0

Date : 11 September 2016

Ms Navita Malik
132 State Bank Colony
G T Karnal Road
New Delhi
New Delhi 110009
Delhi

Policy No. : 10789103

Mobile No. : 9891197670

Dear Ms Navita Malik,

Welcome to a world where what matters, above all, is your Health....Hamesha!
Welcome to a philosophy that adheres to the tested and somewhat traditional adage that caring yields the best cure; from a company 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 welcome you to Religare Health Insurance.
We at Religare Health Insurance are unerringly focused on providing you access to the highest quality of healthcare and putting you back on the road
to a worry-free recuperation, 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 constitutes the
following 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 treatment at our network 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 customerfirst@religarehealthinsurance.com
or call us at 1800-200-4488.
Once again, we thank you for this opportunity to serve you, and wish you and your loved ones good health always!

Team Religare Health Insurance

Religare Health Insurance Company Limited

Correspondence address : Vipul Tech Square, Tower C, 3rd Floor, Sector 43,Golf Course Road, Gurgaon - 122009
www.religarehealthinsurance.com

Policy Certificate

Ms Navita Malik
132 State Bank Colony
G T Karnal Road
New Delhi
New Delhi 110009

Policy No.
Plan Name
Cover type
Policy Period - Start Date

10789103
Care

Policy Period - End Date

Premium Paid

Midnight 11-Sep-2017
Rs. 17871

Floater
00:00 hrs 12-Sep-2016

(Premium 15540.22 + Service Tax 2331.03)

Premium Payment Mode

Delhi

Single Premium

1
0

Policyholder

Gender

Date Of Birth

Client ID

Navita Malik

Female

30-Jul-1967

54443649

Details of Insured
Name

Client ID

Date of Birth
(DD-MM-YYYY) Pre-existing diseases (since)

Insured with the

Company (since)

Relationship

Navita Malik

54443649

Member

30-Jul-1967

None

12-Sep-2016

Nikit Malik

54443650

Son

27-Jan-1998

None

12-Sep-2016

Details of Cover
S No.

Particulars

Details

Sum Insured

Rs. 10,00,000

Contact details for Claims & Policy Servicing

Correspondence address

Religare Health Insurance Company Limited Vipul Tech Square, Tower C, 3rd Floor, Sector 43,Golf Course Road, Gurgaon - 122009.

Contact no.

1800-200-4488

Fax no.

1800-200-6677

E-mail ID for Claims

claims@religare.com

E-mail ID for Policy servicing

customerfirst@religarehealthinsurance.com

Website

www.religarehealthinsurance.com

Intermediary Details
Name

Code

Contact Number

Sarthak Saxena

20028440

9810354984

for Claims & Assistance: Call 1800-200-4488

10

Schedule of Benefits
S No.
1

Particulars
Hospitalization Expenses (In-patient Care and Day Care Treatment)

Basis of Offering
Room Category = Single Private Room

Pre-hospitalization & Post-hospitalization medical Expenses

Pre-hospitalization up to 30 days before & Post-hospitalization up to

60 days after hospitalization

Ambulance Cover

Up to Rs. 2,000 per Hospitalization

Organ Donor Cover

Up to Rs. 1,00,000 per Policy Year

Domiciliary Hospitalization

Up to 10% of the Sum Insured per Policy Year, with a deductible of

first 3 days

Automatic Recharge

One re-instatement of up to Sum Insured per Policy Year

Second Opinion

Once per Policy Year per Insured Person for each major illness/injury

Alternative Treatments

Up to Rs. 20,000 per Policy Year

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

1 Special

Conditions

S No.

Particulars

Co-payment (Applicable where age of member at entry is 61 years or above)

For Religare Health Insurance Company Limited

Authorized Signatory

Date of Issue : 11-Sep-2016

Place of Issue : Saket, New Delhi

Branch Details : RHICL, New Delhi Rajendra Palace, New Delhi, Delhi - 110008 Branch Contact No. : 011-47019045

Correspondence Address:
Religare Health Insurance Company Limited
Vipul Tech Square, Tower C, 3rd Floor, Sector 43,Golf Course Road, Gurgaon - 122009 Contact No : 1800-200-4488
Website : www.religarehealthinsurance.com Email : customerfirst@religarehealthinsurance.com

Fax:1800-200-6677

Consolidated Stamp Duty paid vide F.No.10 (17685)/COS(HQ)/CD dated 10th Jan 2015
Service Tax Registration No:AADCR628INSD001

IRDA Registration Number - 148

UIN: IRDAI/HLT/RHI/P-H/V.II/253/16-17

Registered office address : D-3, P3B, District Centre, Saket, New Delhi 110 017
CIN : U66000DL2007PLC161503
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, ead and understood. If any of these
documents have not been received, please email at customerfirst@religarehealthinsurance.com or contact the Company at 1800-200-4488 / 1860-500-4488.
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.

NIKIT MALIK
54443650

27-Jan-1998

NAVITA MALIK
54443649

30-Jul-1967

NB
1

Premium Acknowledgement

Policy No.
Client ID
Policyholder
Address

Policy Period

10789103
54443649
Ms Navita Malik
132 State Bank Colony
G T Karnal Road
New Delhi
New Delhi 110009, Delhi
12-Sep-2016 to 11-Sep-2017

Premium Details
Particulars

Amount (in Rs.)

Gross Premium
Care

15,540.22

Service Tax & Levies

2,331.03

Total

17,871.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
This is to certify that Religare Health Insurance Co.Ltd. has received an amount of Rs. 17,871.00/- from undefined towards Payment of
Health insurance premium as per the details mentioned above. The premium paid for this policy is eligible for applicable tax benefits
u/s 80D of the Income Tax Act, 1961 and amendments thereof.

For Religare Health Insurance Company Limited

Authorized Signatory

Date of Issue: 11-Sep-2016

Place of Issue: Saket, New Delhi

IRDA Registration Number - 148

Registered office address : D-3, P3B, District Centre, Saket, New Delhi 110 017
CIN : U66000DL2007PLC161503

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.

Proposal Form-'CARE'
Dear Ms Navita Malik
In reference to your online proposal (1120001332290) for 'Care'- Comprehensive Health Insurance policy, please find below the details as provided
by you:

Proposer Details
Name

MS NAVITA MALIK

Address

132 State Bank Colony

G T Karnal Road
New Delhi
New Delhi-110009
Delhi

Date of Birth

30/07/67

Landline

Mobile

9891197670

E-mail

navita_mlk@yahoo.co.in

Details of the Persons be Insured

Name
Navita Malik
NIKIT MALIK

Date of Birth

Relation

Pre-existing Diseases

30/07/67
27/01/98

MEMBER
SON

NONE
NONE

Additional Details
A. Does any person(s) to be insured has any pre-existing diseases?
Insured 1
No

Insured 2
No

B. Have any of the person(s) to be insured ever filed a claim with their current/previous insurer?
Insured 1
No

Insured 2
No

C. Has any proposal for Health insurance been declined, cancelled or charged a higher premium?
Insured 1
No

Insured 2
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
No

Insured 2
No

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,
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.
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, accurate and
complete and correct in all respects and that there is all information which is relevant to this proposal that 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.
You also agreed to receive service SMS and E-mail alerts.

Religare Health Insurance Company Limited

Correspondence address : Vipul Tech Square, Tower C, 3rd Floor, Sector 43,Golf Course Road, Gurgaon - 122009
Website : www.religarehealthinsurance.com
E-mail : customerfirst@religarehealthinsurance.com
UIN: IRDAI/HLT/RHI/P-H/V.II/253/16-17

Call Us : 1800-200-4488