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    Ghi 71 23 0453652 000 - 20230516

    Uploaded by

    raju singh
    This document is a certificate of insurance for Raju . under the Group Activ Health policy issued by Aditya Birla Health Insurance Company Limited to Bajaj Finance Limited. The certificate provides coverage to Raju ., Sonia ., Khush Singh, and Love Singh from April 26, 2023 to April 25, 2024. The certificate details the policy benefits including day care treatments, hospitalization coverage, organ donor expenses, and post/pre-hospitalization expenses. It also lists the premium amount and provides information on making claims, grievance redressal, and coverage exclusions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Ghi 71 23 0453652 000 - 20230516

    Uploaded by

    raju singh
    71 views6 pages
    This document is a certificate of insurance for Raju . under the Group Activ Health policy issued by Aditya Birla Health Insurance Company Limited to Bajaj Finance Limited. The certificate provides coverage to Raju ., Sonia ., Khush Singh, and Love Singh from April 26, 2023 to April 25, 2024. The certificate details the policy benefits including day care treatments, hospitalization coverage, organ donor expenses, and post/pre-hospitalization expenses. It also lists the premium amount and provides information on making claims, grievance redressal, and coverage exclusions.

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    Original Title

    GHI-71-23-0453652-000_20230516

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    This document is a certificate of insurance for Raju . under the Group Activ Health policy issued by Aditya Birla Health Insurance Company Limited to Bajaj Finance Limited. The certificate provides coverage to Raju ., Sonia ., Khush Singh, and Love Singh from April 26, 2023 to April 25, 2024. The certificate details the policy benefits including day care treatments, hospitalization coverage, organ donor expenses, and post/pre-hospitalization expenses. It also lists the premium amount and provides information on making claims, grievance redressal, and coverage exclusions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    71 views6 pages

    Ghi 71 23 0453652 000 - 20230516

    Uploaded by

    raju singh
    This document is a certificate of insurance for Raju . under the Group Activ Health policy issued by Aditya Birla Health Insurance Company Limited to Bajaj Finance Limited. The certificate provides coverage to Raju ., Sonia ., Khush Singh, and Love Singh from April 26, 2023 to April 25, 2024. The certificate details the policy benefits including day care treatments, hospitalization coverage, organ donor expenses, and post/pre-hospitalization expenses. It also lists the premium amount and provides information on making claims, grievance redressal, and coverage exclusions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    Group Activ Health - Certificate of Insurance

    Aditya Birla Health Insurance Aditya Birla Health Insurance


    Company Limited, 7th floor, C Company Limited, 7th floor, C
    Policy Issuing Office building, Modi Business Policy Servicing Office building, Modi Business
    Centre, Kasarvadavali, Centre, Kasarvadavali,
    Mumbai, Thane West 400 615 Mumbai, Thane West 400 615
    Master Policy Number 3-71-23-0001041-000 Certificate Number GHI-71-23-0453652-000
    Master Policyholder
    Bajaj Finance Limited
    Name
    Product Name Group Activ Health Member Id PT92326156
    Raju .
    Name of Insured H NO 6/2, INCOME TAX
    Person and Residential COLONY GUEST HOUSEGUEST Unique Identification
    1396657
    Address of Insured HOUSE, Ludhiana, Number
    Person PUNJAB,,,Ludhiana,Ludhiana,I
    NDIA,PUNJAB,141001
    Mobile Number NA Email Id [email protected]

    Start date & Time of Master Policy 00:01 hrs 11/03/2023


    Expiry Date & Time of Master Policy 23:59 on 10/03/2024
    Period of Insurance 1 Year
    Inception Date 00:01 hrs 26/04/2023
    End Date 23:59 on 25/04/2024
    Coverage Type Floater

    Insured Person Detail


    Super No Claim
    Date of Nominee Sum
    Insured Person Gender Nominee Bonus
    Birth Relationship Insured
    % Amount
    Raju . 25/12/1971 Male Sonia- Self 1000000 NA NA
    Sonia . 10/10/1974 Female
    Khush Singh 09/01/2000 Male
    Love Singh 25/12/2001 Male

    Benefit Description
    Group Mediclaim Refer Coverage Details

    Policy Exclusions
    Group Mediclaim As per Policy Wordings

    Premium Details
    Particulars Amount
    Net Premium 25303.39
    CGST (9%) 2277.31
    SGST / UTGST (9%) 2277.31
    IGST (18%) NA
    Gross Premium 29858.0
    Premium payment mode BG
    GST Registration No.: 27AANCA4062G1ZN Category: General Insurance SAC Code: 997133

    We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover
    notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule

    Group Activ Health, Product UIN: IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17.


