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Date : 11 September 2021

Mr Rajiv Ramchandra Sakpal

R No 103 Sangeeta Appartment Damodar Vitavkar Marg

Vitawa Smashan Bhumi Road Opp Happy Home School Kalwa

Thane

Thane 400605

Maharashtra

Policy No. : 14751079

Mobile No. : XXXXXX2817

Subject : Renewal of Policy No. 14751079

Dear Mr Rajiv Ramchandra Sakpal,

We take this opportunity to thank you once again for entrusting us with your health; and assure you of our commitment to keep you
worry-free….hamesha.

We are pleased to confirm renewal of your policy; and enclosed are the following documents with regard to the same :

Policy Certificate
Premium Acknowledgement (including tax certificate)
To enjoy seamless services offered by your policy, please note the following :

- Health Cards and all other documents issued along with your first policy shall continue to be valid.

- To enable quicker processing, we request you to mention your Member Card Number / Policy Number in all future correspondence with us.

- To further simplify procedures, we’re online at www.careinsurance.com; where you can view network hospitals across the country, cashless
procedures and do much more.

For any clarifications, please feel free to mail us at customerfirst@careinsurance.com or call us at 1800-102-4488.

Wishing you Health….Hamesha!

0

Policy Certificate
Mr Rajiv Ramchandra Sakpal Policy No. 14751079
Plan Name POS CARE
R No 103 Sangeeta Appartment Damodar Vitavkar Marg
Add-on Policy Name Care Shield
Vitawa Smashan Bhumi Road Opp Happy Home School Kalwa Cover type Floater
Policy Period - Start Date 00:00 hrs 13-Sep-2021
Thane Policy Period - End Date Midnight 12-Sep-2022
Premium Paid Rs. 21516
Thane 400605 (Premium Rs 18234.32 + CGST Rs 1641.08 + IGST Rs 0 + SGST
Rs 1641.08 + UGST Rs 0)

Maharashtra 27 Premium Payment Mode Single Premium

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2

Policyholder Gender Date Of Birth Client ID

Rajiv Ramchandra Sakpal Male 10-Jul-1968 70193008

Details of Insured
Insured with the *#No Claim
Name Client ID Date of Birth Relationship Company Pre-existing diseases Bonus
(since)
Rajiv Ramchandra Sakpal 70193008 10-Jul-1968 MEMBER 13-Sep-2019 NONE 80,000.00
Trupti Rajiv Sakpal 70252073 07-Jul-1970 SPOUSE 13-Sep-2019 NONE 80,000.00

*The No Claim Bonus shown in the Policy Certificate is provisional. The No Claim Bonus calculated on the Expiry Date, shall only be considered as final. However, in case of any change in provisional No
Claim Bonus, the same shall be intimated to the Policyholder by the Company through a separate endorsement.
1 #Subject to the Policy Terms&Conditions, the No Claim Bonus shown above would be available only up to the maximum amount of Rs. 80,000 for all the Insureds collectively.
Details of Cover
S No. Particulars Details
1 Sum Insured Rs. 4,00,000

Contact details for Claims & Policy Servicing

Correspondence address Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)
Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA)

Contact no. 1800-102-4488

Fax no. 1800-200-6677

E-mail ID for Claims claims@careinsurance.com

E-mail ID for Policy servicing customerfirst@careinsurance.com

Website www.careinsurance.com

Name Code PAN/Aadhar No. Contact Number

for Claims & Assistance: Call 1800-102-4488

11
Schedule of Benefits
S No. Particulars Basis of Offering
1 Second Opinion Once per Policy Year per Insured Person for each major

00 2 Alternative Treatments Up to Rs. 15,000 per Policy Year

10% of Sum Insured for each Claim free year, maximum upto 50% of
3 No Claims Bonus Sum Insured; reduced by 10% of Sum Insured in case of claim

