United India Insurance Company Limited
Registered Office: 24 Whites Road, Chennai, 600 0 14
IRDAI Reg. No 545
Website: [Link]
03rd Apr, 2024
Your
INDIVIDUAL HEALTH INSURANCE POLICY SCHEDULE
Dear MR JAY JAGDISHBHAI PATEL
Welcome to United India Insurance Company Limited! IMPORTANT!
It is with great pleasure that we present this policy to you. The Policy schedule along with the Policy Wordings and any
We are honoured that you have chosen us for your health Endorsements, form the basis of contract between you and
insurance needs. United India. This contract is based on the statements and
declaration provided in the Proposal Form by you.
We are confident you have made the right choice and we
shall leave no stone unturned to ensure that you are This Schedule and the attached Policy shall be read
satisfied with the level of service and insurance protection together as one contract and any word or expression to
you receive. which a specific meaning has been attached in any part of
this Policy or of the Schedule shall bear the same meaning
Indeed, we are one of the largest Insurers in the country wherever it may appear.
with a history of more than 80 years of untiring service to
the nation through our all‐India network of 1400+ offices If any of the information mentioned in this Schedule is
and have brought a smile to crores of customers. incorrect or if you wish to update your existing
information, please contact us immediately.
At United India, it is always U before I.
IMPORTANT NOTICE: Kindly update your AADHAAR no. and
PAN/Form 60. Please ignore if already updated.
YOUR POLICY No. 0605002824P100303635
This Policy Schedule along with the attached Policy
POLICY ISSUING OFFICE
Wordings define the cover that, You, the Policyholder, and
other Insured Persons mentioned in this Schedule, have
United India Insurance Company Limited
under this Policy, for the period of insurance as mentioned
3RD FLOOR, CP TRUST BUILDING,ABOVE HANDLOOM
below.
HOUSE, ASHRAM ROAD, AHMEDABAD,, AHMADABAD‐
380009 GUJARAT
Hence, please read this Schedule, along with the Wordings
Phone: (079) 26576229 Fax: Email:
carefully so that you understand the terms and conditions of
your policy along with the coverage that you have been
For any Information, Service Requests and Grievances
provided.
please contact the above office.
The genuineness of the policy can be verified through
"Verify Your Policy" link at [Link].
Individual Health Insurance Policy Schedule Printed By : CUSTOMER @ 03/04/2024 [Link] AM
UIN. UIIHLIP24089V052324
This document is digitally signed
Signer: KALAIVENI SUBBIAH
Date: Wed, Apr 3, 2024 [Link] IST
Location: United India Insurance Company Ltd
1/9 Reason: Signing Policy for UIIC
POLICY NO.:0605002824P100303635
United India Insurance Company Limited
Registered Office: 24 Whites Road, Chennai, 600 0 14
IRDAI Reg. No 545
Website: [Link]
Scan this QR code to obtain details about your policy.
POLICY DETAILS
Policyholder Name : MR JAY JAGDISHBHAI PATEL
Policyholder ID : 23047588283
Policy No. : 0605002824P100303635
Previous Policy No. : 0605002823P100230119
Period of Insurance : From 00:00 hrs of 04/04/2024 To Midnight on 03/04/2025
YOUR CONTACT INFORMATION
Address : E/8,PALAK PARK ,OPP UMIYA HALL,GHATLODIA,
AHMADABAD
GUJARAT-380061
Tel (O/R) :
Mobile : 9687499009
Fax :
E-Mail : jaypatel99009@[Link]
Business/Occupation : Service
Coinsurance UIIC 060500 : 100%
DETAILS OF INSURED PERSONS
Nominee Nominee PEDs' Inception Date of first
Insured Name Age/Gender ABHA ID Relation Occupation
Name Relation declared policy
JAY 32/M Self Service JAGDISHBHAI Father None 16/03/2011
SUMMARY OF COVERAGE
Sum Domiciliary
Insured Name Plan Daily Cash Cover
Insured( ) Hospitalisation Limit( )
JAY Platinum 150,000.00 27,250.00 Not Opted
PREMIUM BREAK DOWN
Base Cover Optional Cover Loading for Family Direct Channel Total Annual
Insured Name
Premium( ) Premium( ) PEDs'( ) Discount( ) Discount( ) Premium( )
JAY 4,270.00 0.00 0.00 0.00 0.00 4,270.00
Individual Health Insurance Policy Schedule
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POLICY NO.:0605002824P100303635
PAYMENT DETAILS
Total Basic Premium : 4,270.00 Premium : 4,270.00
Road Ambulance Premium : 0.00 CGST(9%) : 384.00
Daily Cash Premium : 0.00 SGST(9%) : 384.00
Add PED Loading : 0.00 Stamp duty : 1.00
Less Family Discount : 0.00 Total : 5,038.00
Less No Claim Discount : 0 Receipt Number 10106050024100172573
Less Direct Channel Discount : 0.00 Receipt Date 03/04/2024
Less Online Discount : 0.00
INTERMEDIARY DETAILS
Agent Name : BAJAJ CAPITAL INS. BROKING LTD.
