My: Optima Secure

HDFC ERGO General Insurance Company Limited
2856206589176900000
my: Optima Secure
2856206589176900000
2856
MR ANKUR KUMAR VAISHLAY
-
-
NEW DELHI, DELHI, 110073
Contact No. 95XXXXXXX5
Date :02/07/2024
Dear MR ANKUR KUMAR VAISHLAY
Thank you for choosing HDFC ERGO GENERAL INSURANCE COMPANY LTD. as your preferred insurance partner. We welcome you to be a part of our family !
Your Health insurance policy reference no 2856206589176900000 is confirmed on the basis of the information and declaration given by you.
The details of coverage are mentioned in the enclosed policy schedule of insurance.
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Now you can view your policy details and health card at your fingertips. Download our Mobile App now and experience convenience today!!
As per recent directive by Insurance Regulator IRDAI, KYC verification has been mandated for all existing & new insurance customers.
To ensure that we comply with this guidelines, we are retrieving your KYC documents (Address proof and Photo) updated with Pan No from CERSAI portal. Rest assured, your
KYC details will be verified or retrieved for KYC purpose only.
Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.
Soft copy of the policy is valid for all purposes including claims.
For HDFC ERGO General Insurance Company Ltd.
Duly Constituted Attorney
Dear MR ANKUR KUMAR VAISHLAY,
Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This is to certify that we have received an amount of ` 40698 towards premium from MR ANKUR KUMAR VAISHLAY for my: Optima Secure, Policy No.
2856206589176900000 issued to MR ANKUR KUMAR VAISHLAY for the period 04/07/2024 to 03/07/2025.
Member wise premium break up is as follows:

Insured Person’s Premium Details
Name of Insured Person Relation with policy Gender Date of Birth Premium Goods & Services Total Premium including
holder Tax (GST) GST
Ankur Kumar Vaishlay Self Male 16/08/1993 8550 1539 10089
Kanchan Sharma Spouse Female 21/01/1989 20000 3600 23600
Kavyaan Vaishlay Son Male 26/07/2022 5940 1069.2 7009.2
Note:
1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy. In event of incorrect representation of this declaration the liability shall be upon the
policy holder.
Date : 02/07/2024
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: HDFHLIP25011V042425. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
2856206589176900000
Policy Schedule
my: Optima Secure
Optima Secure
2856206589176900000
Policy Number : 2856 2065 8917 6900 000 Issuance Date : 02/07/2024
Period of Insurance : From 04/07/2024 00:01 hrs To 03/07/2025 Midnight
Invoice No. : 206589176900000 Premium Frequency : Single
Policyholder Name : Mr Ankur Kumar Vaishlay Policy Type : FAMILY Floater
MR ANKUR KUMAR VAISHLAY HSN Code : 997133 Premium Tier : Tier1
- - NEW DELHI, DELHI-110073 Place of supply : DELHI Previous Policy : 2805203584440103002
Contact No : 95XXXXXXX5 Customer Id : 101501692249 Renewal : No
EIA No. : Not provided
Email ID : [email protected]
Intermediary Name Intermediary Code Intermediary Contact Number
Monika 201592087451 91-9891585105
Insured Person’s Details and Sum Insured - Optima Secure

Insured Person’s Relation with Gender Date of Nominee Name Relationship First Policy Base Sum Aggregate Plus Benefit Unlimited Overseas
Name policy holder Birth with Nominee Inception Insured Deductible Restore Add Travel
date (`) (`) on(Y/N) Secure
Ankur Kumar Self Male 16/08/1993 Subhash Chand Father 12/06/2019 5000000 0 5000000
No
Vaishlay
No
Kanchan Sharma Spouse Female 21/01/1989 30/06/2021 No
Kavyaan Vaishlay Son Male 26/07/2022 04/07/2023 No
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee.
Unlimited Restore UIN No: HDFHLIA22188V012122 Optima Wellbeing UIN No:HDFHLIA24099V012324
Insured Person’s Details and Sum Insured – Add On Covers
Optima Well my: health Critical illness Add
IPA Rider my: health Hospital Cash Benefit Add on
Being on
Insured Person’s Name Sum Plan Sum Insured Hospital Cash Hospital Cash Companio Hospital Hospital Cash
Insured Benefit - Normal Benefit - ICU n Benefit Cash Global - Global
Room Opted
Special Conditions/ Exclusions

