Navi Health Insurance Policy

Policy Schedule

Policyholder Name Syed Waseem

Policyholder Id PH00049444

Policy Issued On 20/04/2022

UIN No NAVHLIP22133V012122

Policy No RA00101Q

Policy Valid Upto 19/04/2023

Insurance Agent/Intermediary Details

Name Direct Digital

Code P040203000

Contact No. +91 81475 44555

 Insured Person Details

Member ID: RA00101Q-01

Insured Person Name SYED WASEEM

Relation with Policyholder Self

Date of Birth (DD/MM/YYYY) 28/11/1989

Age(Years) 33

Gender MALE

First Enrolment Date 20/04/2022

Waiting Periods 0 - 3L

Pre Existing Disease 12 MONTH

30 days waiting period Applicable

Specific Disease/ Procedure 12 MONTH
 Premium Details

Premium ₹ 3,798

Loading ₹0

Discounts ₹ 569.7

Total Premium ₹ 3,228.3

GST @ 18% ₹ 581.1

Total Amount (inlc GST) ₹ 3,809.4

 Premium Certificate

This is to certify that Syed Waseem has paid a

total amount of ₹ 3,174.5 towards premium for
this policy effective from 02:50 Hrs on 20/04/
2022.

Monthly Instalment amount 317.45

Monthly instalment due date20th of every month

First instalment paid date 21/01/2023

Last instalment due date 20/03/2023

For the purpose of deduction under section 80 D

of Income Tax Act, 1961 and any amendments
thereafter
 Scope of Cover

Type Individual

Plan Select

Base Medical Cover Amount ₹ 300000

Medical Cover Amount (Base + Cumulative

Bonus)

₹ 300000

Organ Donor Expenses

Up to 100% of medical cover

In-patient Hospitalisation

Up to 100% of medical cover

Pre-Hospitalisation 90 Days

Domiciliary Hospitalisation

Up to 100% of medical cover

Non payable expenses

Up to 100% of medical cover

Post-Hospitalisation 180 Days

Emergency Road Transportation

Up to 100% of medical cover

Additional Sum Insured for Accidental injury

Up to 100% of medical cover

Air Ambulance Covered upto 5 lakhs

Wellness Benefits Covered
 Policy Service Office

Name Navi General Insurance Limited

Date of Signature of Proposal 16/02/2023

Receipt Number

Place of Supply Bangalore

State Code

HSN No 997133

Stamp Duty

The Stamp Duty of Rs. 0.50 paid vide defaced no.

CR1021003000267763 dated 07/10/2021
Address

Navi General Insurance Limited

Registered & Corporate Office: NAVI GENERAL
INSURANCE LIMITED, AMR Tech Park, Ground
Floor, No 23 & 24, Hosur Road, Bommanahalli,
Bangalore- 560068

Policy Servicing Office :NAVI GENERAL

INSURANCE LIMITED, AMR Tech Park, Ground
Floor, No 23 & 24, Hosur Road, Bommanahalli,
Bangalore- 560068
 Claim Service Office

TPA Name

MEDI ASSIST INSURANCE TPA PRIVATE LIMITED

Toll Free Number 7406012341

Email claim.help@navi.com

TPA Address

Tower D, 4th Floor, IBC Knowledge Park, 4/1,

Bannerghatta Road, Bangalore- 560 029
Important Note
This Schedule, Policy terms and conditions and
Endorsement shall be read together and word or expression
to which a specific meaning has been attached in any part
of Navi Health Insurance policy or of the Schedule shall
bear the same meaning wherever it may appear. Any
amendments/modifications/ alterations made on this
system generated policy document is not valid and
Company shall not be liable for any liability whatsoever
arising from such changes. Any changes required to be
made in the policy once issued, would be valid and
effective, only after written request is made to the Company
and Company accepts the requested amendments/
modifications/alterations and records the same through
separate endorsement to be issued by the Company. Our
policy wordings, grievance redressal procedure and details
about ombudsman is also available on our website. Please
note that any misrepresentation, non-disclosure or
withholding of material facts will lead to cancellation of
policy ab initio with forfeiture of premium and non-
consideration of claim, if any.
 Transcript of Navi Health Proposal Form

This Insurance policy has been issued on the basis

of the information provided by you. In case of
discrepancy in the below information, you may
please write to us on insurance.help@navi.com
within 15 days of the receipt of the Policy,
otherwise below information will be deemed as
correct.
 Proposer Details

