Certificate of Insurance Group Policyholder Name Madhya Pradesh Gramin Bank

Ms Poorvita . Group Policy No. 13774196

W/o Ujjawal Pathak 42 Parsai Colony Near Barsana Certificate of Insurance No 46094928
Township S
Plan Name Group Care(Scheme 2 MPGB)
Anawad Road Khargone Khargone Madhya Pradesh
451001 Cover type Individual
Khargone 451001 Policy Period - Start Date 00:00 hrs 25/Aug/2023
Madhya Pradesh 23 Policy Period - End Date Midnight 24/Aug/2024

Premium Paid Rs. 1,837.00

Premium Rs 1557+CGST Rs 0.00+IGST Rs
280.26+SGST Rs 0.00+UGST Rs0.00
Premium Payment Mode Single Premium

Details of Applicant

Policyholder Date Of Birth Client ID

Ms Poorvita . 15-Feb-1990 46289765

Details of Insured Person

Insured with the

Name Client ID Date of Birth Relationship Pre-existing diseases since
Company (since)

Poorvita . 46289765 15-Feb-1990 MEMBER 25-Aug-2022 NONE

Contact details for Claims & Policy Servicing

Care Health Insurance Limited, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43,
Correspondence address
Gurugram-122009 (Haryana)

E-mail ID for Claims claims@careinsurance.com

Website www.careinsurance.com

Intermediary Details

Name Code Contact Details

Madhya Pradesh Gramin Bank 20122842 0731-2549053

Benefits
S No. Particulars Basis of Offering

1 Hospitalization : Inpatient Care/Day Care Up to SI

2 Pre-hospitalization & Post hospitalization Upto 15 day & 30 days respectively
3 Maternity Expenses-Comprehensive Cover As per package rates
4 Organ Donor Cover Upto SI
5 Durable Medical Equipment Upto SI
6 Domestic Road Ambulance up to Rs. 1000 per hospitalization
7 Named Ailment (as defined in Group Care Product) NA
8 Pre-existing diseases NA
9 Maternity Wait Period of 9 Months
Key Exclusions
The company shall not be liable to make payment for any claim directly or indirectly caused by, based on, arising out of howsoever
attributable to any of the following except covered by way of an extension: page3
l Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline
for which he is licensed or any kind of self-medication.
l Charges incurred (or Treatment undergone) in connection with routine eye examinations and ear examinations, dentures, artificial
teeth and all other similar external appliances and / or devices whether for diagnosis or treatment.
l Treatment of any external Congenital Anomaly or Illness or defects or anomalies or treatment relating to external birth defects.
l Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during
hospitalization)or expenses towards lawful medical termination of pregnancy during the policy period.
l Cosmetic surgery or plastic surgery or related treatment of any description, including any complication arising from these treatments, other
than as may be necessitated due to an Injury, cancer or burns
l Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured
Member with any criminal intent
l Act of self-destruction or self-inflicted Injury, attempted suicide or suicide while sane or insane
l Any Illness or Injury attributable to consumption, use, misuse or abuse of intoxicating drugs or alcohol or Tobacco (in any Form like cigarettes
or Gutka etc..)or any other hallucinogens drugs.
Note: This is an illustrative list of exclusions. Please refer Group Policy Terms and Conditions at our website www.careinsurance.com or Group
Policy T&C issued to the Group Master Policy Holder.

Portability/Renewability
S NO. Particulars

1. You can renew the policy only if Master Policy is renewed by Group Master Policyholder.

Care Health Insurance reserves the right to change premium/benefits of the Group Policy at the time of Renewal in consultation
2.
with Master Policy Holder.
You can migrate your existing Policy from this scheme to any Health Insurance retail product of Care Health Insurance. Policy
3.
Issuance subject to Underwriting guidelines of company on the date of migration.
Once the Group Care Health Insurance policy is migrated to retail product of Care Health Insurance, customer will have to pay
4.
premium as per the New product underwriting guidelines.

Grievance Redressal/Complaints
In case of any grievance the Insured Person may contact the Company through
Website/link:https://www.careinsurance.com/contact-us.html
Mobile App : Care Health- Customer App
Toll free (WhatsApp Number): 8860402452
Courier: Any of Company's Branch Office or Corporate Office
Insured Person may also approach the grievance cell at any of the Company's branches with the details of grievance.
If Insured Person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the
grievance officer at Branch Office or corporate office.
For updated details of grievance officer, kindly refer the link- https://www.careinsurance.com/customer-grievance-redressal.html
If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach the
office of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance Ombudsman Rules 2017. The
details of insurance ombudsman offices may be referred in the annexure shared along with the Master policy document.
Grievance may also be lodged at IRDAI integrated Grievance Management System -https://bimabharosa.irdai.gov.in/

Optional Cover

1 Sum Insured 1,00,000

For Care Health Insurance Limited

Authorized Signatory

Date of Issue : 29/Aug/2023

Place of Issue : Gurgaon, Haryana
Service Branch : Vipul Tech Square TowerC3rd Floor Sector43Golf Course Road Branch Contact No. Nil
Gurgaon Haryana 122009Gurgaon,Haryana,122009 :

Consolidated Stamp Duty paid vide E-Challan GRN no. 98389442 dated 17 Jan 2023, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State
GSTIN No.: 06AADCR6281N1ZW
UIN :RHIHLGP20126V011924
CIN: U66000DL2007PLC161503
Note:
1- Validity of this certificate is subject to terms and conditions of Group Policy issued to the Group Policyholder.
2- In event of non-receipt of Premium, this certificate of insurance automatically stands cancelled from inception, irrespective of whether a
separate communication is sent or not. This policy is based on the information provided by the Insured to the Group Administrator. In case
you find any discrepancy in the same, please contact us immediately.
3- This Certificate of Insurance is governed by and is subject to the Terms and Conditions of the referred Group Policy.
Premium Acknowledgement
Policy No. 46094928
Client ID 46289765
Policyholder Ms Poorvita .
Address W/o Ujjawal Pathak 42 Parsai Colony Near Barsana Township S
Anawad Road Khargone Khargone Madhya Pradesh 451001
Khargone 451001
Madhya Pradesh 23

Policy Period 25/Aug/2023 to 24/Aug/2024

Premium Details
Particulars Amount (in Rs.) S.no. Receipt Number Amount Mode of Payment
1 A4847021 1,837.00 NEFT
Gross Premium
Group Care 1,557.00
Goods & Services Tax (GST) 280.26
Total 1,837.00
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.

Signature Not Verified

For Care Health Insurance Limited
Digitally signed by MANISH DODEJA
Date: 20230829205638
Reason: I'm the author
Location: India

Authorized Signatory
Date of Issue : 29/Aug/2023
Place of Issue : Gurgaon, Haryana
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.
4)This Policy is issued subject to realization of the premium amount. In case the instrument given towards the premium
amount is dishonored, then the cover provided under this Policy shall automatically get cancelled. In the given scenario, if
any amount has been paid by the Company in respect of a claim or due to any other reason than the amount so advanced
by the Company shall be refunded to the Company forthwith.
5) We may credit upto Rs. 1/- to your account for validation, before remitting any further payment.