Name of Insured Person Exclusion/Exclusion Wavier Loading Reason Special Condition / Declared Pre-existing
Disease
Renewal Continuity Benefits

Sum Insured (`) Waiting Periods Remaining Waiting Periods Remaining Waiting Periods Remaining: (30
Name of Insured Person
(Pre-existing Diseases) (Specific Waiting Period) Days Waiting Period)
Portability Continuity Benefits

Name of Insured Person Previous Sum Insured inclusive Porting Benefits on Waiting Periods Waiting Periods Waiting Periods
Policy Year of Cumulative Bonus Sum Insured (`) Remaining (Pre-existing Remaining (Specific Remaining: (30 Days
(`) Diseases) Waiting Period) Waiting Period)
ANKUR KUMAR VAISHLAY 3 5000000 5000000 Waived Waived Waived
KANCHAN SHARMA 3 5000000 5000000 Waived Waived Waived
KAVYAAN VAISHLAY 1 5000000 5000000 2 Years 1 Year Waived
The Policy Wording attached herewith includes all the standard coverages offered by the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the
coverage/benefits as mentioned in this Policy Schedule issued to you. Please read the Policy Wording in conjunction with the Policy Schedule. For any clarification, please call our
toll free number 022 - 6234 6234 / 0120 - 6234 6234.
For declared and accepted pre-existing medical conditions, waiting period (s) shall apply per policy terms and conditions from 1st policy inception date of the policy
, fresh waiting period (s) shall apply on enhanced sum insured.
Premium Details (`)

Particulars ANKUR KUMAR VAISHLAY KANCHAN SHARMA KAVYAAN VAISHLAY
Base Premium (A) 8550 20000 5940
Optional Cover Premium (B) 0 0 0
Add on Cover Premium (C) 0 0 0
Loading (D) 0 0 0
Total Premium (E=A+B+C+D) 8550 20000 5940
Aggregate Deductible Discount 0 0 0
Online Discount 0 0 0
Employee Discount 0 0 0
Loyalty Discount 0 0 0
NRI Discount 0 0 0
Family Discount 0 0 0
Long term Policy Discount 0 0 0
Total Discount (F) 0 0 0
GST 18% : Central Tax 9% ( `3104 ) + State Tax 9% ( `3104) 8550 20000 5940
HDFC ERGO General Insurance Company Limited 2856206589176900000
Particulars ANKUR KUMAR VAISHLAY KANCHAN SHARMA KAVYAAN VAISHLAY

Goods & Service Tax (GST)
1539 3600 1069.2
Total Premium including GST 10089 23600 7009.2

