Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
MANIPALCIGNA FLEXICARE GROUP INSURANCE
POLICY
CERTIFICATE OF INSURANCE
Policy Issuing Office: ManipalCigna Health Insurance Company Limited, Policy Servicing Office: Manipalcigna Health Insurance Company Limited,
401/402, 4th Floor Raheja Titanium, Western Express Highway, 401/402, 4th Floor, Raheja Titanium, Western Express Highway, Goregaon
Goregaon (East), Mumbai Maharashtra - 400063 (East), Mumbai, Maharashtra - 400063
Name of Master Policy Holder:M/s INCRED FINANCIAL SERVICES LIMITED
Address of Master Policyholder:UNIT NO. 1203,12TH FLOOR,, THE CAPITAL BUILDING,C-70,G-BLOCK,, BANDRA KURLA COMPLEX, BANDRA EAST,
MUMBAI SUBURBAN, BANDRA, MAHARASHTRA - 400051
Master Policy Number:508300000033/00/00
Certificate No:506100082338/00/00
Proposer’s Details:
Name: Madan Pal Customer ID: 36145279
Address: ROOM NO 22 1ST FLOOR, KATARIA COLONY, MANSHA CHOWK BHIWADI, TIJARA, TIJARA, ALWAR, RAJASTHAN - 301019
Telephone (R) (O) 8302405014
number(s):
Email ID:
Period of Insurance: Inception Date: Expiry date
From: 00 Hrs: 00 Mins on 29/03/2025 To: 23 Hrs: 59 Mins on 28/03/2026
No. of Travel days
Premium Payment Mode RTGS/ NEFT
Area/s of cover: India
Portable Case No
Policy type: New Business
Policy Tenure 1 Year
Policy Zone
Name of the TPA/ Service Provider ManipalCigna Health Insurance Company Limited,
Insured Details ReferAnnexure I
Cover Details ReferAnnexure II
Special Conditions ReferAnnexure II
Premium Details
Base Cover Premium (Rs.) 3614.76
Optional Covers Premium (Rs.) 0.00
Loading(Rs.) 0.00
Discount(Rs.) 0.00
Goods & Service Tax (Rs.) 650.66
GST Cess(Rs.) 0.00
Total Premium(Round Off) 4265.42
(PAN Number :AAECC7904J Consolidated Stamp Duty of Rs. 1.00 paid in cash or by demand draft or by payorder or by cheque, vide Receipt/ Challan
no. LOA/ENF-1/CSD/63/2024-25/10/10/2024 to 30/10/2029/4741 dated 04/10/2024)
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.
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 1
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
In the event of a claim
Address for ManipalCigna Health Insurance Company Limited
Correspondence 401/402, Raheja Titanium, Goregaon (East), Mumbai, Maharashtra - 400063
Please contact Us through any of these
modes Contact Number 1800-102-4462
E-mail ID servicesupport@manipalcigna.com
Annexure I
Details of Insured Persons
Deatils Insured 1
Unique identification No./Employee No./ 9523457323471090A
membership no.
Name of Insured member MADAN PAL
Relationship of the family members with the Self
Employee/ Member
Date of Birth 08/07/1982
Age 42
Gender Male
Height -
Weight -
Nationality Indian
Passport No.
Passport Expiry Date
Profession/Designation/ Category/ position
Nature of Duty
Out of Country Location
Date of Enrollment / Joining 29/03/2025
Trip Start date/ Coverage Commencement
Date
Trip End Date
No. of Travel days
City of origin
Place of residence
Area/s of Cover India
Overseas Address
Visa Type (Immigrant/ Non-immigrant)
Visa Validity (From - To)
Purpose of Visit (Business/ Holiday/ studies/
Others (specify))
Email ID
Mobile No 8302405014
Pre-existing Diseases
<< Any Medical information provided>>
Plan/ Base Cover/s
Sum Insured 1143263
Deductible and other limits, Sub Limits and
condition
Optional Covers
Permanent Exclusion
Details of Nominee / Appointee (name, age, relation)
Nominee Name : Kaushalya Devu Relationship with Proposer:
Appointee Name : NA Relationship with Minor: NA
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 2
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
Address of the Insured (if different from proposer/ policy holder) :
Insured 1 Insured 2
Annexure II
Cover Details
MADAN PAL
Benefits Applicable to Employee Band/ Member Category (GRP7--)
Plan Benefits
Covered Peril/ Name of Other Limits & Conditions Sum Aggregate Sub-limits Co-Pay % Deductible/s Other Limits
ailments/ the Cover etc. Insured Limit &
event/risks Conditions
etc.
