HDFC ERGO General Insurance Company Limited

2822200084205003000

POLICY SCHEDULE

Policy No. 2822 2000 8420 5003 000

Critical Illness Policy
Proposer Name

MR KOMMISETTI - MURTHY RAJU

Premium Frequency

Yearly

Correspondence
Address

Mobile

HOUSE NUM:1-2-50 CHEKURI TOWERS FLAT NO:101 Permanent PARADISE APPARTMENTS FLAT NO 201 VASAVANI ST
RK ADARSH NAGAR STREET NO:9 BHIMAVARAM
Address
SAJJAPURAM TANUKU W
WEST GODAVARI (D) ANDHARAPRADESH
WEST GODAVARI,534211
WEST GODAVARI,534202
ANDHRA PRADESH
ANDHRA PRADESH
9440118008
Phone
E Mail VENKATESWARA106@GMAIL.COM

Period of Insurance

From Date & Time 04/06/2014 00:01 hrs

To Date & Time

03/06/2015 Midnight

st

Policy Inception

04/06/2010

Insured Persons Details & Sum Insured

Insureds Name
KOMMISETTI MURTHY RAJU

Sum Insured

Plan

Date of Birth

500000

Platinum

20/05/1973

Pre Existing Disease

Coverage Details
1. Heart Attack (Myocardial Infraction)

6. Coronery Artery Bypass Surgery

11. Aorta Graft Surgery

2. Stroke

7. Multiple Sclerosis

12. Cancer

3. Kidney failure

8. Alzheimer's Disease

13. Heart Valve Replacement

4. Primary Pulmonary Arterial Hypertension

9. Paralysis

14. Parkinson's Disease

5. Benign Brain Tumor

10. Major organ transplantation

15. End Stage Liver Disease

The Policy Wording attached herewith includes all the standard coverage offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s
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.

Premium Details ( ` )
Basic Premium

4,750.00

Loadings

0.00

Service Tax (Including Education Cess & Higher Education Cess, wherever applicable)

587.00

Total Premium

5,337.00

Payment Details
Cheque No./DD/Fund Transfer
ERGO_CC_240514-01282990000126-SE

Date

Bank Name

24/05/2014

HDFC Bank Ltd

Special Conditions

Exclusions

List of Endorsements
Endt No Description

For Claim Services

Address

Effective Date

Phone

18002001999

Fax no.

18602000600

E-mail

healthclaims@hdfcergo.com

HDFC ERGO General Insurance Company Ltd. 5th floor, Tower 1, Steller IT Park, C-25, Sector-62,Noida-201301.

For any other query call toll-free 1800 2 700 700 or email us at care@hdfcergo.com or log on to
INSURER / LEAD INSURER
Co-insurers

:
:

www.hdfcergo.com

HDFC ERGO General Insurance Co.Ltd. 70%

Apollo Munich Health Insurance Company Limited 30%

The policy i s valid subject to payment received b y us. I f the premium i s not realised the policy shall be void from inception. The Insurer and Co-insurers liability in respect of any payment that may be
due under this policy i s strictly limited to the % stated above, subject always to the sum insured o r that part of the sum insured that remains in respect of a claim. For the avoidance of doubt under this
co-insurance arrangement, the lead Insurer i s the Insurer for all policy purposes including but not limited to the collection of premium, policy administration, notices, policy and claims decisions and
the payment of claims.
Consolidated stamp duty for this Insurance Policy i s paid b y Demand Draft, vide Receipt/Challan no 661258201314 dated 28/02/2014 a s prescribed in Government Notification Revenue and Forest
Department No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004.
Policy Issuing Office: Mumbai

Agent Name :HDFC BANK LTD

Agent Code :201587086428 Tel No. : 91-22-28561818

For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

Corporate Off.: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059. Toll-Free No.1800-2-700-700 Fax 91 22 66383699 care@hdfcergo.com www.hdfcergo.com
Registered Off.: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.

HDFC ERGO General Insurance Company Limited

Mr Kommisetti - Murthy Raju

House Num:1-2-50 Chekuri Towers Flat No:101 Rk Adarsh Nagar Street
No:9 Bhimavaram
West Godavari (D) Andharapradesh West Godavari
Andhra Pradesh 534202

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 ` 5,337.00 (RUPEES FIVE THOUSAND THREE
HUNDRED
THIRTY-SEVEN
AND
ZERO
PAISE Only)
towards
premium
for Critical
Illness
Policy No. 2822200084205003000 issued
to KOMMISETTI
MURTHY
RAJU for
the
period 04/06/2014 to 03/06/2015.
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 : 04/06/2014
Policy Issuing Office: Mumbai
For HDFC ERGO General Insurance Company Ltd.

Duly Constituted Attorney

Corporate Off.: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059. Toll-Free No.1800-2-700-700 Fax 91 22 66383699 care@hdfcergo.com www.hdfcergo.com
Registered Off.: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.