Payment Details
Instrument details 902000195306442 Date 27/06/2024 Bank Name BizDirect
Processing Centre
HDFC ERGO General Insurance Co. Ltd. , Stellar IT Park, Tower-1, Fifth Floor, C - 25, Sector 62, Noida - 0120 398 8360
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make
changes/register & track claim.
If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide
Receipt/Challan noNO.LOA/ENF-1/CSD/34/2023/6045 dated 27/12/2023 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the
09th January 2018. GST Registration No: 07AABCL5045N1ZA". GST for this invoice is not payable under reverse charge basis.
I/ 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
Branch :ground floor eros corporate tower - nehru place,new delhi south delhi
For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings
SCHEDULE OF BENEFITS
Section* Plans Optima Secure
All figures Geography
India Only
in (`)
2 Base Sum Insured per Insured Person per Policy
5000000
Year (in Lakh)
1.1. Hospitalization Expenses Covered
1.1.a. Room Rent At Actuals
1.1.1.h. Road Ambulance Covered upto sum insured
1.1.1.i. Dental Treatment Covered upto sum insured
1.1.1.j. Plastic surgery Covered upto sum insured
1.1.1.k. Day Care Treatment Covered upto sum insured
1.2. Home Healthcare Covered upto sum insured
1.3. Domiciliary Hospitalization Covered upto sum insured
1.4. Ayush Treatment Covered upto sum insured
1.5. Pre-Hospitalization 60 days
1.6. Post-Hospitalization 180 days
1.7. Organ Donor Expenses Covered upto sum insured
2.1. Emergency Air Ambulance Covered Up to 500000
2.2. Daily Cash for choosing Shared Accommodation 800 per day max up to 4800
2.3. Protect Benefit Covered upto sum insured
2.4. Plus Benefit Bonus of 50% of the Base Sum Insured, maximum upto 100%.
2.5. Secure Benefit Equal to 100% of Base sum insured
2.6. Automatic Restore Benefit Equal to 100% of Base sum insured
2.7. Aggregate Deductible 0
2.8. E-Opinion for Critical Illness In India
Preventive Health Check-up
3.
Sum Insured 50 Lakhs 5000000
Floater Policy* 10000
*For Individual policy sum insured and limits mentioned in the table are applicable on per Insured Person per Policy Year basis and for Family Floater policy sum insured and limits
apply on per policy per Policy Year basis
*Claims shall be payable as per geography mentioned in the above table unless explicitly stated otherwise in a specific cover.
#Aggregate Deductible & Overseas Travel Secure are not an inbuilt feature in any of the above Plans. However, these cover can be separately opted at inception of the Policy or at
subsequent Renewals. Aggregate Deductible if opted, shall apply only for claims arising in India. However, a Per Claim Deductible of Rs. 10,000 will apply separately for each and
every claim arising out of India in Global plans
*Preventive Health Check-up benefit will not be available under the policy if Aggregate Deductible of INR 5 Lakhs or more is in force

Policy No.:2856206589176900000 This card is for identification purpose only.
Valid From: 04/07/2024 Renewal Date: 3 July
Card has to be presented to the Network Service Provider at the time of admission/ availing
Insured Name Member ID Date Of Birth Gender cashless hospitalization o r any other services. Insurance claim will be processed in accordance
ANKUR KUMAR VAISHLAY 2024410041516430 16/08/1993 Male with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
KANCHAN SHARMA 2024410041516431 21/01/1989 Female service. For more details and updated list of Network Service Provider please refer our website or
KAVYAAN VAISHLAY 2024410041516432 26/07/2022 Male call our call centre. This card is valid till the time policy is active.
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

Email : [email protected]
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com
CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

This document provides key information about your policy. You are also advised to go through your policy
document.
Policy
Description (Please refer to applicable Policy Clause Number in next
S.No Title Clause
column)
Number
Name of Insurance
1 my:Optima Secure NA
Product/Policy
2 Policy number 2856206589176900000 NA
Type of Insurance
3 Both Indemnity and Benefit NA
Product/ Policy
• Individual Sum Insured -Where each member has a separate sum
insured under the policy), or
• Floater Sum Insured-Where all members under the policy have a
4 Sum Insured single sum insured limit which may be utilized by any or all members NA
Sum Insured opted:5000000
on FAMILY Sum Insured basis
Note: For complete details of Sum Insured applicability, please refer to
your Policy Schedule
Policy Coverage Base Covers: Coverages in force for the Insured Persons shall be
5 (What the policy as per the plan opted
covers?)
Expenses in respect of:
1. Admission in Hospital for minimum 24 hours B-1.1

