care.healthinsurance@adityabirlacapital.com or Toll Free: 1800 270 7000. Address: Any of Our Branch office or Corporate office. For senior
citizens, please contact respective branch office of the Company or call at 1800 270 7000 or write an e- mail at
seniorcitizen.healthinsurance@adityabirlacapital.com. The Insured Person can also walk-in and approach the grievance cell at any of Our branches. If
in case the Insured Person is not satisfied with the response, then they can contact Our Head of Customer Service at the following email
carehead.healthinsurance@adityabirlacapital.com. If the Insured Person is still not satisfied with Our redressal, he/she may approach the nearest
Insurance Ombudsman. The contact details of the Ombudsman offices are provided on Our website and in the Policy.

Important –

1. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate of Insurance. For
complete set of benefits, terms, conditions & exclusions please refer policy wordings.

2. The assignment of Benefits under the Policy shall be allowed subject to applicable law.
• Below Sublimit is applicable from the age 61 Years up to the age of 80 years for Emergency Medical Expenses.
Sub limi t A pp lica bl e - from 6 1 Ye a rs - 80 Ye a rs
Room Re nt incl ud in g B oardi ng lo dgi ng $ 150 0/day up to 30 days
Intens i ve Ca re un i t $ 200 0/day u p to 7 d ays
Op eratio n Th eatre ch arges ( Inclu si ve s urgeo n c ha rge s ) ” M ax im um Up to U SD 7 5 00
An esth eti st s e r vi ces Up to 25 % o f S urg ica l Tre atm e nt
Physi ci an Vis it M ax $ 75/d ay up to 10 v is i ts
D iagn ostic an d R ad i olo g y s er vi ce s M ax up to US D 50 0
Amb ul an ce S e r vi ces Max up to $ 3 00
Hos p i tal Mis cel la n eou s Ex pe n se s M ax im um o f U S D 10 0 0

• Sublimit applicable for age group 81- 85 years is limited to Emergency Medical Expenses is restricted to USD 5000 per illness &
Injury.
• These sublimit are waived if Waiver of Restriction/ Sub-Limit On Medical Expenses Rider is specifically opted for by the Insured &
is mentioned on the certificate.

Scan the code to

authenticate policy
For Detailed Terms & Conditions of your Travel Insurance Policy Kindly Click here or paste the link https://asego.co/new/GroupTravelProtect.pdf on
your browser.
Website: www.adityabirlacapital.com; IRDA Reg. No: 153, Email: care.healthinsurance@adityabirlacapital.com
Aditya Birla Health Insurance Company Limited, 7th floor, C building, Modi Business Centre, Kasarvadavali, Mumbai, Thane West – 400615
UIN: ADITGBP19020V011819 & ADITGBP23002V012223. CIN: U66000MH2015PLC263677
*This is a computer generated statement doesn't need any signature