HDFC ERGO General Insurance Company Limited

2952200871807204000

Mr K Achari
Dr No 24/156 Dosulava Street Oppt Ramalam
Temple Ananthapur Old Town . Ananthapur,
515001
Andhra Pradesh
Contact No : 88XXXXXXX2

Date : 20/11/2023

Dear Mr K Achari

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 2952200871807204000 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.

As a measure of our customer convenience we have implemented a Lifetime Validity Health Card. For you, this simply means that your Health Card is valid for all subsequent
renewals and as long as your policy is active with us. Hence, you need not replace your health card every year

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!!
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.

Arun Sharma
Head - Customer Experience Management

HDFC ERGO General Insurance Company Limited 2952200871807204000

TAX CERTIFICATE

Dear MR K ACHARI

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax Act, 1961

This i s to certify that we have received an amount of ` 14349 towards premium for my: health Suraksha Policy , Policy No. 2952200871807204000 issued to for
the period 20/11/2023 to 19/11/2024.

Note : This is subject to the provisions of Section 80D of income tax Act, 1961 as amended from time to time.

For HDFC ERGO General Insurance Company Ltd.

Date : 20/11/2023

Policy Issuing Office: Mumbai

Duly Constituted Attorney

Congratulations !!!! Basis your claim history, you are now eligible for 4 claim free year coupons

Step 1: Call 022 - 6234 6234 / 0120 - 6234 6234 to fix an appointment

Step 2: Visit nearest Diagnostic centre opted for check up

Subject to the conditions laid down in the Policy, the eligible Insured Person(s), included in each policy year is/are entitled for one time health check up benefit up
to an amount equals to Rs. 3000. To avail this benefit, the Insured Person(s) is/are required to carry the photo copy of the policy.
Health check up benefit is valid till 365 days from policy renewal date. Please call 022 - 6234 6234 / 0120 - 6234 6234 for any further details
and assistance.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. 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
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE my: health Suraksha Policy
Silver

2952200871807204000

Policy No. :2952 2008 7180 7204 000 Issuance Date :20/11/2023
Period of Insurance :From 20/11/2023 18:55 hrs To 19/11/2024 Midnight
Invoice No. :200871807204000 Premium Frequency :Yearly
0

HSN Code :997133 Policy Type :Family Floater

Mr K Achari Proposer Name :Mr K Achari PAN :
Dr No 24/156 Dosulava StreetOppt Ramalam
Customer Id :101308171465
TempleAnanthapur Old Town .Ananthapur
Andhra Pradesh, 515001, Contact No : 88XXXXXXX2
EIA No. : Not provided
Payment Details : 1002311206250 , Bank Name:HDFC Bank Ltd
Email ID :
Insured Person’s Details & Sum Insured
Insured's Name Relation with Gender DOB Nominee Name Nominee 1st Policy Basic Sum Tier CB Amount Pre
policy holder Relationship Inception Insured (`) (`) Existing
Disease
K Dhanujaya Self Male 12/08/1980 K Ratna Spouse 07/10/2014 500000 Tier 2 240000 NO
K Ratna Wife Female 12/09/1984 07/10/2014 NO
Schedule of Coverage
Section Covers Details/ Applicability of Sum Insured Limit
Base Covers
A Hospitalization Cover up to Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
Medical Expenses Basic Sum Insured and CB
1B Mental Healthcare Basic Sum Insured and CB
2 Home Healthcare Basic Sum Insured and CB
3 Domiciliary Hospitalization Basic Sum Insured and CB
4 Pre-Hospitalization 60 Days
5 Post-Hospitalization 180 Days
6 Day Care Procedures Basic Sum Insured and CB
7 Road Ambulance cover Sub limited within the Basic Sum Insured including SI 1 to 5 L -2,000
Cumulative Bonus SI 6 to 50 L -3,500
SI Above 50 L -15,000
8 Organ Donor Expenses upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
9 Alternative Treatment upto Basic Sum Insured including cumulative Bonus Basic Sum Insured and CB
* You will have to bear 20% of the admissible claim amount, if you undergo treatment in Delhi, NCR, Mumbai, Thane, Mumbai Suburban, Navi Mumbai, Surat,
Ahmedabad & Vadodara.
Optional Covers
C6 Sum Insured Rebound over and above the Basic Sum Insured Upto 100% of Basic Sum Insured
C12 ECB Extended Cumulative Bonus per claim free year, as per <10% of sum insured, Max 100%>
option opted for
Renewal Benefits
1 Prevent Health Check-up 1% of Sum insured for every 4 claim free years (max upto 5000)
2 Cumulative Bonus Applicable (5% of sum insured , max upto 50%)
3 my:health Active Applicable
Waiting Periods
Sec E 1 i - General waiting period - 30 days from Policy inception date
Section A Hospitalization Cover Sec E 1 ii - Listed illness & procedures - 24 Months
Sec E 1 iii - Preexisting conditions - 48 Months
Premium Details (`)
Basic Premium 12,160.00
Loadings 0.00
Integrated Tax 18% 2,189.00
Total Premium 14,349.00
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.The stamp duty of Rs. 1/- ( Rupees One And Zero Paise Only ) paid vide e-stamp Certificate No.(LOA/ENF-1/CSD/34/2023/ Validity Period
Dt. 28/12/2023 to Dt. 31/12/2026. OW No. 6045 Date 27/Dec/2023 GRN NO. MH011651000202324M Dt. 05/12/2023, SBI Bank & DEFACE No. 0006692260202324 Dt. 21/12/2023) dated 27/12/2023 as
prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". GST Registration No: 36AABCL5045N1Z9. 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 :aditya jr towers, 8-2-120/86/9/a&b, 3rd floor road no-2, banjara hills hyderabad Write to us : feedbackgeneral.insurance@in.hdfcbank.com

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. 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
HDFC ERGO General Insurance Company Limited
POLICY SCHEDULE

my: health Suraksha Policy

MY: HEALTH SURAKSHA POLICY

For HDFC ERGO General Insurance Company Ltd.

Agent Name :HDFC BANK LTD Agent Code :201587086428 Tel No. : 91-22-61606161

Duly Constituted Attorney

"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. 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
HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited 2

Policy No.:2952200871807204000 This card is for identification purpose only.
Valid From: 20/11/2023 Renewal Date: 19 November
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
K RATNA 10010000 12/09/1984 Female call our call centre. This card is valid till the time policy is active.

K DHANUJAYA 10010000 12/08/1980 Male Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
Fax Number : 022 - 6234 6234/0120 - 6234 6234
Email : healthclaims@hdfcergo.com
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

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP24079V072324. 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