4 Annual Health Check-up One Health Check-up per Insured Person per Policy Year

Room Rent = up to 1% of Sum Insured per day; ICU

5 Hospitalization Expenses (In-patient Care and Day Care Treatment)
Charges = up to 2% of Sum Insured per day

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

6 Pre & Post-hospitalization medical expenses 60 days after hospitalization

7 Daily Allowance Rs. 500 per day; Maximum up to 5 days per Hospitalization

8 Ambulance Cover Up to Rs. 1,500 per Hospitalization

9 Organ Donor Cover Up to Rs. 50,000 per Policy Year

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

10 Domiciliary Hospitalization first 3 days

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

Portability Details of the Insured

First Policy Number Date of First Enrollment Expiry Policy SI Rs.

Name Previous Insurer (Original SI+CB)
Rajiv Ramchandra Sakpal National Insurance Co. Ltd 240900481685 11-Sep-2017 300000 + 15000
Trupti Rajiv Sakpal National Insurance Co. Ltd 240900481685 11-Sep-2017 300000 + 30000

*SI = Sum Insured, CB = Cumulative Bonus

Special Conditions
S No. Particulars
1 Co-payment (Not Applicable)
Add-on Policy Benefits
UIN No- RHIHLIA21168V012021
Schedule of Benefits
S No. Particular Description
1 Claim Shield Applicable
2 NCB Shield Applicable
3 Inflation Shield Applicable
For Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue : 11-Sep-2021 Place of Issue : Gurgaon, Haryana

Service Branch : CHIL, Krishna Plaza, Office No. 704, 7Th Floor, Near Thane Railway Station, , Naupada Thane West, Maharashtra - 400602 Branch Contact No. : 022-25383022
Correspondence Address:
Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)
Unit no 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector 39, Gurgaon -122001.(HARYANA) Contact No : 1800-102-4488
Website : www.careinsurance.com Email : customerfirst@careinsurance.com
Consolidated Stamp Duty paid vide E-Challan GRN no. 77150994 dated 17 May 2021, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State GSTIN No.: 27AADCR6281N1ZS IRDA Registration Number - 148 UIN : RHIHLIP20091V041920
Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
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@careinsurance.com or contact the Company at 1800-102-4488 / 1800-102-6655.
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.
14751079

70193008 10-Jul-1968 RAJIV RAMCHANDRA SAKPAL

70252073 07-Jul-1970 TRUPTI RAJIV SAKPAL
REN
1

Premium Acknowledgement

Policy No. 14751079

Client ID 70193008
Policyholder Mr Rajiv Ramchandra Sakpal
Address R No 103 Sangeeta Appartment Damodar Vitavkar Marg
Vitawa Smashan Bhumi Road Opp Happy Home School Kalwa
Thane
Thane 400605, Maharashtra
Policy Period 13-Sep-2021 to 12-Sep-2022

Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Payment
1 35629733 21516 INTERNET PAYMENT GATEWAY (IPG)
Gross Premium
POS Care 17,121.44

-Care Shield 1,112.88

Goods & Services Tax (GST) 3,282.16

Total 21,516.00

The Premium is rounded off to the nearest rupee.

Eligibility of Premium for Deduction u/s 80D of the Income Tax Act, 1961
The premium paid through any mode other than cash for this policy is eligible for Income tax benefits to the person making the payment subject to the
provisions of section 80D of the Income Tax Act, 1961 and amendments thereof. Effective from Assessment year 2019-20, in cases where health
insurance premium for multiple years is paid in one year, it will be eligible for proportionate deduction in the years in which the health insurance continues
to be effective.
For Care Health Insurance Limited
(Formerly known as Religare Health Insurance Company Limited)

Authorized Signatory Date of Issue: 11-Sep-2021 Place of Issue: Gurgaon, Haryana

IRDA Registration Number - 148

Registered office address : 5th Floor, 19 Chawla House, Nehru Place, New Delhi - 110019
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.

Signature Not
Verified
Digitally signed by
MANISH DODEJA
Date: 2021.09.12
20:51:56 IST
Reason: I'm the author
Location: India