    Authorized Signatory

    Claim Process
    Address for Aditya Birla Health Insurance Company Limited, 5th floor, C building, Modi
    Please contact us
    Correspondence Business Centre, Kasarvadavali, Mumbai, Thane West - 400615
    through any of these
    Contact Number 1800 270 7000
    Modes
    Email ID [email protected]

    Grievance Redressal

    In case of a grievance, the Insured Person/ Policyholder can contact Us with the details through
    our website:https://www.adityabirlacapital.com/healthinsurance
    Email:[email protected]
    or Toll Free : 1800 270 7000.
    Address: Any of Our Branch office or Corporate office. For senior citizens, please contact respective branch office of the Company or
    [email protected].
    The Insured Person can also walk-in and approach the grievance cell at any of Our branches. If in case the Insured Person is not sa
    with the response, then they can contact Our Head of Customer Service at the following email
    [email protected] the Insured Person is still not satisfied with Our redressal, he/she may approach
    of the Ombudsman offices are provided on Our website and in the Policy.

    Group Activ Health, Product UIN: IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17.


    Stamp Duty - The stamp duty of Rs. 1 paid vide MH007928409202223E & 20/09/2022, received from Stamp Duty Authorities vide
    Receipt No. 0004344810202223 & 06/10/2022, payment has been made vide Letter of Authorisation No. CSD/488/2022/4368 &
    10/10/2022 from Main Stamp Duty Office

    Master Policy Number: 3-71-23-0001041-000 Certificate Number: GHI-71-23-0453652-000

    Date: 26/04/2023 Place: Mumbai

    Authorized Signatory

    Note: Amount is inclusive of all taxes and cesses as applicable. 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.

    Coverage Details

    Base Covers
    Sr No Cover Name Coverage
    No Of Day Care Procedures Covered 527
    1 Day Care Treatment c. Joint Replacement: 1 lac per Joint
    d. Hernioplasty - 40 K
    1000000
    2 Domiciliary Hospitalization a. Cataract limit to 30K
    b. Appendix : 40 K
    Room Type: Single Private A/c Room
    ICU Coverage : Upto SI
    3 In Patient Hospitalisation
    1000000
    e. Pacemaker Implantation : 1.5 lac
    1000000
    4 Organ Donor Expenses

    60 days
    5 Post hospitalization Medical Expenses

    30 days
    6 Pre hospitalization Medical Expenses

    3000 INR
    7 Road Ambulance Expenses 3000

    Waivers and Discounts


    1 30 day waiting period No
    2 Copayment % 10
    3 Coverage for Non Medical Expenses Not Applicable
    4 Pre Existing Diseases Waiting Period Waived Off
    Specified Disease Procedure Waiting
    5 Not Applicable
    Period
    Waiver of exclusion of attempted
    6 Not Applicable
    Suicide

    Riders
    Riders Limit / Options
    1 Super Reload Rider NA
    2 Super No Claim Bonus Rider NA
    3 Tele – OPD consultation Rider NA
    Additional S.I. for Pandemic and
    4 NA
    epidemic Rider

    Group Activ Health, Product UIN: IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17.


    Pre Existing Disease
    Member Name Relationship Pre Existing Disease
    Love Singh Son NA
    Khush Singh Son NA
    Sonia . Spouse NA
    Raju . Self Hypertension,Diabetes Mellitus

    Group Activ Health, Product UIN: IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17.


    Group Activ Health, Product UIN: IRDAI/HLT/ABHI/P-H(G)/V.I/19/2016-17.
    Policy No: 3-71-23-0001041-000 COI No. GHI-71-23-0453652-000
    Coverage Start Date: 26/04/2023 Coverage End Date: 25/04/2024

    Name Membership No. Relationship DOB


    Raju . PT92326156 Self 25/12/1971
    Sonia . PT92326160 Spouse 10/10/1974
    Khush Singh PT92326165 Son 09/01/2000
    Love Singh PT92326166 Son 25/12/2001

    • This card is only identification and is not an authorization to proceed with the treatment or guarantee for payment.
    • In case photo less identity cards issued to beneficiaries, acceptable proof of identity such as Aadhar Card/Passport/Driver
    License /Ration Card/Voters ID/ PAN Card should be presented at the hospital.
    • This non-transferable identification card is valid at selected Network Hospitals & will enable Card Holder to avail cashless
    hospitalization only on pre-authorization by Aditya Birla Health Insurance Co. Ltd
    • For latest updated network hospital list, log on to https://www.adityabirlahealth.com/healthinsurance/#!/provider-search

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