HDFC ERGO General Insurance Company Limited

Frequently Asked Questions (FAQs) - Critical Illness Policy
WHAT ARE THE MAJOR COVERS OF THE POLICY?
This policy assures you a lump sum amount upto the sum insured upon the first diagnosis of any one of the critical illnesses (varies as per plan opted) to take care of your treatment/personal
commitments etc.
The applicable list of Critical illnesses are mentioned in the Coverages section of your policy schedule.
DO I GET INCOME TAX BENEFIT?
Yes, you can avail a tax benefit under Section 80D of Income Tax Act 1961(Subject to change in income Tax law). Tax certificate is provided along with the policy copy. You can mail the same on
your registered email id through IPO,online insurance portfolio organizer.
CLAIM PROCEDURES
1. DETAILS TO KEEP HANDY WHILE REGISTERING A CLAIM
Policy Number
Nature of disease/illness
Brief history of diagnosis (first diagnosis date is mandatory)
2. HOW DO I FILE MY CLAIM?
Call toll-free : 1800 200 1999
Email : healthclaims@hdfcergo.com with mentioned details, your policy number,
correspondence address and contact numbers in the communication.
3. WHOM SHOULD I SEND THE CLAIM DOCUMENTS TO?
Send your documents to - HDFC ERGO General Insurance Company Limited
5th floor, Tower 1, Stellar IT Park,
C-25, Sector-62, Noida-201301

4. WHAT ARE THE BASIC DOCUMENTS REQUIRED IN CASE OF A CLAIM?

Duly filled and signed claim form (available on our website)
Copy of Photo ID proof of insured and claimant
Discharge card and original discharge summary,
Consultation note/ Relevant treatment papers
All relevant medical reports along with supporting invoices and doctors requisition
advising the same
Original and final hositalisation bills with detailed breakup
Pharmacy bills along with prescriptions
Please note: This is not an exhaustive list. Additional docs may be required on case to case
basis.

WHAT IS IPO(INSURANCE PORTFOLIO ORGANIZER)?

IPO is an online insurance portfolio account of the customer. You can create your portfolio
by creating your login id and password under Insurance Portfolio Organizer section on our
portal, www.hdfcergo.com. You can manage your insurance portfolio on your mobile phone
also through the IPO Mobile Application. The IPO Mobile Application is supported on the
mobile platforms Symbian(OS version 9.3,9.4 & 9.5), Blackberry(OS version 5 & 6), Android,
iPhone & Windows 8.

HOW TO REGISTER/TRACK MY CLIAM STATUS?

You can track your claim status from any of the below options:
Call toll free : 1800 200 1999
Call: 1860 2000 700
Fax: 1860 2000 600
Email : healthclaims@hdfcergo.com
Visit IPO : Login into online Insurance Portfolio Organiser(IPO) on
the home page of our website,www.hdfcergo.com
Kindly mention your claim number and/or policy/ reference number in the correspondence.
Above numbers can be dialed for queries pertaining to hospitalisation, critical illness,
cashless facility and authentication of the health cards.

BASIC CHECKS IN THE POLICY & CORRECTION/CHANGE PROCEDURE

Check the accuracy and completeness of the below mentioned details in the
policy schedule.
Insureds name and proposers name (salutation, gender, spelling)
Correspondence address (house number, street name, locality, pincode, city, village,
landmark, etc)
Mobile number, landline number and personal email id
Policy period
Coverage & sum insured details
Date of birth of insured i.e. policy holder

For making changes or correction in your policy, please send duly signed
request via any of the below options:
Fax : 022-66383669 / 66383699
Email : care@hdfcergo.com (please mail the scanned letter)
Visit our nearest branch in your city
Post/courier : Corporate office at Mumbai
Call toll-free 1800 2 700 700 for assistance (from your registered mobile number)
Please do mention your policy number & contact details (mobile number & address) in the
communication

Note: Supporting documents may be called for such corrections whereby change of premium amount is involved or otherwise in the policy on case to case basis.
You would receive an endorsed policy schedule reflecting the changes made in the policy details on your correspondence address as per policy. Same would be captured in the policy under the
section list of endorsements.
WOULD I RECEIVED ANY CONFIRMATION ON THE CHANGES DONE IN MY POLICY?
You will receive an endorsed policy schedule reflecting the changes made in the policy details on your correspondence address as provided & mentioned in the policy. Same would be captured in
the policy under the section List of Endorsement .You can view/print the endorsed policy schedule on IPO, the online insurance portfolio organizer.
HOW DO I RENEW MY POLICY?
You can renew your policy via any of the below options:
a) Visit www.hdfcergo.com to renew instantly online.
b) SMS"RENEW <POLICY NO> " to 9999 700700 ( from your registered mobile number)
c) Visit our nearest branch or contact your agent
d) Send a copy of the renewal notice along with premium cheque to our branch office or
Corporate office
e) Call toll-free 1800 2 700 700 / 1800 226 226
f ) Email to care@hdfcergo.com

Manage Your Portfolio

@ hdfcergo.com /
Smartphones*

HOW TO CONTACT US?

For Claims call
For General Queries Call
Fax
E-Mail
Write to us
(Corporate office)

Add/View your policies

Register motor/health claims
Track your claim status online

* supports smart phone based on Blackberry, iPhone, Windows 8, Android & Symbian platform.

:
:
:
:
:

1800 200 1 999 (Toll free)

1800 2 700 700 (Toll free)
022 6638 3669
care@hdfcergo.com
HDFC ERGO General Insurance Company Limited
6th floor, Leela Business Park, Andheri Kurla Road,
Andheri(East), Mumbai - 400 059

Change your personal details on the go

Track your interactions on endorsement dispatch status
Find branches, garages and cashless network hospitals
Dowload IPO mobile appliaction from IPO website post log in

This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy
wordings. In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.