Date : 09 Apr 2024
Mr Samir Surendrabhai Shah
A4 Narnaryan Soc
Maninagar
.
Ahmedabad 380008
Gujarat
State Code : 24
Policy No: 82138852
Mobile No: XXXXXX1042
Dear Mr Samir Surendrabhai Shah,
Thank You for trusting us as your preferred Health Insurer.
At Care Health insurance, it is our endeavor to make quality healthcare easily accessible for our customers as well as ensure a truly hassle-free claim
servicing experience
To help you understand our services better, please go through the 'Know your policy better' kit that accompanies this
letter and constitutes the following
l Policy certificate
l Premium Acknowledgement
l Key Policy Information
l Claim Process - http://bit.ly/3EyPRnT
l Policy Terms and Conditions- https://bit.ly/3UMzQ3S and also available on Customer App
Also appended herewith for your convenience is your Care Health Card. This card should be presented at the time of an emergency or a planned
hospitalization, to avail cashless treatment at our network of over 16000+ cashless network pan-India.
To further simplify procedures, we're online as well. Visit our portal www.careinsurance.com and view network hospitals across the country, cashless
procedures and do much more.
For any assistance, please feel free to write to us at https://www.careinsurance.com/contact-us.html.
Once again, we thank you for this opportunity to serve you, and wish you and your loved ones good health always!
Team Care Health Insurance
CUSTOMER APP
For Android For iOS
Policy Certificate Policy No. 82138852
Mr Samir Surendrabhai Shah Plan Name Care Supreme
A4 Narnaryan Soc Cover Type Floater
Maninagar Policy Period - Start Date 00:00 hrs 11-Apr-2024
.
Policy Period - End Date Midnight 10-Apr-2025
Ahmedabad 380008
Gujarat Nominee Name (Relation) Shah Sukeshi Samirkumar (SPSE)
State Code : 24 Premium Paid Rs.26,472.00
(Premium Rs 22433.76+Underwriting Loading
Rs 0.00+CGST Rs0.00+IGST Rs4,038.10+SGST
Rs0.00+UGST Rs0.00)
Premium Payment Mode Single Premium
Policyholder Gender Date Of Birth Client ID
Mr Samir Surendrabhai Shah Male 30-Jan-1979 B4993639
Details of Insured Person
Date of Birth Pre-existing diseases Insured with the
Name Client ID Relationship Sum Insured
(DD-MM-YYYY) (since) Company (since)