Name Syed Waseem

Date of Birth 28/11/1989

 Plan Details

Tenure 1 Year

Period 20/04/2022 to 19/04/2023

Type Individual

Sum Insured ₹ 300000

Plan Select
 Insured Details - Member

Name SYED WASEEM

Gender MALE

Date of Birth (DD/MM/YYYY) 28/11/1989

Relation with Proposer Self

 Nominee Details

Name Ruksana K H

Relation with Proposer Spouse

Date of Birth (DD/MM/YYYY) 20/03/1997

 Medical & Health Information

1.Do you have any existing illnesses or history of

hospitalisation due to an illness?

No

✓ I/We hereby declare that I have read and understood the

mentioned Terms & Conditions. I/We confirm compliance to
AML guidelines
I hereby consent that the Policy Documents shall be sent to
me by e-mail only on my registered e-mail Id. I understand
that this authorisation can berevoked by me at the time of
renewal by contacting your branch office personally or
customer care by writing a mail/ calling your toll-free
number.
I hereby declare, on my behalf and on behalf of all persons
proposed to be insured, that the above statements, answers
and/or particulars given by me are true and complete in all
respects to the best of my knowledge and that I am
authorised to propose on behalf of these other persons.
I understand that the information provided by me will form
the basis of the insurance policy, is subject to the Board
approved underwriting policy of the insurer and that the
policy will come into force only after full payment of the
premium chargeable.
I further declare that I will notify in writing any change
occurring in the occupation or general health of the life to
be insured/proposer after the proposal has been submitted
but before communication of the risk acceptance by the
company.
I declare that I consent to the company seeking medical
information from any doctor or hospital who/which at any
time has attended on the person to be insured/proposer or
from any past or present employer concerning anything
which affects the physical or mental health of the person to
be insured/proposer and seeking information from any
insurer to whom an application for insurance on the person
to be insured /proposer has been made for the purpose of
underwriting the proposal and/or claim settlement.
I authorize the company to share information pertaining to
my proposal including the medical records of the insured/
proposer for the sole purpose of underwriting the proposal
and/or claims settlement and with any Governmental and/
or Regulatory authority.”
Any GST liability and payment for the same is dependent on
the details (viz GSTIN, address, zero-rating entitlement etc)
provided by me. Navi General Insurance Limited will rely on
such information for the purpose of compliance with
applicable GST regulations and shall not be under
obligation to evaluate authenticity/accuracy of the same.
Further, in case any GST liability (in terms of tax, interest,
penalty and associated litigation cost) arises on Navi
General Insurance Limited on account of any incorrect/
incomplete/ non-compliance on behalf of me. I will be
immediately liable to pay the same on notification by Navi
General Insurance Limited. The said liability shall vest
irrespective of the completion of the insurance period
covered within the policy contract.
I hereby consent to and authorize Navi General Insurance
Limited to make welcome calls, service calls or any other
communication (electronic or otherwise) with respect to the
proposed or existing policy of the Company from time to
time.
I/We hereby confirm that all premiums have been/will be
paid from bonafide sources and no premiums have been/
will be paid out of proceeds of crime related to any of the
offence listed in Prevention of MoneyLaundering Act,2002. I
understand that the Company has the right to call for
documents to establish sources of funds. The insurance
company has right to cancel the insurance contract in case
I am/have been found guilty by any competent court of law
under any of the statutes, directly or indirectly governing
the prevention of money laundering in India.

UIN No.: NAVHLIP22133V012122

IRDAI Registration Number: 155

GSTIN: 29AAFCD7985H1Z0
CIN: U66000KA2016PLC148551
Registered & Corporate Office: NAVI GENERAL
INSURANCE LIMITED, AMR Tech Park, Ground Floor, No 23
& 24, Hosur Road, Bommanahalli, Bangalore- 560068
Policy Servicing Office : NAVI GENERAL INSURANCE
LIMITED, AMR Tech Park, Ground Floor, No. 23 & 24 Hosur
Road, Bommanahalli, Bangalore Karnataka 560068 India
Toll-Free No: +91 81475 44555
Web: www.naviinsurance.com
Email: insurance.help@navi.com
Navi Health(by Navi General Insurance) is the Trademark
used by Navi General Insurance Ltd. for its digital
platform.