Agent Code : BRC0000140
9910555930
Mobile/Landline Number/Email :
info@[Link]
Development Officer Name :
Development Officer Code :
Customer GST/UIN No.: Office GST No.: 24AAACU5552C3ZN
SAC Code: 997133 Invoice No. & Date: 2824I100303635 & 03/04/2024
Amount Subject to Reverse Charges-NIL
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified
under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT [Link]
Date of Proposal and Declaration: 04/04/2024
IN WITNESS WHEREOF, the undersigned being duly authorised has hereunto set his/her hand at DO 5 AHMEDABAD on this 03th day of April ,2024.
For and On behalf of
United India Insurance Co. Ltd.
Affix
Policy
Stamp
Here
Authorised Signatory
Underwritten By - CUSTOMER ( CUSTOMER )
WHAT TO DO IN THE EVENT OF A CLAIM?
If a claim arises under this Policy, kindly contact the TPA mentioned here. Notice or communication in respect of claim or for any other reason to be given to TPA as
per Notification Clause (V.B.5.i) in the Policy Wordings.
Additionally, for issue of ID Cards, Cashless Approvals & Claims Settlement, please contact the TPA mentioned here.
Anti-Money Laundering Clause: In the event of a claim under the policy exceeding Rs. 1 lakh or a claim for refund of premium exceeding Rs. 1 lakh, the Insured
will comply with the provisions of AML policy of the Company. The AML policy is available in all our operating offices as well as on the Company's website.
Details of TPA
Name of TPA/ID MEDSAVE HEALTH INSURANCE TPA LIMITED / TPA00001
Address F-701A, LADO SARAI, MEHRAULI, NEW DELHI - 110030, Pin Code : 110030, Fax No : 91-11-29521067
Toll Free number 011-71221234 / 1800120111234
Contact Details For General Enquiries For Cashless approval For Claim intimation For Grievances
Telephone Numbers 011-71221234 / 011-71221234 011-71221234 011-71221234
1800120111234 /1800120111234 /1800120111234 /1800120111234
Email IDs info@[Link] cashless@[Link] callcenter@[Link] info@[Link]
Individual Health Insurance Policy Schedule
UIN. UIIHLIP24089V052324
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POLICY NO.:0605002824P100303635
UNITED INDIA INSURANCE COMPANY LIMITED
INDIVIDUAL HEALTH INSURANCE POLICY
UIN. UIIHLIP24089V052324
POLICY NO.: 0605002824P100303635
Details of Previous Policies
Insurer Name Policy No. Period From Period To Sum Insured( )
UNITED INDIA INSURANCE [Link]. 0605002823P100230119 04/04/2023 03/04/2024 150000
UNITED INDIA INSURANCE [Link]. 0605002822P100254150 04/04/2022 03/04/2023 350000
UNITED INDIA INSURANCE [Link]. 0605002821P100308175 04/04/2021 03/04/2022 150000
UNITED INDIA INSURANCE [Link]. 0602002820P100298371 04/04/2020 03/04/2021 150000
INDIVIDUAL HEALTH INSURANCE POLICY
CUSTOMER INFORMATION SHEET (CIS)
Guide to the CIS
• This document provides key information about your Individual Health Insurance Policy. You are also advised to
go through your policy document.
