Mr.
DEVANDRA PITARAM CHOUDHARI
TA, AINWADI, BHAIRAVNATH MANGAL KARYALAY
BHAIRAVNATH MANGAL KARYALAY SANGLI
MAHARASHTRA - 415311
Mobile No: XXXXXX2196
Certificate of Insurance (COI) - Health Plus
How to reach us?
Website Online Renewal
[Link] It takes a few minutes to renew your policy Log on to
[Link]/renew
Customer Helpline No. Like us on Facebook
1860-500-8888
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Important Terms & Conditions (T&C)
a. Niva Bupa requests you to refer to the detailed Terms and Conditions (T&C) available with the Group Master Policyholder.
You may also refer the T&C on our website.
b. Free Look Provision: You can review the T&C within the number of days specified overleaf and request cancellation of the
Certificate of Insurance in case of objections to any T&C. We will refund the premium as specified in the T&C provided
that no claim has been registered under the cover.
c. Grievances Redressal In case of any query or complaint/grievance, you may approach our office at the below mentioned
address. In case you are not satisfied with our resolution, You ,may register a complaint in the Integrated grievance
Management System (IGMS) of IROAI or approach the Insurance Ombudsman. Details about the IGMS and Ombudsman
are available on our website.
Certificate of Insurance (COI) - Health Plus
Group Master Policy Number 50357300202402 Group Master PolicyHolder's Name Axis Bank Limited
Group Master Policyholder's Axis Bank Limited Group Master Policy Issue date 10/11/2024
Address & Pincode
Certificate Number 144000725130 Proposer’s Name [Link] PITARAM
CHOUDHARI
Cover Inception Date and Time 16/03/2025 12:00 AM Proposer’s Address & Pincode TA, AINWADI, BHAIRAVNATH
MANGAL KARYALAY
BHAIRAVNATH MANGAL
KARYALAY SANGLI
MAHARASHTRA - 415311
Cover Expiry Date and Time 15/03/2026 11:59 PM Contact Number XXXXXX2196
Certificate No. Salutation Insured Name Date of Birth/ Age Gender Relationship Sum Insured NCB Loyalty
144000725130 Mr. DEVANDRA PITARAM CHOUDHARI 19/02/1985 M Self NA NA
144000725131 Mrs. MANJU DEVENDRA CHOUDHARI 27/12/1986 F Spouse NA NA
3,000,000
144000725132 Ms. AARATI DEVENDRA CHOUDHARI 05/05/2007 F Daughter NA NA
144000725133 Mr. GOUTAM DEVENDRA CHOUDHARI 11/12/2010 M Son NA NA
Nominee details
Nominee Address (if Nominee Contact Appointee Details (if nominee is
Nominee Name Relationship different) Details minor)
MANJU DEVENDRA SPOUSE Same as insured Same as insured NA
CHOUDHARI
Policy Tenure 1 year
Details
Hospitalization Benefit
Plans 30L
Base Sum Insured 30 lac with 3 lac deductible
Sub Sections
Inpatient Care Up to Base Sum Insured
Hospital accommodation- Room Rent/day Single Private Room
Hospital accommodation- ICU/day Up to Base Sum Insured
Day Care Treatment Listed 536 Day Care Treatments covered up to Base Sum Insured
Pre - hospitalization Medical Expenses 30 days; up to base sum insured
Post- hospitalization Medical Expenses 60 days; up to base sum insured
Domiciliary Hospitalization Up to Base Sum Insured
Organ Transplant Up to Base Sum Insured
Emergency Ground Ambulance- Within India INR 1000 per hospitalization
Modern Treatment Up to Base Sum Insured as per T&C
Accompanying person accommodation cover INR 1000/Day (Maximum of 10 Days)
Initial Waiting Period 30 days
Specific Disease Waiting Period 24 months
Pre-Existing Diseases Waiting Period 24 Months
Accidental cover
Accidental Death 30 lacs for primary insured
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No
Axis Bank Limited BNK0160001 18605008888
GST Details:
GSTI No.: 09AAFCM7916H1Z6 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code : 09 Customer State Code / Customer GSTI No. : 27 / NA
Premium Details
Net CGST SGST/UTGST IGST Gross Gross Premium (Rs.) (in words) Premium
Premium (0.00%) (0.00%) (18.00%) Premium frequency
(Rs.) (Rs.)
2118.00 0.00 0.00 381.24 2499.00 Two Thousand Four Hundred Ninety Nine Only Single
Income tax benefit u/s 80D is available as per the existing Income Tax Laws. Please consult your tax advisor for more details.
This Policy is subject to the terms, conditions and exclusions mentioned in the HEALTH PLUS, UIN : NBHHLGP22157V032122
The contract will be cancelled ab intio in case; the consideration under the policy is not realized.
Policy issuing office : Delhi , Consolidated Stamp Duty deposited on the Master policy
Goods and Service Tax Registration No.: 09AAFCM7916H1Z6
Pursuant to Notification no 13/2020– Central Tax and Notification no 14/2020– Central Tax both dated 21st March 2020 read with rule 54 (2) of
CGST Rules 2017, the provisions of E Invoicing & QR code are not applicable to an Insurance company, hence E Invoice number and QR code has
not been printed on this document. GST under RCM: NIL
The cover may be renewed on sole discretion of Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Co.
Ltd.) subject to member being the part of the group at the time of renewal also. In case You cease to be a member of the group, the cover will stand
cancelled as per T&C of the policy
Where the proposal form is not received, information obtained from insured, 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 an insured 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.
For registration of claims You may contact us at:
Claims Department, Niva Bupa Health Insurance Company Limited, 2nd Floor, Plot No D-5, Sector 59, Noida, Gautam Budhnagar – 201301 Fax No.:
011-3090-2010 Or Email us through our service platform [Link]
Location: Noida, Uttar Pradesh
Director - Operations & Customer Service
Date: 16/03/2025
For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
