Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
MANIPALCIGNA FLEXICARE GROUP INSURANCE POLICY
CERTIFICATE OF INSURANCE
Policy Issuing Office: Policy Servicing Office:
ManipalCigna Health Insurance Company Limited, ManipalCigna Health Insurance Company Limited,
401/402, Raheja Titanium, Western Express Highw ay, 401/402, Raheja Titanium, Western Express Highw ay,
Goregaon East, Goregaon East,
Mumbai - 400063, India Mumbai - 400063, India
Name of Master Policyholder: Coverplan Technology Private Lim ited
Address of Master Policyholder: 775, 42 High Street, 100 ft Road, HAL 2nd Stage, Indiranagar, Bengaluru (Bangalore) Urban,
Karnataka, 560008
Master Policy Number: 500200000061/00/00
Certificate No: 509400023606
Proposer’s Details:
Name: sapna tamta Customer ID 20503279
Address:
Telephone number(s): (R) (O) (M) 9599164932
Email ID:
Period of Insurance: From 00 Hrs : 00 Mins. on : 11/12/2023To 23 Hrs : 59 Mins. On Till the end of Journey
Policy type: GFC-Travel
Policy Tenure: 1 Day (During the Journey)
Name of the TPA/ Service Provider:
Insured Details: Refer Annexure I
Cover Details: Refer Annexure II
Special Conditions: Refer Annexure III
Prem ium Details
Base Cover Premium (₹) 4.31
Loadings/Discounts(₹) 0.00
Goods & Service Tax (₹) 0.78
GST Cess(₹) 0.00
Total Premium(₹) 5.09
PAN Number : AAECC7904J
Note: Basic premium is inclusive of opted Add on’s and after adjustments of premium discounts, wherever applicable.
In the event of dishonour of cheque , this policy document automatically stands cancelled from inception, irrespective of whether a separate
communication is sent or not.
In the event of a claim other than Travel Emergency Medical Cover
Address for Correspondence ManipalCigna Health Insurance Company Limited
Please contact Us through 401/402, Raheja Titanium,, Goregaon (East), Western Express
any of these modes Highway, Mumbai - 400063
Contact Number 1800-102-4462
Email ID servicesupport@manipalcigna.com
In the event of a claim for Travel Emergency Medical Cover
Address for Correspondence Medi Assist Insurance TPA Pvt. Ltd.
Please contact Us through Tower D, 4th Floor, IBC Knowledge Park, 4/1, Bannerghatta
any of these modes Road, Bengaluru, Bengaluru, Karnataka - 560020
Contact Number 1800-419-1159
Fax Number 1800-425-9559
Email ID manipalcignagroup@mediassist.in
Certificate of Insurance_ ManipalCigna FlexiCare Group Insurance Policy UIN: [ MCIHLGP20120V011920 ] Page 1
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
Annexure I
Details of Insured Persons
Details Insured
Unique identification No./Employee No./ membership no 20503279
Name of Insured member sapna tamta
Relationship to the Insured Member
Date of Birth (DD/MM/YYYY)
Gender (M/F/O)
Trip Start date 11/12/2023
Trip End Date Till the end of Journey
No. of Travel days
Annexure II
Cover Details
Covered Peril/ ailments/ Name of the Sum
Aggregate Limit Sub Limit/s Deductible/s
event/risks Cover Insured
Travel Accidental Death Death
Travel Permanent Total PTD 7,50,000
Disablement (PTD)
Travel Emergency ●Hospitalisation 3,00,000 Sublimit 30 - Limit the
Medical Cover ● Day Care scope of cover to the
triggered event -
Hospitalisation due to
accidental injury only
w hilst on the trip .
Travel Emergency ● Out-Patient 25,000 Sublimit 30 - Limit the
Medical Cover Expenses scope of cover to the
triggered event -
accidental injury only,
w hilst on the trip .
Travel Emergency Travel 10,000
Medical Evacuation
Cover
Travel Repatriation of Death 10,000
Mortal Remains Cover
Loss of Baggage Cover Travel 5,000
Sublimit 31- Condition
Travel Accidental for cover eligibility after 24 Hrs (1
Hospitalisation 750 upto 7 days
Hospitaliation Cash continuous Day)
hospitalisation of 48 Hrs.
Annexure III
Special Condition
1. AOA (Any One Accident) - The maximum claim Limit is 30,00,000. In case of multiple Deaths/Permanent Total
Disablements due to single accident event, the claim w ill be honoured up to AOA limit of 30 lakhs, the total AOA limit amount
in that situation, w ill be divided amongst insured or nominee of deceased members.
3. As per the scope of cover under the scheme, coverage w ill be effective for insured person on the trip considering the start
and end date and time, mentioned basis the ticket issued by the partner (travels).
3. Capital Sum Insured - The maximum liability for any one or all claims under Accidental Death Benefit, Permanent Total
Disablement Benefit in a Policy Year w ill be limited to the Capital Sum Insured for that Insured Person. Once the sum insured
is paid equivalent to 100%, the cover for the insured person w ill seize.
4. In Situation of Loss of Baggage - is required to be reported to the Police having jurisdiction at the place of loss w ithin 24
hours of the occurrence of the incident, and a w ritten FIR being obtained for the same.
EASP/ TPA details:
Certificate of Insurance_ ManipalCigna FlexiCare Group Insurance Policy UIN: [ MCIHLGP20120V011920 ] Page 2
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
NA
ManipalCigna Health insurance Company Limited is pleased to acknow ledge that the Group member and dependents (if any)
designated above are now covered under this Policy. This Policy is subject to the terms and conditions contained in the Master Policy .
If at any time during the Policy Period, the Master Policy is cancelled or terminated and is no longer in force, all applicable Certificates
under the aforesaid master policy shall become automatically void.
This Policy has been issued based on the information provided by the Master Policy Holder on your behalf at the time of application
for cover. In case you find any discrepancy in the same, please contact us immediately.
For any grievance related to the policy you may w rite to The Grievance Officer at the policy issuing office address mentioned above
or email at headcustomercare@manipalcigna.com
You may also w rite to us at servicesupport@mainipalcigna.com Or call us at toll free no. 1800-102-4462
In w itness, w hereof this Policy has been signed at on
For and on behalf of ManipalCigna Health Insurance Company Limited
Authorised Signatory
“This is a System generated communication and does not require signature”
Certificate of Insurance_ ManipalCigna FlexiCare Group Insurance Policy UIN: [ MCIHLGP20120V011920 ] Page 3