(Description is illustrative and not exhaustive)
Policy
Sl
Title Description Clause
No
No
Name of Insurance
1 Individual Health Insurance Policy -
Policy
2 Policy Number 0605002824P100303635 -
Type of Insurance
3 Indemnity Policy
Policy
Sum Insured Basis Individual Sum Insured Basis
4 Name SI(Rs.) II.B.16
Sum Insured JAY 150000
5 Policy Coverage Base Covers
(What the Policy 1. In-Patient Hospitalisation Expenses III.A.1
Covers?) i. Covers hospitalisation expenses for a minimum period of 24 hours.
These include expenses for Room Rent, ICU/ICCU and other associated
medical expenses.
ii. All Day Care Treatments are covered
iii. Covers hospitalization expenses for an Organ Donor's treatment for
the harvesting of Organ which is donated to the Insured
2. Pre-Hospitalisation and Post-Hospitalisation Expenses III.A.2
Covers expenses incurred in the 30 days prior to hospitalisation and in the
60 days post hospitalisation subject to a maximum of 10% of SI for Pre &
Post combined. (this sub-limit is only for Gold & Senior Citizen plans).
3. Domiciliary Treatment III.A.3
Covers expenses incurred for availing treatment at home which would
otherwise require hospitalization
4. Ayurvedic Treatment III.A.4
Covers expenses for availing treatment under Ayurvedic system of
medicine in a registered Ayush Hospital.
5. Road Ambulance III.A.5
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POLICY NO.:0605002824P100303635
Covers expenses incurred incurred on transportation of the Insured Person
by Road Ambulance to a Hospital for treatment in an Emergency upto Rs.
2,500 per policy period
6. Modern Treatment Methods & Advancement in Technologies III.A.6
Covers expenses for advanced medical procedures such as Robotic
Surgeries, Oral Chemotherapy, Deep Brain Stimulation Bronchial
Thermoplasty, Stereotactic Radio Surgeries, etc.
7. Cost of Health Check-Up III.A.7
Insured Person is entitled to a health check-up for a block of every three
claim-free years
OPTIONAL COVERS
1. Daily Cash Allowance on Hospitalization III.B.1
A cash amount will be paid daily to the Insured Person for every continuous
and completed period of 24 hours of Hospitalisation. Daily cash benefit
amount varies based on Sum Insured opted.
6 Exclusions The following is a partial list. Please refer to Policy Wordings for the
(What the hospital complete list of exclusions IV.B.4
does not cover) 1. Admission primarily for investigation & evaluation (Code - Excl04)
2. Admission primarily for rest cure, rehabilitation, and respite care (Code - IV.B.4
Excl05)
3. Expenses related to the treatment for correction of eyesight due to IV.B.15
refractive error less than 7.5 dioptres. (Code - Excl15)
