Mr.

ASHIT BISWAS
VILL SIMULPUR - 743287
Mobile No: ******4700

Certificate of Insurance(COI) -Smart Health

How to reach us?

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www.nivabupa.com/renew

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Important Terms & Conditions (T&C)

a. Niva Bupa requests you to refer to the detailed Terms and Conditions (T&C) available with the Group Master Policyholder.
You may also refer the T&C on our website.
b. Free Look Provision: You can review the T&C within the number of days specified overleaf and request cancellation of the
Certificate of Insurance in case of objections to any T&C. We will refund the premium as specified in the T&C provided that
no claim has been registered under the cover.
c. Grievances Redressal In case of any query or complaint/grievance, you may approach our office at the below mentioned
address. In case you are not satisfied with our resolution, You ,may register a complaint in the Integrated grievance
Management System (IGMS) of IROAI or approach the Insurance Ombudsman. Details about the IGMS and Ombudsman
are available on our website.
 Certificate of Insurance(COI) - Smart Health

Group Master Policy Number 50648400202400 Group Master PolicyHolder Name Bandhan Bank Limited

Group Master Policyholder Address DN 32 Salt Lake City Sector V Group Master Policy Issue date 14/01/2025
& Pincode Kolkata WEST BENGAL 700091

Certificate Number 20350003367989 Proposer Name Mr. ASHIT BISWAS

Cover Inception Date and Time 14/01/2025 12:00 AM Proposer Address & Pincode VILL SIMULPUR - 743287

Cover Expiry Date and Time 13/01/2026 11:59 PM Contact Number ******4700

Insured details

Certificate No. Salutation Insured Name Date of Birth/ Age Gender Relationship Sum Insured

20350003367989 Mr. ASHIT 13/12/1981 M Self

500000.00
BISWAS

Nominee details

Nominee Name Relationship Nominee Address (if different) Appointee Details(if nominee is minor)

BINDU BISWAS Mother

Benefit Structure

In-patient Treatment Covered upto Sum Insured

Single Private Room, ICU Up to Sum

Room Rent/Day, ICU rent/day
Insured

Pre (90 days) & Post (180 days) Hospitalization Covered upto Sum Insured

Listed 536 treatments Covered upto Sum

Day Care Treatments
Insured

Organ Transplant Covered upto Sum Insured

Alternative treatment Up to Base Sum Insured

Emergency Ground Ambulance- Within India (one transfer per Hospitalization) INR 2000 per Hospitalization

Domiciliary Hospitalization Up to Base Sum Insured

Modern Treatment Up to Base Sum Insured as per T&C

INR 1000 after 1st Renewal for the full

Health Check-Up
policy

Critical Illness Multiplier Indemnity Cover 2x of base sum insured

10% increase in base sum insured. Up to

Loyalty Benefit
100% of base sum insured

100% of base sum insured. Unlimited.

Reassure Benefit
Same illness

INR 1000 per day, Maximum 15 days in a

Daily Cash Benefit
policy year

Waiting Periods

Initial Waiting Period 30 Days

Waiting Period for Disease Specific Exclusions 24 Months

Pre-Existing Disease (PED) Waiting Period 36 Months

Free Look Period 15 days

Intermediary Details
 Intermediary Name Intermediary Code Intermediary Contact No

Bandhan Bank Ltd BNK0180001 018002588181

GST Details:

GSTI No.: 09AAFCM7916H1Z6 SAC Code / Type of Service : 997133 / General Insurance Services

Niva Bupa State Code : 09 Customer State Code / Customer GSTI No. : 19 / NA

Premium Details

Net CGST(0.00%) SGST/UTGST(0.00%) IGST(18.00%) Gross Gross Premium(Rs.) (in words) Premium
Premium(Rs.) Premium(Rs.) frequency

6419.49 0.00 0.00 1155.51 7575 Seven Thousand Five Hundred Seventy Five Single
Only

Income tax benefit u/s 80D is available as per the existing Income Tax Laws.Please consult your tax advisor for more details.
This Policy is subject to the terms, conditions and exclusions mentioned in the Smart Health, UIN : NBHHLGP25038V012425
The contract will be cancelled ab intio in case; the consideration under the policy is not realized.
Policy issuing office : Delhi , Consolidated Stamp Duty deposited on the Master Policy.
Goods and Service Tax Registration No.: 09AAFCM7916H1Z6
The cover may be renewed on sole discretion of Niva Bupa Health Insurance Co Ltd subject to member being the part of the group at the time of
renewal also. In case You cease to be a member of the group, the cover will stand cancelled as per T& C of the policy
Where the proposal form is not received, information obtained from insured, whether orally or otherwise, is captured in the policy document.
Discrepancies, if any, in the information contained in the policy document may be pointed out by an insured within 15 days from the policy issue date
after which information contained in the policy document shall be deemed to have been accepted as correct.
For registration of claims You may contact us at:
Claims Department, Niva Bupa Health Insurance Company Limited, 2nd Floor, Plot No D-5, Sector 59, Noida, Gautam Budhnagar – 201301 Fax No.:
011-3090-2010 Or reach Us on customercare @nivabupa.com

Location: Noida, Uttar Pradesh

Director - Operations & Customer Service
Date: 14/01/2025
For and on behalf of Niva Bupa Health Insurance Co.Ltd.
(Formerly known as Max Bupa Health Insurance Co.Ltd.)