Date : 22 September 2021
Mr. Mukesh Suraiya
Siddheshwar Park
Adipur 370205
Kutchh
Gujarat
Policy No. : 16627587
Mobile No. : 9712940531
Dear Mr Mukesh Suraiya,
Welcome to a world where what matters, above all, is your Health . Ham es ha!
Welcome to a philosophy that adheres to the tested and somewhat traditional adage that caring yields the best cure; from a co mpany that is driven
by its commitment to provide you with the very best healthcare, as much as its determination to delight and surprise you, at every given
opportunity.
We welcom e you to Religare Health Insurance .
We at Religare Health Insurance are unerringly focuse d on providin g you access to the highest quality of healthcar e and puttin g you back on the road
to a worry-free recuper ation, without a care about medical bills and other related expenses.
To help you understand our services better, please go through the 'Know your policy better' kit that accompanies this letter and constitu te s the
follow in g details:
Policy Certificate
Premium Acknowledgement
Key Policy Information
Policy Terms and Conditions
Claim Process
Also enclosed for your convenience is your Religare Health Card(s). This card should be presented at the time of an emergency or a planned
hospitalization , to access cashless treatme n t at our networ k of over 4,500+ hospitals pan-India.
To further simplify procedures, we're online as well. Visit our portal www.religarehealthinsurance.com; and view network hospitals across the
country, cashless procedures and do much more. In case of a query at any juncture, feel free to mail us at [email protected] or
call us at 1800-102-4488.
Once again, we thank you for this opportun ity to serve you, and wish you and your loved ones good health always!
Team Religare Health Insurance
Religare Health Insurance Company Limited
Correspon de n ce address : Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA)
www.religarehealthinsurance.com
Policy Certificate
Mr Mukesh Suraiya Policy No. 16627587
Plan Name CARE
Sidhes w ar Park,
Cover type Floater
Adipur-370205 Policy Period - Start Date 00:00 hrs 22-sept-2021
Policy Period - End Date Midnigh t 21-sept-2022
Kutch Premium Paid Rs. 21347
Gujarat
Premium Paymen t Mode Single Premium
Policyholder Gender Date Of Birth Client ID
Mukesh Suraiya Male 24-Jun-1981 73801416
Details of Insured
Name Client ID Relationship Date of Birth Pre-existing diseases (since) Insured with the
(DD-MM-YYYY) Comp an y (since)
Mukesh Suraiya 73801416 Member 24-June-1981 None 22-Sept-2020
Total Suraiya 73801417 Spouse 11-July-1981 None 22-Sept-2020
Ishwa Suraiya 73801418 Daughter 04-Jan-2012 None 22-Sept-2020
Details of Cover
S No. Particulars Details
1 Sum Insured Rs. 10,00,000
Contact details for Claims & Policy Servicing
Corresp on de n ce address Religare Health Insurance Com pa n y Lim ite d Unit no 604 - 607, 6th Floor, Towe r C, Unitech Cyber Park , Sector 39, Gurgao n -122001.(HARYANA)
Contact no. 1800 -1 02- 4488
Fax no. 1800 -2 00- 6677
Website www.religarehealthinsurance.com
Intermediary Details
Name Code Contact Number
Jayanti Oza 20167562 9879866522
for Claims & Assistance: Call 1800-102-4488
Schedule of Benefits
S No. Particulars Basis of Offering
1 Hospitalization Expenses (In-patien t Care and Day Care Treatment) Room Categor y = Single Private Room
2 Pre-hos pitalization & Post-h os pitalization medical Expenses Pre-hos pitalization up to 30 days before & Post-h os pitalization up to
60 days after hospitalization
3 Ambulan ce Cover Up to Rs. 2,000 per Hospitalization
4 Organ Donor Cover Up to Rs. 1,00,000 per Policy Year
5 Domiciliar y Hospitalization Up to 10% of the Sum Insured per Policy Year, with a deductib le of
first 3 days
6 Automatic Recharge One re-instate m en t of up to Sum Insured per Policy Year
7 Secon d Opinion Once per Policy Year per Insured Person for each major illness/injury
8 Alternative Treatments Up to Rs. 20,000 per Policy Year