4. Any expenses incurred on Out-patient treatment (OPD treatment) IV.C.3
5. Congenital External Diseases or Defects or anomalies IV.C.8
6. Cost of hearing aids; including optometric therapy IV.C.9
7. Dental treatment or surgery of any kind unless necessitated by disease or IV.C.11
accident and requiring hospitalisation
8. Intentional self-inflicted Injury or attempted suicide
IV.C.12
9. Routine eye-examination expenses, cost of spectacles, contact lenses
IV.C.13
10. Vaccination or inoculation of any kind unless it is post animal bite.
IV.C.18
7 Waiting Period Initial Waiting Period: IV.A.3
30 days for all illness (not applicable on renewal or for accidents)
Specific Waiting Periods IV.A.2
1.24 months for certain specified diseases/procedures/treatments Table A
IV.A.2
2. 48 months for certain specified diseases/procedures/treatments
Table B
Pre-Existing Diseases: Covered after forty-eight (48) months of IV.A.1
continuous coverage
(Note: the above waiting periods are applicable only for Gold & Senior
Citizen plans)
8 Financial Limits of The policy will pay only you to the limits specified hereunder for the following IV.A.1.2
Coverage: diseases/procedures:
[Link] (only for Gold & Senior Citizen Plan):
[Link]-Limits 25% of Sum Insured subject to a maximum of Rs. 40,000 per eye
2. Hernia &Hysterectomy (only for Gold & Senior Citizen Plan): IV.A.1.2
[Link]-payment 25% of Sum Insured subject to a maximum of Rs. 1,00,000 per
surgery/hospitalization
[Link] 3. Major Surgeries (only for Gold & Senior Citizen Plan): IV.A.1.2
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POLICY NO.:0605002824P100303635
up to 70% of the Sum Insured for surgeries including Cardiac Surgeries;
[Link] Other Limit Brain Tumour Surgeries; Pace Maker Implantation for Sick Sinus
Syndrome; Cancer Surgeries; Hip, Knee, Joint Replacement Surgery;
Organ Transplant.
4. Pre-Post Hospitalization Expenses combined(only for Gold & III.A.2
Senior Citizen Plan):
10% of S.I
5. Domiciliary Hospitalization: Annexure-
Sum Insured (in Rs.) Annual Limit (in Rs.) 3
50,000 10,000
75,000 15,000
100,000 20,000
125,000 23,750
150,000 27,250
175,000 31,250
200,000 35,000
225,000 37,500
250,000 40,000
275,000 42,500
300,000 45,000
325,000 47,500
350,000 - 1,000,000 50,000
1,500,000 75,000
2,000,000 100,000
6. Road Ambulance: Rs. 2,500 per person per policy period III.A.5
7. Health Check: upto 1% of Sum Insured of preceding 3 policy years, III.A.7
subject to a maximum of Rs. 5,000 per policy period.
ii. No co-payment III.A.1.i
[Link] equivalent to Daily Cash Allowance for the first 48 hours [Link]
Hospitalization
iv. In-Patient Hospitalisation expenses
Room Rent 1% of Sum Insured per day
ICU/ICCU charges 2% of Sum Insured per day
Proportionate Payment Clause: III.A.1.1.i.1
In case of admission to a room at rates exceeding the aforesaid limits, the
payment of all associated medical expenses incurred at the Hospital shall
be effected in the same proportion as the admissible rate per day bears to
the actual rate per day of Room Rent.
9 Claims Procedure Turn Around Time (TAT) for claims settlement:
i. TAT for preauthorization of cashless facility 2 hours [Link]
ii. TAT for cashless final bill authorization 3 hours [Link]
Link for below: IV.B.11
i. Network Hospitals details:
[Link]
[Link] number:
[Link]
iii. Excluded Providers:
[Link]
Downloading claim form:
[Link]
10 Policy Servicing Call service number of insurer: Please contact your Policy issuing office, V.A.14
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POLICY NO.:0605002824P100303635
details of which are mentioned in your Policy Schedule.
Details of company officials: Please contact your Policy issuing office,
details of which are mentioned in your Policy Schedule.
11 Grievance/ComplaintIn case of any grievance, you may contact UIIC through:
[Link]: [Link]
[Link] Free Number: 1800 425 333 33
c.E-Mail: customercare@[Link]
[Link] may also approach the grievance cell at any of our branches with
details of the grievance
Alternatively, you may lodge a complaint at the IRDAI Integrated Grievance
Management System ([Link] ) OR approach the Office of
the Insurance Ombudsman in your respective Area/Region. Details of
Insurance Ombudsman offices have been provided as Annexure - 3 in the
Policy Wordings.
12 Things to remember Free Look cancellation : You are allowed a period of 15 days from date of V.A.7
receipt of the policy document to review its terms and conditions and to
return the policy if not acceptable to you. This is not applicable on renewals.
