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    Navi Gi PolicyDocumentRA0020FP 1

    Uploaded by

    Tapas
    This document is a health insurance policy schedule issued by Navi Health Insurance to Tapas Singha. It provides key policy details such as the policyholder name, policy number, policy validity period, insured person details, premium payment details, scope of coverage, and claim service office contact information. The policy covers medical expenses of up to Rs. 300,000 with a 1 year waiting period for pre-existing diseases and specific illnesses or procedures. Premium is due on the 13th of every month.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Navi Gi PolicyDocumentRA0020FP 1

    Uploaded by

    Tapas
    18 views22 pages
    This document is a health insurance policy schedule issued by Navi Health Insurance to Tapas Singha. It provides key policy details such as the policyholder name, policy number, policy validity period, insured person details, premium payment details, scope of coverage, and claim service office contact information. The policy covers medical expenses of up to Rs. 300,000 with a 1 year waiting period for pre-existing diseases and specific illnesses or procedures. Premium is due on the 13th of every month.

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    This document is a health insurance policy schedule issued by Navi Health Insurance to Tapas Singha. It provides key policy details such as the policyholder name, policy number, policy validity period, insured person details, premium payment details, scope of coverage, and claim service office contact information. The policy covers medical expenses of up to Rs. 300,000 with a 1 year waiting period for pre-existing diseases and specific illnesses or procedures. Premium is due on the 13th of every month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    18 views22 pages

    Navi Gi PolicyDocumentRA0020FP 1

    Uploaded by

    Tapas
    This document is a health insurance policy schedule issued by Navi Health Insurance to Tapas Singha. It provides key policy details such as the policyholder name, policy number, policy validity period, insured person details, premium payment details, scope of coverage, and claim service office contact information. The policy covers medical expenses of up to Rs. 300,000 with a 1 year waiting period for pre-existing diseases and specific illnesses or procedures. Premium is due on the 13th of every month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 22

    Navi Health Insurance Policy

    Policy Schedule

    Policyholder Name Tapas Singha

    Policyholder Id PH00098825

    Policy Issued On 13/10/2022

    UIN No NAVHLIP22133V012122

    Policy No RA0020FP

    Policy Valid Upto 12/10/2023

    Insurance Agent/Intermediary Details

    Name Direct Digital

    Code P040203000

    Contact No. 1800-123-0004


    Insured Person Details

    Member ID: RA0020FP-01

    Insured Person Name TAPAS SINGHA

    Relation with Policyholder Self

    Date of Birth (DD/MM/YYYY) 28/09/2001

    Age(Years) 21

    Gender MALE

    First Enrolment Date 13/10/2022

    Waiting Periods 0 - 3L

    Pre Existing Disease 1 YEAR

    30 days waiting period Applicable


    Specific Disease/ Procedure 1 YEAR
    Premium Details

    Premium ₹ 3,236

    Loading ₹0

    Discounts ₹ 485.4

    Total Premium ₹ 2,750.6

    GST @ 18% ₹ 495.11

    Total Amount (inlc GST) ₹ 3,245.71


    Premium Certificate

    This is to certify that Tapas Singha has paid a total


    amount of ₹ 270.48 towards premium for this
    policy effective from 13:23 Hrs on 13/10/2022.

    Monthly Instalment amount 270.48

    Monthly instalment due date 13th of every month

    First instalment paid date 13/10/2022

    Last instalment due date 13/09/2023

    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

    Post-Hospitalisation 180 Days

    Non payable expenses Up to 100% of medical cover

    Air Ambulance Covered upto 5 lakhs

    Pre-Hospitalisation 90 Days
    In-patient Hospitalisation

    Up to 100% of medical cover

    Additional Medical Cover Amount for Accidental


    injury

    Up to 100% of medical cover

    Emergency Road Transportation

    Up to 100% of medical cover

    Home Hospitalisation Cover

    Up to 100% of medical cover

    Organ Donor Expenses

    Up to 100% of medical cover

    Wellness Benefits Covered


    Policy Service Office

    Name Navi General Insurance Limited

    Date of Signature of Proposal 13/10/2022

    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, 4th Floor, Salarpuria
    Business Center, 93, 5th A Block, Koramangala,
    Industrial Layout, Bangalore - 560095
    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 Tapas Singha

    Date of Birth 28/09/2001


    Plan Details

    Tenure 1 Year

    Period 13/10/2022 to 12/10/2023

    Type Individual

    Sum Insured ₹ 300000

    Plan Select
    Insured Details - Member

    Name TAPAS SINGHA

    Gender MALE

    Date of Birth (DD/MM/YYYY) 28/09/2001

    Relation with Proposer Self


    Nominee Details

    Name Lakshmi singha

    Relation with Proposer Son

    Date of Birth (DD/MM/YYYY) 01/01/1981


    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, 4th Floor, Salarpuria Business Centre, 93, 5th A
    Block, Koramangala Industrial Layout, Bangalore - 560095
    Toll-Free No: 1800-123-0004
    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.

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