port benefits passed
Samir Surendrabhai
B4993639 MEMBER 30-Jan-1979 for Diabetes and 11-Apr-2024 10,00,000.00
Shah
Hypertension
Shah Harsh Samir B5000791 SON 31-Aug-2005 NONE 11-Apr-2024
Shah Sukeshi
B5000797 SPOUSE 24-Oct-1983 NONE 11-Apr-2024
Samirbhai
Shah Krisha Samirbhai B5000799 DAUGHTER 27-Aug-2008 NONE 11-Apr-2024
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
Care Health Insurance Ltd. Direct https://www.careinsurance.com/contact-us.html
Schedule of Benefits
S No. Particulars Basis of Offering
1 Sum Insured 1000000
2 In-Patient Care Up to SI
3 Day Care Treatment All Day Care Procedures
4 Advance Technology Methods Up to SI
Up to SI, Pre-Hospitalization expense cover for 60 days prior to
5 Pre-Hospitalization Medical Expenses
hospitalization
Up to SI, Post-Hospitalization expense cover for 180 days after
6 Post Hospitalization Medical Expenses
discharge
7 AYUSH Treatment Up to SI
8 Domiciliary Hospitalization / Organ Donor Cover Up to SI
9 Ambulance Cover Up to Rs. 10,000
Schedule of Benefits
10 Cumulative Bonus 50% of SI, max up to 100% of SI.
11 Unlimited Automatic Recharge Available for unlimited times for unrelated or same illness.
12 Unlimited E-Consultations Available for Consultations with General Physicians
13 Health Services (Health Portal) Doctor on chat, Healthy tips reminder, etc.
Discounts on services such as consultations, diagnostics etc at our
14 Health Services (Discount Connect)
network
15 Room Rent All categories covered.
16 ICU No Limit
17 Named Ailments Coverage 24 Months
18 Pre-existing Diseases Coverage 48 Months
19 Initial Wait Period 30 Days
20 Organ Donor Cover Up to SI
Optional Cover
S NO. Particulars Details
1 Annual Health check up Once for all Insured every policy year
Upto 100% increase in the Sum Insured, on a cumulative basis for
2 Cumulative Bonus Super
each completed and continuous policy year upto a max of 500%
Discount on renewal premium based on active days achieved.
1 Wellness Benefit Online fitness Coaching/Counselling session from Wellness
Coaches
2 Air Ambulance Cover Up to 5 lacs per year.
Portability Details of the Insured
Previous Insurer : United India Insurance
1st Enrollment Expiry Policy SI Rs.
Name First Policy Number Expiry Policy Number
Date (Original SI+CB)
SAMIR SURENDRABHAI SHAH 0604002823P1 0604002823P100372670 09-Apr-2008 3,00,000 + 0
Shah Harsh Samir 0604002823P1 0604002823P100372670 09-Apr-2008 3,00,000 + 0
Shah Sukeshi Samirbhai 0604002823P1 0604002823P100372670 11-Apr-2022 3,00,000 + 0
Shah Krisha Samirbhai 0604002823P1 0604002823P100372670 09-Apr-2008 3,00,000 + 0
For Care Health Insurance Limited
Authorized Signatory
Date of Issue : 09 Apr 2024
Place of Issue : Gurgaon, Haryana
Service Branch : 1st and 2nd floor Plot no F1 Sector6 Noida 201301Noida,Uttar Pradesh, Branch Contact No. : 0120-4888701
201301
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.: 09AADCR6281N1ZQS_GSTIN_No
UIN :CHIHLIP23128V012223
Note:
- Attached with this Policy Certificate are the Policy terms and conditions, Optional Covers (if opted) and Annexures. Please ensure that
these documents have been received, read and understood. If any of these documents have not been received, please feel free to write
to us at https://www.careinsurance.com/contact-us.html
- For waiting periods and exclusions under this Policy, please refer to Clause 4 of the Policy terms and conditions.
- This Policy Certificate in original must be surrendered to the Company in case of cancellation of the Policy.
Premium Acknowledgement
Policy No. 82138852
Client ID B4993639
Policyholder Mr Samir Surendrabhai Shah
A4 Narnaryan Soc
Maninagar
Address .
Ahmedabad 380008
Gujarat
Policy Period 11-Apr-2024 to 10-Apr-2025
Premium Details
Particulars Amount (in Rs.) S.No. Receipt Number Amount Mode of Payment
1 A9470350 26,472.00 IPG
Gross Premium
Care Supreme 18,806.40
Annual Health Checkup(Supreme) 1,212.60
Cumulative Bonus Super 1,880.68
Wellness Benefit (Supreme) 123.24
Air Ambulance Cover (Supreme) 410.84
Goods & Services Tax (GST) 4,038.10
Total 26,472.00
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.
For Care Health Insurance Limited Signature Not Verified
Digitally signed by Manish Dodeja
Date: 20240409142948
Reason: I'm the author
Location: India
Authorized Signatory
Date of Issue : 09 Apr 2024
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.