If the Insured has not made any claim during the free look period, the Insured
shall be entitled to: If the Insured has not made any claim during the free look
period, the Insured shall be entitled to:
i. A refund of the premium paid less any expenses incurred by the V.A.7.i
Company on medical examination of the insured persons and the stamp
duty charges or
ii. Where the risk has already commenced and the option of return of the [Link]
policy is exercised by the insured person, a deduction towards the
proportionate risk premium for period of cover or
iii. Where only a part of the insurance coverage has commenced, such [Link]
proportionate premium commensurate with the risk covered during such
period
Policy renewal : Except on grounds of fraud, moral hazard or V.A.15
misrepresentation or non-cooperation, renewal of your policy shall not be
denied, provided the policy is not withdrawn.
Migration : Insured Person has the option to migrate the policy to other V.A.8
health insurance products/plans offered by UIIC by applying at least 30 days
before the policy renewal date.
Portability: Insured Person has the option to port the entire policy to an V.A.12
individual health insurance product offered by another Insurer by applying at
least 45 days before policy renewal date. Portability is subject to
underwriting.
Change in Sum Insured: Sum Insured can be changed V.B.3
(increased/decreased) only at the time of renewal or at any times subject to
underwriting by the Company. For increase in S.I, the waiting period if any
shall start afresh only for the enhanced portion of the sum insured.
Moratorium Period: After completion of eight continuous years under the V.A.9
policy no look back to be applied. This period of eight years is called as
moratorium period. The moratorium would be applicable for the sum
insured of the first policy and subsequently completion of eight continuous
years would be applicable from date of enhancement of sum insured only on
the enhancement limits.
After the expiry of Moratorium Period no health insurance policy shall be
contestable except for proven fraud and permanent exclusions specified in
the policy contract
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POLICY NO.:0605002824P100303635
13 Your Obligations Please disclose all pre-existing disease/s or condition/s. Policyholder is V.A.5
required to disclose all material information such as, but not limited to,
preexisting diseases/conditions, medical history, etc. as sought in the
Proposal form and other connected documents. Non-disclosure,
misrepresentation or misdescription of such information may result in claim
not being paid and shall make the policy void and all premium paid thereon
shall be forfeited to UIIC.
Nomination: Policyholder is required at the inception of the policy to make
a nomination for the purpose of payment of claims under the policy in the
event of death of the Policyholder.
Declaration by the Policy Holder
I have read the above and confirm having noted the details.
Place:
Date:
Signature of Policy Holder
Legal Disclaimer Note:The information must be read in conjunction with the policy document. In case of any
conflict between the CIS and the policy document, the terms and conditions mentioned in the policy shall prevail.
Individual Health Insurance Policy Schedule
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POLICY NO.:0605002824P100303635
UNITED INDIA INSURANCE COMPANY LIMITED
3RD FLOOR, CP TRUST BUILDING, ABOVE HANDLOOM HOUSE, ASHRAM ROAD, AHMEDABAD, ,
AHMADABAD - 380009 GUJARAT
PH: (079) 26576229 FAX: EMAIL:
Premium Certificate for the purpose of deduction under Section 80-D of Income Tax (Amendment) Act,
1986.
This is to certify that MR JAY JAGDISHBHAI PATEL has paid 5,038.00 ( Five thousand thirty-eight rupees only) towards Premium for INDIVIDUAL HEALTH POLICY
for the period from 00:00 hrs On 04/04/2024 To Midnight of 03/04/2025
Policy No: 0605002824P100303635
For and On behalf of
United IndiaInsurance Co. Ltd.
Place: DO 5 AHMEDABAD 060500
Date:03/04/2024 [Link] AM
Authorised Signatory
NOTE: This Certificate must be surrendered to the Insurance Company for issuance of fresh certificate in case of cancellation of the policy or any alteration in the
Insurance affecting the premium.
REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014
Website: [Link] Email - info@[Link]
Individual Health Insurance Policy Schedule
UIN. UIIHLIP24089V052324
This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
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