9 No Claims Bonus 10% of Sum Insured for each Claim free year, maximum upto 50% of
Sum Insured; reduced by 10% of Sum Insured in case of claim
10 Annual Health Check-up One Health Check-up per Insured Person per Policy Year
11 No Claim Bonus - SUPER (Add-on Cover) 50% of Sum Insured for each Claim free year, maximum upto 100% of
Sum Insured; Reduced by 50% of Sum Insured in case of Claim
Optional Cover
S No. Particulars Details
1 No Claim Bonus - SUPER Applicable
2 Unlimite d Auto Recharge Applicable
Special Conditions
S No. Particulars
1 Co-paym e n t (Applicable where age of member at entry is 61 years or above)
For Religare Health Insurance Company Limited
Autho rize d Signatory D ate of Issue : 15-Jan-2020 Place of Issue : Gurgaon, Haryana
Service Branch : RHICL , 209, Toral Com m er ci al Com ple x Opp. Sbi, Jawah ar Road, Nera Trikon Baug, Rajkot, Gujarat - 360001 Branch Conta c t No. : 2812221359
Corre spo nde nce Address:
Religare Heal th Insuran ce Compa ny Limited
Unit no 604 - 607, 6th Floor, Towe r C, Unite c h Cyber Park, Secto r 39, Gurga on -122001.(HARYANA) Contac t No : 1800-102-4488
Website : www.religarehealthinsurance.com Email : [email protected]
Consolid a t e d Stamp Duty paid vide E -Chall an GRN no. 61347960 dated 27 Dec 2019, RCM Applicabili ty - N/A
SAC: 997133 and D escription of Service : Acciden t and Health Insurance Service s State GSTIN No.: 24AADCR6281N1ZY IRDA Registra ti on Number - 148 UIN : RHIHLIP20091V041920
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New D elhi - 110019
CIN : U6 6 0 0 0DL20 07PLC1 61503
Note:
Attached with this Policy Certificate are the Policy terms and condit io n s, Optional Covers (if opted) and Annexures. Please ensure that these documents hav e been received, ead and understood. If any of these
docum e nt s have not been recei v e d, please email at cust o m e r fi r s t @ r e l i g a r eh e a l t hi n s u r a nc e. c o m or cont a c t the Company at 1800-102-4488 / 1860-500-4488.
For waiti n g per i o d s and excl u s i o n s under this Policy, please refer to Cla u s e 4 of the Policy terms and conditions.
This Policy Cer t ifi ca t e in origi na l must be surr e n d e r e d to the Com p a n y in case of cancel l at i o n of the Policy.
16627272
73801416 24-Jun-1981 MUKE SH SURA IY A
73801417 11-Jul-1981 TORALSURAIYA
73801418 04-Jan-2012 ISHWA SURIYA
Premium Acknowledgement
Policy No. 16627587
Client ID 73801416
Policyholder Mr Mukesh Suraiya
Address Siddh esh w ar Park,
Adipu r 37020 5
Kutch h
Guja ra t
Policy Period 22-Se p-2 02 1 to 21-Sep-2022
Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Paym ent
1 3 0 6 6 3 98 8 1932 4 INTER N E T PAYMENT GATEWAY (IPG)
Gross Premium
Care 15651.91
-NCB-Super 1,393.77
-Unlim ite d Autom ati c Recharge 1,045.32
Goods & Service s Tax (GST) 3256.00
Total 21347.00
The Premium is rounde d off to the nearest rupee.
Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
The premium paid throu gh any mode other than cash for this policy is eligible for Incom e tax benefits to the person making the paymen t subject to the
provision s of section 80D of the Incom e Tax Act, 1961 and amendm e n ts thereof. Effective from Assessmen t 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 Religare Health Insurance Company Limited
Autho rize d Signatory D ate of Issue: 15-Jan-2020 Place of Issue: Gurga on, Haryana
IRD A Registra ti o n Number - 148
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New D elhi - 110019
CIN : U6 6 0 0 0DL20 07PLC1 61503
Note
1) In case of any discr ep a n cy , the Policyh o l d e r is requ e s t ed to cont a ct the Co m p a n y immediately.
2) Any amount paid in cash towa r d s the premium would not qualify for tax benefits as mentioned above.
3) This docum e nt must be surr e n d e r e d to the Company in case of Cance l l a t i o n of the Policy or for the issua n ce of a fresh cert i fi c a t e in the case of any alter a ti o n in the Policy.