2. All Day Care procedures requiring less than 24 hours of B-1.1.1.i
hospitalization v
3. Home Health Care (Medical Expenses incurred on availing
B-1.2
treatment at Home)
4. Domiciliary Hospitalization (Treatment at home due to
non-availability of room in a Hospital or patient could not be B-1.3
removed/admitted to a Hospital)
5. AYUSH Treatment (Medical Expenses incurred for Inpatient Care
under Ayurveda, Yoga and Naturopathy, Unani, Siddha and B-1.4
Homeopathy)
6. Pre-hospitalisation of 60 days (treatment prior to admission in
B-1.5
hospital)
7. Post-hospitalisation (treatment after discharge from hospital) within
B-1.6
180 days from date of discharge
8. Organ Donor Expenses (Cost of Organ donor’s hospitalization for
harvesting of the donated organ where an Insured Person is the B-1.7
recipient)
9. Cumulative Bonus (Applicable only to Optima Suraksha plan) B-1.8
10. Preventive Health Check-up - Basic (Cost of a Preventive Health

B-3
Check-up for the Insured Person will be paid)
Optional Covers: Optional coverages for the Insured Persons

shall be in force only if the same is available under the plan
and/or is opted
1. Emergency Air Ambulance (Cost incurred by the Insured Person

towards Ambulance transportation in an airplane or helicopter for
Emergency Care which requires immediate and rapid ambulance B-2.1
transportation that ground transportation cannot provide from the site
of first occurrence of the Illness or Accident to the nearest Hospital)
2. Daily Cash for Shared Room (Daily cash amount for each
continuous and completed 24 hours of Hospitalization if the Insured
Person is Hospitalized in shared accommodation in a Network B-2.2
Provider Hospital and such Hospitalization exceeds 48 consecutive
hours)
3. Protect Benefit (Payment towards Non-Medical Expenses listed
B-2.3
under Annexure B of Policy Document)
4. Plus Benefit (50% of the Base Sum Insured under the expiring
Policy will be added to the Sum Insured available under the Renewed B-2.4
Policy)
5. Secure Benefit (An additional amount will be available to the Insured
B-2.5
Person as Sum Insured for all claims admissible)
6. Automatic Restore Benefit (Restoration of Sum Insured in the event
of complete or partial utilization of the Base Sum Insured due to any B-2.6
claim admitted during the Policy Year)
7. Aggregate Deductible (Aggregate Deductible is an amount as
specified in the Policy Schedule that Insured Person shall bear for all B-2.7
admissible claims)
8. E-Opinion for Critical Illness (Expenses towards E-Opinion for
Critical Illness availed from a Medical Practitioner in respect of any B-2.8
Major Medical Illness)
9. Global Health Cover (Emergency Treatments Only) Emergency
B-2.9
Medical Expenses which are diagnosed and incurred outside India.
10. Global Health Cover (Emergency & Planned Treatments)
Emergency & Planned Medical Expenses which are incurred & paid B-2.10
outside India.
11. Overseas Travel Secure (Covers overseas travel &
B-2.11
accommodation expenses)
Exclusions (what the
6 policy does not 1. Investigation & Evaluation: Code Excl04 C.1.d
cover)
i. Expenses related to any admission primarily for diagnostics and
evaluation purposes only are excluded.
ii. Any diagnostic expenses which are not related or not incidental to
the current diagnosis and treatment are excluded.
2. Rest Cure, rehabilitation and respite care: Code – Excl05: C.1.e
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.
3. Obesity/Weight control: Code – Excl06: C.1.f
Expenses related to the surgical treatment of obesity that does not
i. Surgery to be conducted is upon the advice of the Doctor
ii. The surgery/Procedure conducted should be supported by clinical
protocols
iii. The member has to be 18 years of age or older and
iv. 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:
1) Obesity-related cardiomyopathy
2) Coronary heart disease
3) Severe sleep apnea
4) Uncontrolled type2 diabetes
4. Change-of-Gender treatments: Code – Excl07: C.1.g
Expenses related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex
5. Cosmetic or plastic Surgery: Code – Excl08: C.1.h
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
6. Hazardous or Adventure Sports: Code – Excl09: Expenses C.1.i
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.
7. Breach of Law: Code – Excl10: C.1.j
Expenses for treatment directly arising from or consequent upon any
Insured Person committing or attempting to commit a breach of law
with criminal intent.
8. Excluded Providers: Code – Excl11: C.1.k

