Mr.
CHAVALA PEDDANNA
S/O CHAVALA VENKAIAH 5 82 TOKAVARI PALEM
VILLAGE TOKAVARI PALEM VILLAGE GUNTUR
ANDHRA PRADESH - 522005
Mobile No: XXXXXX2586
Certificate of Insurance (COI) - Health Plus
How to reach us?
Website Online Renewal
www.nivabupa.com It takes a few minutes to renew your policy Log on to
www.nivabupa.com/renew
Customer Helpline No. Like us on Facebook
1860-500-8888
Customer Services Follow us on twitter
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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 50947300202400 Group Master PolicyHolder's Name Bajaj Finance Ltd.
Group Master Policyholder's 4th Floor, Viman Nagar, Finserv Off Group Master Policy Issue date 29/09/2024
Address & Pincode Pune - Ahmed Nagar Road,
Pune – 411014, Maharashtra
Certificate Number 113014921526 Proposer’s Name Mr. CHAVALA PEDDANNA
Cover Inception Date and Time 04/08/2025 12:00 AM Proposer’s Address & Pincode S/O CHAVALA VENKAIAH 5 82
TOKAVARI PALEM VILLAGE
TOKAVARI PALEM VILLAGE
GUNTUR ANDHRA PRADESH -
522005
Cover Expiry Date and Time 03/08/2026 11:59 PM Contact Number XXXXXX2586
Insured details
Insured Name(s) Certificate no Date of Birth/ Age Gender Relationship with proposer Sum Insured (in Rs)
Mr. CHAVALA PEDDANNA 113014921526 09/06/1977 M Self 100,000
Nominee details
Nominee Name Relationship Appointee Details (if nominee is minor)
DINESH Son NA
Benefit Structure
Hospitalization Sum Insured (SI) Rupees 100,000
Family Combination 1A
Baseline cover benefits
In-patient treatment Intensive Care Unit charges Up to 4% of Sum Insured per day
Doctors’ fees Hospital Accommodation Up to 2% of Sum Insured per day
Pre and post hospitalization
expenses (30 days / 60 days) 30 days pre and 60 days post
Diagnostics Tests including doctor's consultation, hospitalisation. Covered up to Sum
diagnostics tests, medicines, drugs Insured
and consumables
Listed day care procedures,
Medicines, drugs and consumables Day care procedures
Covered up to SI Covered up to Sum Insured
Intravenous fluids, blood
Organ transplant when medically
transfusion, injection administration Covered up to Sum Insured
necessary
charges
Operation theatre charges Emergency Ground Ambulance Rs.1000 per hospitalization
Cost of prosthetics and other
devices or equipment if implanted
Disease Specific Limits** As per grid
internally during a Surgical
Operation
20% for 'individual' policies; 10%
Pre-existing Disease Waiting 36 month waiting period for pre-
Copayment for 'floater' policies; per claim per
Period existing conditions
hospitalisation
30 day Initial waiting period from
Initial Waiting Period Specific Waiting Period Waived Off
inception
Critical Illness Cover
Group Critical Illness SI (per 30 day Initial waiting period from
Not Applicable Initial Waiting Period
member) inception
Pre-existing Disease Waiting 36 months waiting period for pre-
Survival Period 30 days
Period existing conditions.
Accidental Cover
Group Personal Accident Sum
200000.00 Coverage Self & Spouse
Insured (SI) Rupees
100% of SI for Self & 50% of SI for
Accidental Death
Spouse in case of floater
**Sub-limit on specified illness/conditions
Procedure Cost in Rs. Procedure Cost in Rs.
Hernioplasty/Herniorraphy- Bilateral
Appendicectomy 32000 37000
including Cost of mesh and tacker
Cataract per eye including Cost of Total Knee Replacement (Bilateral)
18000 109000
Lens including cost of implants
Cholecystectomy 26000 PCNL- Bilateral 43000
Hernioplasty/Herniorraphy- Temporary Pacemaker Implantation
Unilateral including cost of mesh 32000 including cost of temporary 14000
and tacker pacemaker
Hip Replacement (Unilateral)
Hydrocele 18000 72000
including cost of implants
Angioplasty including cost of
Hysterectomy (Abdominal/Vaginal) 40000 109000
implants and angiography
Total Knee Replacement (Unilateral) Hip Replacement (Bilateral)
72000 109000
including cost of implants including cost of implants
Haemorrhoidectomy including Cost
29000 CABG 145000
of stapler
Arthroscopic Surgery ( Other Than
PCNL- Unilateral 37000 29000
ACL / Menisectomy)
Valve Replacement including cost of
145000
implants
List of CI
Open Heart Replacement or Repair Stroke resulting in Permanent Motor neurone disease with
Cancer of specified severity
of Heart Valves Symptoms permanent symptoms
Major organ /bone marrow Multiple sclerosis with persisting
Myocardial Infarction Coma of Specified Severity
transplant symptoms
Kidney failure Requiring Regular
Open chest CABG Paralysis of Limbs
Dialysis
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No
Bajaj Finance Ltd. CA00070001 02039575152
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. : 28 / 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.)
847.00 0.00 0.00 152.39 999.00 Nine 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 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 https://rules.nivabupa.com/customer-service/
For the list of recognized / un-recognized hospitals, kindly refer to the link https://rules.nivabupa.com/hospital-network/
Location: Noida, Uttar Pradesh
Date: 07/08/2025
Director - Operations & Customer Service
For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
Disclaimer - We would like to inform you that the name of Max Bupa Health Insurance Company Limited (“Our Company”) has changed to Niva Bupa
Health Insurance Company Limited effective from 5th July 2021. In this context, the name of the product bought by you has changed from “Max Health
Plus” to “Health Plus” (“Product”). We further state that the changes in name of Our Company along with Product name does not alter any Product
benefits. We would like to reiterate that our core ideology and brand ethos remain unchanged. As we progress on our brand transition journey, we will
stand by the promises made to you at all times and you will continue to enjoy all benefits.