Selection Other Limits
(Mandatory) &
Conditions
etc.
Benefit on INR - - Limit the 0.00
diagnosis 1106000.00 scope of cover
to a section/
part of the
cover. - List of
listed critical
Illness Only 1
- Cancer
of specific
severity 2
-
Myocardial
Infarction
(First Heart
Attack – of
Specific
Severity) 3
- Open
Chest CABG 4
- Open
Heart
Replacement
or Repair of
Heart Valves 5
- Coma
of Specified
Severity 6
- Kidney
Failure
Requiring
Regular
Dialysis 7
- Stroke
Resulting in
Permanent
Symptoms 8
- Major
Organ/ Bone
Marrow
Transplant 9
-
Permanent
Paralysis of
Limbs 10
- Motor
Neurone
Disease with
Permanent
Symptoms 11
- Multiple
Sclerosis with
Persisting
Symptoms
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 3
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
EMI 3 EMI’s INR 12421.00 - - limit 0.00
Protection maximum
number of
events in a
policy year
and apply per
event limit for
multiple events
- Once in a
policy tenure.
- Limit on claim
payout/ total
liability,
maximum up to
outstanding
loan amount
Mediclaim/Specific or Sum
Disease/Critical Insured,
Illness 11 CIs whichever is
lower - Upon
diagnosis of
listed critical
illnesses only.
1-
Cancer of
specific
severity 2
-
Myocardial
Infarction
(First Heart
Attack – of
Specific
Severity) 3
- Open
Chest CABG 4
- Open
Heart
Replacement
or Repair of
Heart Valves 5
- Coma
of Specified
Severity 6
- Kidney
Failure
Requiring
Regular
Dialysis 7
- Stroke
Resulting in
Permanent
Symptoms 8
- Major
Organ/ Bone
Marrow
Transplant 9
-
Permanent
Paralysis of
Limbs 10
- Motor
Neurone
Disease with
Permanent
Symptoms 11
- Multiple
Sclerosis with
Persisting
Symptoms
irrespective of
number of
days of
hospitalisation,
3 EMIs will be
paid together
Upto Actual
EMI or Max. as
per the limit
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 4
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
Specified
below. ----------
-- Maximum SI
in point: a. 1
EMI upto INR
25,000 b. 2
EMI upto INR
50,000 c. 3
EMI upto INR
75,000
Sr. No Name of the Waiting Period Waiting Period
1 Diagnosis Waiting period 30 days Days since date of inception of the cover
2 Initial Waiting Period for hospitalisation 30 days Days since date of inception of the cover
3 Pre-existing Diseases Waiting Period Pre-existing diseases are not covered
4 Survival Period for diagnosis based benefit cover NIL
Annexure III
Special Condition
The scope of cover under the scheme is limited to the diagnosis of critical illnesses from the list below.
1. Cancer of specific severity,
2. Myocardial Infarction (First Heart Attack – of Specific Severity)
3. Open Chest CABG,
4. Open Heart Replacement or Repair of Heart Valves,
5. Coma of Specified Severity,
6. Kidney Failure Requiring Regular Dialysis,
7. Stroke Resulting in Permanent Symptoms,
8. Major Organ/ Bone Marrow Transplant
9. Permanent Paralysis of Limbs,
10. Motor Neurone Disease with Permanent Symptoms
11. Multiple Sclerosis with Persisting Symptoms
Exclusions :
E.I.4 Investigation & Evaluation- Code- Excl 04
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
E.I.5 Rest Cure, rehabilitation and respite care- Code- Excl 05
a. Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving
around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
E.I.6 Obesity/ Weight Control: Code- Excl 06
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1. Surgery to be conducted is upon the advice of the Doctor
2. The surgery/Procedure conducted should be supported by clinical protocols
3. The member has to be 18 years of age or older and
4. Body Mass Index (BMI);
a. greater than or equal to 40 or
b. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
E.I.7 Change-of-Gender treatments: Code- Excl 07
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
E.I.8 Cosmetic or plastic Surgery: Code- Excl 08
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or
Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical
necessity, it must be certified by the attending Medical Practitioner for reconstruction following an Accident, Burn(s) or Cancer.