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.
9. Treatment for Alcoholism, drug or substance abuse or any
C.1.l
addictive condition and consequences thereof. Code – Excl12 .
10. Treatments received in health hydros, nature cure clinics,
spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where C.1.m
admission is arranged wholly or partly for domestic reasons.
Code – Excl13.
11. 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 C.1.n
Practitioner as part of Hospitalization claim or Day Care
procedure. Code – Excl14.
12. Refractive Error: Code – Excl15:
Expenses related to the treatment for correction of eye sight due to C.1.o
refractive error less than 7.5 dioptres.
13. Unproven Treatments: Code – Excl16: C.1.p
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.
14. Sterility and Infertility: Code – Excl17:
C.1.q
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
15. Maternity: Code – Excl18
i. Medical treatment expenses traceable to childbirth(including
complicated deliveries and caesarean sections incurred during C.1.r
hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident)and
lawful medical termination of pregnancy during the Policy Period.
Specific Exclusions: C.2
In addition to the foregoing general exclusions, the Company shall not

be liable to make any payment under this Policy caused by or arising
out of or attributable to any of the following:
a) War or any act of war, invasion, act of foreign enemy, (whether war
be declared or not or caused during service in the armed forces of any
country), civil war, public defence, rebellion, revolution, insurrection, C.2.a
military or usurped acts, Nuclear, Chemical or Biological attack or
weapons, radiation of any kind.
b) Aggregate Deductible - Claims/claim amount falling within
Aggregate Deductible limit if opted and in force, as specified in the C.2.b
Policy Schedule.
c) Any Insured Person committing or attempting to commit intentional
C.2.c
self-injury or attempted suicide or suicide.
d) Any Insured Person’s participation or involvement in naval,military
C.2.d
or air force operation.
e) Investigative treatment for sleep-apnoea, general debility or
C.2.e
exhaustion (“run-down condition”).
f) Congenital external diseases, defects or anomalies. C.2.f
g) Stem cell harvesting. C.2.g
h) Investigative treatments for analysis and adjustments of spinal sub
luxation, diagnosis and treatment by manipulation of the skeletal
structure or for muscle stimulation by any means except treatment of C.2.h
fractures (excluding hairline fractures) and dislocations of the mandible
and extremities.
i) Circumcisions (unless necessitated by Illness or Injury and forming
C.2.i
part of treatment).
j) Vaccination including inoculation and immunisations (except post
C.2.j
animal bite treatment).
k) Non-Medical expenses such as food charges (other than
patient’s diet provided by hospital), laundry charges, attendant
charges,ambulance collar, ambulance equipment, baby food,
C.2.k
baby utility charges and other such items. Full list of Non-Medical
Expenses is attached as Annexure B of policy document and also
available at www.hdfcergo.com.
l) Treatment taken on outpatient basis. C.2.l
m) The provision or fitting of hearing aids, spectacles or contact
C.2.m
lenses.
n) Any treatment and associated expenses for alopecia, baldness
including corticosteroids and topical immunotherapy wigs, toupees,
C.2.n
hair pieces, any non-surgical hair replacement methods,optometric
therapy.
o) Expenses for Artificial limbs and/or device used for diagnosis or

