Date: 22/01/2022
Policy Number: 00523200202200
Customer ID: 0010044572
Mr. Manoj Khantwal
Asst Director
Mnfs Assct For Infr Tech
4Th Floor Phd Chamber
Hauz Khas
New Delhi – 110016
Delhi
Dear Mr. Manoj Khantwal,
Welcome to Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health
Insurance Company Limited)
We know your health is of prime importance and at Niva Bupa we are committed to providing you with
world-class health insurance solutions, dedicated to helping you to protect your regular affairs by
protecting your employees.
In every evaluation & subsequent proposal, we consider cost-effective & suitable employee benefits,
efficient limit, ease to use, our extensive insurance experience, and our ongoing client support.
We are committed to the proposition that Insurance is a critical part of employee protection and
satisfaction and thereofore, to your subsequent career success. We also realise that our business ethics
and our ongoing professional support services are essential in maintaining your customer loyalty, which
as a professional, we know you understand. We guarantee to be readily available to assist you in
answering questions and providing ongoing personal service in all your Insurance affairs. Our goal is to
develop a long term, mutually beneficial relationship by protecting you in a cost effective, friendly,
personal and professional manner.
We are able to provide you with services necessary to meet key objective:
- Stability: The services, knowledge and expertise of well-known and respected Insurance
company.
- Customer service: A well staffed dedicated unit of experts has been assembled to be an advocate
for effective problem solving.
- Claim service: Quality effective claim management provided by a staff of experienced claim
management professionals utilizing sate of art computer claims processing.
Your Customer Pack contains the following documents, which will collectively help you in understanding
your policy and accessing our services:
- Employee & dependent personalized health card.
- Certificate of Insurance
- Premium Receipt
- Benefits of the policy (Annexure)
- Terms & conditions of the policy.
- Employee & dependent list covered under the policy.
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024| Corporate Office: 14 Floor, Capital Cyberscape
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
We urge all our valued group customers to read their policy documents including benefits, inclusions and
exclusions carefully. Also check their Health cards which will be helpful at the point of claim. It is the
responsibility of the employer to inform all the beneficiaries about the same and ensure the group
customers are aware of their health policy details.
Should you need additional information, please write us at [Link]@[Link]
Apart from this you can view the policy details on our dedicated Group Portal at the following link:
[Link]
A separate individual communication on “Healthlink” would be sent on your registered email id available
in our records. These communications would be with respect to “Employer” & “Employee” Login.
.
Again, thank you for choosing Niva Bupa Health Insurance Co Ltd. We appreciate the opportunity given
to us to serve you and looking forward for a continued beneficial relationship.
Here's wishing to a healthy and happy life ahead.
Yours Sincerely,
Padmesh Nair
Director-Operations & Customer Service
Important - Please read this document and keep in a safe place.
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Internal Corporate Office: 14 Floor, Capital Cyberscape
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024|
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
Policy Document – Health Plus
Schedule of Insurance Certificate
Issuing office National Operating Centre - NOIDA
Policyholder's name Mnfs Assct For Infr Tech
Policyholder's address 4Th Floor Phd Chamber Hauz Khas New Delhi Delhi - 110016
Policy number 00523200202200
First Policy inception date 11-January-2022
Date and time of Policy commencement 11-January-2022
Date and time of Policy expiry 10-January-2023
Aggregate Sum Insured 4500000.00
Premium Payment Frequency Anually
Free look Period 15 Days
Agent name POLICY BAZAAR
Agent code WEB0030001
Agent contact number NA
Claims Administrator Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited)
[Link] Basic Details Particulars
1 Family Structure Employee, Spouse and Kids
2 Total no of employees/Primary Members 9
3 Total no of Insured Members 28
Cover Type (Individual/Floater) Floater
Benefit Structure
Inpatient Care – Sum Insured INR 5 Lakhs
Listed Day Care Treatment Covered upto Sum Insured
Normal 1%
ICU 2%
Hospital Accommodation – Room rent/day & ICU/day If the Insured Person is admitted in the Hospital in a room category or in a room where the Room Rent is higher than the eligibility as specified above, then Niva
Bupa shall be liable to pay only a pro-rated proportion of the total Associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the
difference between the Room Rent actually incurred and the entitled room category/eligible Room Rent.
Pre Hospitalization Medical Expenses Covered upto Sum Insured for 30 days
Post Hospitalization Medical Expenses Covered upto Sum Insured for 60 days
Emergency Ambulance INR 1000 per hospitalization
Normal 50,000
C-Section 50,000
1. Maternity Expenses Benefit is available for Employees or Spouse only if both are covered in Insured members data received from Policyholder.
Maternity Expenses
2. The Maternity Benefit may be claimed under the Policy in respect of eligible Insured Person(s) only twice during the lifetime of the Policy including any
Renewal thereafter for the delivery of a child or Medically Necessary Treatment and lawful termination of pregnancy up to maximum of 2 pregnancies or
terminations.