Proposal Form-'CARE'
Dear Mr Mukesh Suraiya
In reference to your online propos al (1120010780883) for 'Care'- Compre he ns ive Health Insuran ce policy, please find below the details as provided
by you:
Proposer Details
Name : MR Mukesh Suraiya
Address : Siddhesh war Park
Adipur 370205
Date of Birth : 24/06/81
Landline :
Mobile : 9712940531
E-mail :
[email protected]Details of the Persons be Insured
Name Date of Birth Relation Pre-existing Diseases
Mukesh Suraiya 24/06/81 MEMBER NONE
Toral Suraiya 11/07/81 SPOUSE NONE
Ishwa Suraiya 04/01/12 DAUGHTER NONE
Additional Details
A. Does any person(s ) to be insured has any pre-existin g diseases?
Insured 1 Insured 2 Insured 3
No No No
B. Have any of the person(s ) to be insured ever filed a claim with their current/pre vious insurer?
Insured 1 Insured 2 Insured 3
No No No
C. Has any propos al for Health insuran ce been declined , cancelle d or charge d a higher premium?
Insured 1 Insured 2 Insured 3
No No No
D. Is any of the person(s ) to be insured, already covered under any other health insurance policy of Religare Health Insurance?
Insured 1 Insured 2 Insured 3
No No No
You agreed to following terms & conditions of the purchase of policy
a. I have read and understoo d the brochure /prospe c tus/sale s literature /T e rms and Conditi ons of the Policy and confirm to abide by the same.
b. Recei pt of proposal form by the Company shall not be construe d as accept ance of proposal. Comme nce m e n t of risk under the Policy shall be subject to realizati o n of full
premium and individual underw ri ti ng by the Compa ny. The Compa ny at its sole discre ti o n reserve s the right to acce pt or reject or load any proposal. Policy would start
from the date as specified in the Policy Certificate.
c. I understan d that the Policy Period Start Date as specifi e d in the Policy Certificate shall be from the 00:00 hours of the next day of the Proposal receipt at branch,
propose d policy period start date as opted by me or cheque date, whiche ve r is later.
d. I understan d that the Policy shall become void at the Company's option, in the event ofanyuntrue or incorre ct stateme nt, misreprese ntati on, non-de scri pti o n or
non-discl osure of any material fact, in the proposal form/pe rso nal stateme nt, declarati on and connecte d docume nt s or any material informati o n having been withhel d by
me or anyone acting on my behalf.
e. I hereby declare that the lives propose d to be insure d woul d submi t to medical exami nati o ns before the nominat e d docto rs of the Compa ny or unde rgo diagnosti c or
other medical tests, as suggest e d by the Company for its underwriting.
f. I consent to and authorize the Company and/or any of its authori ze d represe ntati ve agents to seek medical informa tion from any hospital /m e di cal practiti one r or any other
relate d entity that I have attende d or may attend in future concerni ng 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 require d by the Company. h.I authori ze the Company to exchange,
share or part with the informati on relatin g to myself/pe rso n( s) to be insure d with any external entity other than regulatory and statuto ry bodies, as may be require d and I
will not hold the Compan y or its agents liable for use/shari ng of this information.
h. I authori ze the Compa n y to exchange, share or part with the informati on relating to myself/pe rson(s ) to be insured with any external entity other than regulatory and
statuto ry bodies, as may be require d and I will not hold the Company or its agents liable for use/shari ng of this information.
i. I/We agree and undertak e to conve y to the Compa ny any change /al te rati o n s carrie d out in the risk propose d for insurance after submissi o n of this proposal form.
j. I/We conse nt to receive informati o n from the Company the through physi cal, electroni c or telecom m uni ca ti o n means from time to time.
the undersigne d hereby declare on my behalf and on behalf ofeach ofthe persons propose d to be insured that the above statements and particulars are true, accurate and
compl e te and correct in all respe ct s and that thereisall informati on which isrelevant to this proposal that has been disclosed and not withheld from the Compa ny. I declare
that the money used to make the premiumpayment has not been derived from any illegal activity or unaccounte d funds. I further declare and agree that this declarati on and
the answe rs give n above shall be held to be promisso ry and shall be the basis of the contra ct between me/us and the Company.
You also agreed to receive service SMS and E-m ail alerts.
Religare Health Insurance Company Limited
Corr e s p o nd e n c e addres s : Unit no 604 - 607, 6th Floor , Tow er C, Unit e c h Cyber Park, Sect o r 39, Gurga o n -122001.(HARYANA)
Webs it e : www.religarehealthinsurance.com E-mail :
[email protected]