treatment (except when used intra-operatively), prosthesis,corrective
devices external durable medical equipment of any kind, wheelchairs,
C.2.o
crutches, and oxygen concentrator for bronchial asthma/ COPD
conditions, cost of cochlear implant(s) unless necessitated by an
Accident.
p) Any treatment or part of a treatment that is not of a reasonable
charge and not Medically Necessary. Drugs or treatments which are C.2.p
not supported by a prescription.
q) Any permanent exclusion applied on any medical or physical
condition or treatment of an Insured Person as specifically mentioned
in the Policy Schedule and as specifically accepted by
Policyholder/Insured Person. Such exclusions shall be applied for the C.2.q
condition(s) or treatment(s) that otherwise would have resulted in
rejection of insurance coverage under this Policy to such Insured
Person as per Company’s Underwriting Policy
1. Initial waiting Period: 30 days for all illnesses (not applicable in case
7 Waiting period C.1.c
of continuous renewal or accidents)
• Time period during
which specified 2. Specific Waiting periods (Not applicable for claims arising due to an
C.1.b
diseases/treatments accident):
are not covered.
• It is counted from • 24 months for listed diseases/procedure
3. Pre-existing diseases: Covered after 36 months C.1.c
Note: Waiting Periods in force for Insured Persons shall be as per the
plan opted or option selected
Financial limits The policy will pay only up to the limits specified hereunder for the
8
coverage of following diseases/ procedures:
Sub-limit (It is a pre- Base Cover:
1. Preventive Health Check-up (basis plan chosen) : B-3
Deductible (It is a
i. Individual Policies : Upto Rs 1500/2000/4000/5000/8000
specified amount:
- up to which an
insurance company
ii. Family Floater Policies : Upto Rs 2500/5000/8000/10,000/15,000
will not pay any
claim, and
- which will be
deducted from total
claim amount (if Optional Covers :
claim amount is
more
than the specified

amount)
1. Emergency Air Ambulance : Up to 5 L B-2.1
2. Daily Cash for Shared Room (basis plan chosen) : B-2.2
Rs. 800 per day max upto 4800 or Rs. 1000 per day max up to 6000
3. Overseas Travel Secure :
Accomodation Expenses :upto Rs. 15,000 per day max upto 30 days B-2.11
Deductibles :
1. Aggregate Deductible (Optional Cover) :
B-2.7
25k/50k/100k/200K/300K/5L/10L/20L/25L
2. Per Claim Deductible (Applicable for each and every claim arising out B-2.9 &
of India in Global plans) : 10K (Per Claim) B-2.10
Claims/Claims A. Details of procedure to be followed for cashless service as well as for
9 E
Procedure reimbursement of claim including pre and post hospitalization in India.
Turn Around Time (TAT) for claims settlement:
For Cashless Process :
i. TAT for preauthorization of cashless facility: 2 hours from the time the
last necessary document is received.
ii. TAT for cashless final bill authorization: 2 hours from the time the last
necessary document is received.
(Note: In case of internal verification, the final stand will be confirmed
within 24 hours from the time the last necessary document is received
by us)
B. Procedure for Cashless Claims Outside India: You shall intimate the
Claims to us through any available mode of communication as specified
in the Policy, Health Card or our Website.
Toll Free No: 800 08250825 Global Toll Free No : +800 08250825
(accessible from locations outside India only) Landline no
(Chargeable) : 0120-4507250 [email protected]
For Reimbursement Process :
i. TAT for Claim settlement – 30 days from the time the last necessary
document is received.
(Note: In case of internal verification, the final stand will be confirmed
within 45 days from the time the last necessary document is received by
us)
Provide the details /web link for following:
i. Network Hospital details :
https://www.hdfcergo.com/locators/cashless-hospitals-networks
ii. Helpline number :
https://www.hdfcergo.com/customercare/grievances
Call - : 022 6234 6234 / 0120 6234 6234
iii. Hospitals which are excluded or from where no claims will be accepted by inurer
https://www.hdfcergo.com/docs/default-source/documents/excluded-hospital1.pdf
iv. Downloading/getting claim form
https://www.hdfcergo.com/download/claim-form
10 Policy Servicing
Call center number : D.1
022 6234 6234 / 0120 6234 6234
Or visit help section on www.hdfcergo.com
B. Procedure for Cashless Claims Outside India: You shall intimate the
Claims to us through any available mode of communication as
specified in the Policy, Health Card or our Website.
Customer Happiness Center: D-301, 3rd Floor, Eastern Business
District LBS Marg, Bhandup (West), Mumbai - 400 078.
Grievances/Complai In case of any grievance the insured person may contact the Company
11 D.1.17
nts through:
- Website: www.hdfcergo.com
- Toll free: 022 6234 6234 / 0120 6234 6234
- E-mail: [email protected]
- Contact Details for Senior Citizen: 022 – 6242 – 6226
- E-mail specific for Senior citizens : [email protected]
- Insured Person may contact the Grievance officer