Pre & Post Natal Expenses Covered within Maternity Expenses with a capping of INR 5000 in case of IPD only.
Corporate Floater Not Covered
Corporate Floater Limit NA
Corporate Floater utilization/family NA
List of Critical Illness NA
OPD Coverage Not Covered
Co-payment Not Applicable
Disease wise capping Not Applicable
Waiting Periods
Pre-Existing Disease (PED) Waived Off
2 yr exclusions (Disease Specific Exclusions) Waived Off
Initial Waiting Period Waived Off
Special Conditions:
1. New born baby would be covered from the date of delivery provided we receive the endorsement within 90 days of delivery.
2. Claim for lasik treatment - if power of eye is above +/- 7.5, is payable
GST Details
GSTI No.:06AAFCM7916H1ZC SAC Code/ Type of Service : 997133 / General Insurance Services
Niva Bupa State Code : 6
Customer State Code 7
Customer GSTI No. : 07AAATM0970B1Z0
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024| Corporate Office: 14 Floor, Capital Cyberscape
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
Premium Details:
Hospitalization Cover Premium (Rs.) 0.00
Fixed Benefit coverage for named Illness Premium (Rs.) 0.00
Hospital Cash Benefit Premium (Rs.) 0.00
OPD Treatment & Diagnostic Cover Premium (Rs.) 0.00
International Coverage Premium (Rs.) 0.00
Accidental Cover Premium (Rs.) 0.00
Critical Illness Premium (Rs.) 0.00
Wellness Benefits Premium (Rs.) 0.00
Total Net premium (Rs.) 1,43,686
Integrated Goods and Service Tax (18%) 25,863
Central Goods and Service Tax (9%) 0.00
Duties and cess (Rs.) 0.00
State/UT Goods and Service Tax (9%) 0.00
Gross premium (Rs.) 1,69,549
Gross premium (Rs.) (In words) Rupees One Lakh Sixty Nine Thousand Five Hundred and Forty Nine Only
Next premium due date 11-January-2023
Cheque no./ Demand Draft no./ Transaction no.(Online fund
transfer) NEFT
Date: 10-01-2022
This Policy is subject to the terms, conditions and exclusions mentioned in Health Plus policy document.
*Goods and Service Tax Registration No: 07AAFCM7916H1ZA. Service tax is subject to changes in tax laws.
The contract will be cancelled ab intio in case the consideration under the policy is not realized.
Policy issuing Office : Noida, Consolidated Stamp Duty deposited on the Master Policy.
According to rule 54(2) of CGST Rules 2017, policies issued by an Insurance Company can be treated as a tax invoices and such invoices need not be serially numbered
Location: NOIDA
Date: 22-01-2022 Director-Operations & Customer Service
Note:
• The above details may be altered basis customers requirements.
• Where the proposal form is not received, information obtained from Policyholder, whether orally or otherwise, is captured in the policy document. Discrepancies, if any, in the information contained in the policy document may be
pointed out by Policyholder within 15 days from the policy issue date after which information contained in the policy document shall be deemed to have been accepted as correct.
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024| Corporate Office: 14 Floor, Capital Cyberscape
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
Premium Rater
Per Person Rate (Excl. tax)
Sum Insured 500000
Age Band Band A
0-2 yrs 2136.564
3-17 yrs 2136.564
18-25 yrs 3564.65
26-30 yrs 3796.688
31-35 yrs 4121.459
36-40 yrs 4760.285
41-45 yrs 5829.803
46-50 yrs 7477.975
51-55 yrs 9483.476
56-60 yrs 14157.21
61-65 yrs 18991.68
65+ yrs 21931.11
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024| Corporate Office: 14 Floor, Capital Cyberscape
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
Premium Receipt
Mnfs Assct For Infr Tech
4Th Floor
Phd Chamber Hauz Khas
New Delhi - 110016
Delhi
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policy Number 00523200202200
Policy Holder’s Name : Mnfs Assct For Infr Tech
Aggregate Sum Insured (Rs. 4500000.00
Commencement Date 11-01-2022 Expiry date 10-01-2023
Gross Premium(Rs.) Rs.1,69,549/-
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void.
GST Details
GSTI No.:06AAFCM7916H1ZC SAC Code/ Type of Service : 997133 / General Insurance Services
Niva Bupa State Code :6 Customer State Code / Customer GSTI 07/ 07AAATM0970B1Z0
For & On behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
Location: NOIDA
Date: 22-01-2022 Director-Operations & Customer Service
Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Company Limited)
IRDAI Registration No. 145|CIN: U66000DL2008PLC182918
th
Registered Office: C-98, Lajpat Nagar 1, Delhi-110024| Corporate Office: 14 Floor, Capital Cyberscape
Golf Course Extension Road Sector-59, Gurugram-122011(Haryana) | Website: [Link]
Tel.:+ 91-11-30902000, Fax No.: + 91- 011-30902010