E.I.9 Hazardous or Adventure sports: Code- Excl 09
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to,
para-jumping, rock climbing, mountaineering, rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep-sea diving.
E.I.10 Breach of law: Code- Excl 10
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 5
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with
criminal intent. (e.g. Intentional self-Injury, suicide or attempted suicide (whether sane or insane).
E.I.11 Excluded Providers: Code- Excl 11
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and
disclosed in its website / notified to the policyholders are not admissible.
However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete
claim.
(Explanation: Details of excluded providers shall be provided with the policy document. Insurers to use various means of communication to notify the
policyholders, such as e-mail, SMS about the updated list being uploaded in the website.)
E.I.12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- Excl 12
E.I.13 Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to
such establishments or where admission is arranged wholly or
partly for domestic reasons. Code- Excl13
E.I.14 Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and Organic
substances unless prescribed by a Medical Practitioner as part of
Hospitalization claim or day care procedure. Code- Excl 14
E.I.15 Refractive Error: Code- Excl 15
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres
E.I.16 Unproven Treatments: Code- Excl 16
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments,
procedures or supplies that lack significant medical documentation to
support their effectiveness.
E.I.17 Sterility and Infertility: Code- Excl 17
Expenses related to sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization
E.I.18 Maternity: Code Excl 18
i. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except
ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
For coverage specific exclusions refer policy terms & conditions.
EASP/ TPA details:
NA
Claim process & Mandatory Document requirements:
Group ID : GRP007
Details of procedure to be followed for cashless services as well as for reimbursement of claim including pre and post hospitalization:
To know the process for our cashless and reimbursement claims visit https://www.manipalcigna.com/claims
Turn Around Time (TAT) for claim settlement
i. TAT for pre-authorization of cashless facility – 1 hour from the last complete document for initial approval
i. TAT for cashless final bill settlement – 3 hours from the last complete document
Web links for the followings:
i. Network hospital details - https://www.manipalcigna.com/locate-us
i. Helpline Number - https://www.manipalcigna.com/claims
ii. Hospital which are blacklisted or from where no claims will be accepted by insurer - https://www.manipalcigna.com/locate-us
iii. Link for downloading claim form -https://www.manipalcigna.com/downloads/claims
ManipalCigna Health insurance Company Limited is pleased to acknowledge that the Group member and dependents(if any) designated above are now
covered under the ManipalCigna FlexiCare Group Insurance Policy, This Policy is subject to the terms and conditions contained in the Master Policy.
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.
You may also write to us at servicesupport@manipalcigna.com or call us at HealthLine No. (Toll Free): 1800-102-4462
For any grievance related to the policy you may write to The Grievance Officer at the policy issuing office address mentioned above or email at
headcustomercare@manipalcigna.com
In witness, whereof this Policy has been signed at Mumbai on 29/03/2025
For and on behalf of ManipalCigna Health Insurance Company Limited
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 6
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
Authorized Signatory
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 7
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
(Applicable for Contributory Policy Only)
PREMIUM CERTIFICATE
Premium Certificate for the purpose of deduction under Section 80-(D) of Income Tax Act 1961.
This is to certify that MADAN PAL has paid Rs.4265.42 (In words Rupees Four Thousand Two Hundred Sixty Five and Forty Two Paisa Only) towards
Premium for ManipalCigna FlexiCare Group Insurance Policy for the Period from 29/03/2025 to midnight 28/03/2026.
Master Policy Number:508300000033/00/00 Certificate Number: 506100082338/00/00
Date: 29/03/2025 Place: MUMBAI
Certificate Number 506100082338/00/00
Receipt Number GC02032727 Date 29/03/2025 Receipt Amount 1511385.72 Payment Mode RTGS/
NEFT
Stamp duty has been paid vide receipt no LOA No.CSD/111/2023/28/08/2023 to 28/08/2028/3581 dated 28/08/2023
Note :
Note: For your eligibility and deductions please refer to provisions of Income Tax Act 1961 as modified and/or consult your tax consultant. Any amount
paid in cash towards premium will not qualify for tax benefits.
This certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation of Master Policy or any alteration
in the insurance affecting the premium.
For and on behalf of ManipalCigna Health Insurance Co. Ltd
Authorised Signatory
Certificate of Insurance | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 8