[email protected]
- For updated details of grievance officer, kindly refer the link:

https://www.hdfcergo.com/customer-voice/grievances
- Ombudsman: https://bimabharosa.irdai.gov.in/.
Free Look cancellation:
12 Things remember to You may cancel the insurance policy if you do not want it, within 15 D.1.8
days from the beginning of the policy.
Process for free look cancellation:

1. The Free Look Period shall be applicable on new individual health
insurance policies and not on renewals or at the time of
porting/migrating the policy.
2. The insured person shall be allowed free look period of fifteen days
from date of receipt of the policy document to review the terms and
conditions of the policy, and to return the same if not acceptable.
Policy renewal:
Except on grounds of fraud, moral hazard or misrepresentation or
D.1.9
non-cooperation, renewal of your policy shall not be denied,
provided the policy is not withdrawn.
Migration and Portability:
D.1.10 &
When your policy is due for renewal, you may migrate to another
D.1.11
policy with us or port your policy to another insurer.
Process for migration:
The Insured Person will have the option to migrate the Policy to
other health insurance products/plans offered by the Company by
applying for Migration of the policy atleast 30 days before the
policy renewal date as per IRDAI guidelines on Migration.
Process for portability:

The Insured Person will have the option to port the Policy to other
insurers by applying to such Insurer to port the entire policy along
with all the members of the family, if any, at least 45 days before,
but not earlier than 60 days from the policy renewal date as per
IRDAI guidelines related to Portability.
Change in Sum Insured:

Sum Insured can be changed (increased/ decreased) only at the
time of renewal, subject to underwriting by the company. For
increase in SI, the waiting period if any shall start afresh only for
the enhanced portion of the sum insured.
Moratorium Period:
After completion of eight continuous years under the policy no look
back to be applied. This period of eight years is called as
moratorium period. The moratorium would be applicable for the
D.1.6
sums insured of the first policy and applicable for the sums
insured of the first policy and subsequently completion of eight
continuous years would be applicable from date of enhancement
of sums insured only on the enhanced limits.
After the expiry of Moratorium Period no health insurance policy shall
be contestable except for proven fraud and permanent exclusions
specified in the policy contract.
Please disclose all pre-existing disease/s or condition/s and fill in the
13 Your Obligations complete details in the proposal form before buying a policy.
Non-disclosure may affect the claim settlement.
Note:
1. Web-link of the product documents: https://www.hdfcergo.com/download >>
2. In case of any conflict, the terms and conditions mention in the policy document shall prevail.
Declaration by the Policy Holder;
I have read the above and confirm having noted the details.
Place:
(Signature of the Policyholder)
Date:

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HDFC ERGO General Insurance Company Limited

MR ANKUR KUMAR VAISHLAY

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited

Dear MR ANKUR KUMAR VAISHLAY,

Member wise premium break up is as follows:

For HDFC ERGO General Insurance Company Ltd.

Insured Person’s Details and Sum Insured - Optima Secure

Special Conditions/ Exclusions

Renewal Continuity Benefits

Portability Continuity Benefits

Premium Details (`)

Particulars ANKUR KUMAR VAISHLAY KANCHAN SHARMA KAVYAAN VAISHLAY

Total Premium including GST 10089 23600 7009.2

Duly Constituted Attorney

HDFC ERGO General Insurance Company Limited 3

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

Expenses in respect of:

1. Admission in Hospital for minimum 24 hours B-1.1

10. Preventive Health Check-up - Basic (Cost of a Preventive Health

Optional Covers: Optional coverages for the Insured Persons

1. Emergency Air Ambulance (Cost incurred by the Insured Person

8. Excluded Providers: Code – Excl11: C.1.k

In addition to the foregoing general exclusions, the Company shall not

o) Expenses for Artificial limbs and/or device used for diagnosis or

than the specified

- Insured Person may contact the Grievance officer

- For updated details of grievance officer, kindly refer the link:

Process for free look cancellation:

Process for portability:

Change in Sum Insured:

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