Proposal Form-'CARE SUPREME'
Dear Mr Samir Surendrabhai Shah
In reference to your online proposal (1120073133102) for 'Care Supreme'- Comprehensive Health Insurance policy, please find below the
details as provided by you:
Proposer Details
Name : Mr Samir Surendrabhai Shah
Address : A4 Narnaryan Soc
Maninagar
Ahmedabad .,Gujarat
380008
Date of Birth : 30-Jan-1979
Landline : +91-
Mobile : XXXXXX1042
E-mail : [email protected]
Details of the Persons be Insured
Name Date of Birth Relation Pre-existing Diseases
port benefits passed for Diabetes and
Samir Surendrabhai Shah 30-Jan-1979 MEMBER
Hypertension
Shah Harsh Samir 31-Aug-2005 SON NONE
Shah Sukeshi Samirbhai 24-Oct-1983 SPOUSE NONE
Shah Krisha Samirbhai 27-Aug-2008 DAUGHTER NONE
Additional Details
1. Does any person(s) to be insured has any pre-existing diseases?
Insured1 Insured2 Insured3 Insured4
Y N N N
2. Have any of the person(s) to be insured ever filed a claim with their current / previous insurer?
Insured1 Insured2 Insured3 Insured4
N N N N
Has any of your proposal(s) for Health insurance been declined, cancelled, charged a higher premium or issued with
3.
special condition(s)?
Insured1 Insured2 Insured3 Insured4
N N N N
Is any of the person(s) proposed for insurance covered under any other health insurance policy with the Company or any
4.
other Company without break?
Insured1 Insured2 Insured3 Insured4
N N N N
You agreed to following terms & conditions of the purchase of policy
a. I have read and understood the Brochure/Prospectus/Sales Literature/Terms and Conditions of the Policy and confirm to abide by
the same.
b. Receipt of proposal form by the Company shall not be construed as acceptance of proposal. Commencement of risk under the
Policy shall be subject to realization of full premium and individual underwriting by the Company. The Company at its sole discretion
reserves the right to accept or reject or load any proposal. Policy would start from the date as specified in the Policy Certificate.
c. I understand that the Policy Period Start Date as specified in the Policy Certificate shall be from the 00:00 hours of the next day of
the Proposal receipt at branch/online, proposed policy period start date as opted by me or cheque date, whichever is later.
d. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement,
misrepresentation, non-description or non-disclosure of any material fact, in the proposal form/personal statement, declaration and
connected documents or any material information having been withheld by me or anyone acting on my behalf.
e. I hereby declare that the lives proposed to be insured would submit to medical examinations before the nominated doctors of the
Company or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.
f. I consent to and authorize the Company and/or any of its authorized representative agents to seek medical information from any
hospital/ medical practitioner or any other related entity that I have attended or may attend in future concerning any illness or injury.
g. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.
h. I authorize the Company to exchange, share or part with the information relating to myself/person(s) to be insured with any external
entity other than regulatory and statutory bodies, as may be required and I will not hold the Company or its agents liable for use/
sharing of this information.
i. I/We agree and undertake to convey to the Company any change/alterations carried out in the risk proposed for insurance after
submission of this proposal form.
j. I/We consent to receive information from the Company the through physical, electronic or telecommunication means from time to
time.
The undersigned hereby declare on my behalf and on behalf of each of the persons proposed to be insured that the above
statements and particulars are true, complete and correct in all respects and that all information which is relevant to this proposal has
been disclosed and not withheld from the Company. I declare that the money used to make the premium payment has not been
derived from any illegal activity or unaccounted funds. I further declare and agree that this declaration and the answers given above
shall be held to be promissory and shall be the basis of the contract between me/us and the Company.
By virtue of this communication, I give my implicit approval on receiving Whatsapp, SMS, E-mail (Transactional & promotional) from
the company.
The details mentioned in above proposal form have been verified through OTP received on my registered mobile number.
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.
82138852
Member ID DOB NAME
B4993639 30-Jan-1979 Samir Surendrabhai Shah
B5000791 31-Aug-2005 Shah Harsh Samir
B5000797 24-Oct-1983 Shah Sukeshi Samirbhai Submit Your Queries/Requests: www.careinsurance.com/contact-us.html
B5000799 27-Aug-2008 Shah Krisha Samirbhai 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 Valid
4. proofupto policy period end date or cancellation date,whichever is earlier
IRDAI Registration No.148
