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Group Arogya Sanjeevani Policy - Aditya Birla Health Insurance Co. Limited

Certificate Number: GAS-PP-22-2000424

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Aditya Birla Health Insurance Co. Limited
(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority
of India [IRDAI] vide Regd. No.153)
Master Policy Number : 66-21-00001-00-00 Master Policy Start Date : 02/12/2021 Master Policy End Date : 01/12/2022
CIN : U66000MH2015PLC263677 UIN : ADIHLGP21229V012021

Group Manager: PhonePe Private Limited, Intermediary: PhonePe Insurance Broking Services Private Ltd. (IRDA/DB 822/20) |
A quick look at your
Certificate of Insurance
On receipt of full premium,GAS-PP-22-2000424 certificate dated 30/05/2022 has been issued by Aditya Birla Health Insurance
Co. Limited, 5th Floor, Modi Business Centre, Kasarvadavali, Near Hypercity Mall, Thane, Maharashtra - 400615 to the below
mentioned Insured as specified in the Certificate

Valid In Sum Insured Cover Type

India Rs. 100000 INDIVIDUAL

Certificate Number Coverage Start Date Coverage End Date

GAS-PP-22-2000424 from 30/05/2022 to 29/05/2023

00:00 hrs 23:59 hrs

Insured Members

SATYA RISHI TEJA JANGA

23 year(s)

Date of Birth 03-Dec-1998 Health Card Number 000748325301

Insured Relationship with

Self Pre-existing Disease None
Proposer

Proposer details Premium

SATYA RISHI TEJA JANGA Net Premium Rs. 1667.00

Proposer IGST (18%) Rs. 300.06
Email ID [email protected] 03/12/1998
DOB
Total Premium Rs. 1967.00
20-6-44, 2ND LANE, RAMALINGESWARAPETA, AYODHYA
Address
NAGAR, VIJAYWADA, 520003

Nominee
Nominee SATEESH KUMAR JANGA (Father) 19/10/1965
DOB

Claims assistance
For detailed coverage, terms and conditions and exclusions, kindly visit website www.adityabirlacapital.com/healthinsurance In
the event of hospitalisation of insured person, intimation should be given to the company immediately, however within 24Hrs from
the time of admission.
 National Toll Free Number

For 24*7 assistance,reach the insurer at

1800-270-7000

Email address
For emails,reach the insurer at

[email protected]

Comprehensive Coverage Details

An extensive list of all benefits and their coverage value in your policy

Pre-Hospitalisation, Hospitalisation and Post-Hospitalisation Expenses

Hospitalisation expenses incurred due to an illness or accident, including treatment and hospitalization for the
Covid-19. Expenses of Hospitalisation for a minimum period of 24 consecutive hours only shall be admissible. Time
limit of 24 hrs shall not apply when the treatment is undergone in a Day Care Centre.
Pre-Hospitalisation Expense: Medical expenses 30 days before any 24 hour or longer hospitalisation event are
covered
Post-Hospitalisation Expense: Medical expenses 60 days after any 24 hour or longer hospitalisation event are
covered

Room Rent
Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to 2% of the sum insured subject
to maximum of Rs.5,000/-, per day

ICU/ICCU
Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of
Rs.10,000/- per day.

Ambulance
Ambulance charges with a maximum cap of Rs. 2,000 per hospitalization are included in the policy.

Covid-19
Hospitalisation costs for Covid-19 will be covered 30 days after the start date of the policy.

Dental and Plastic Surgery

Dental or plastic surgery-expenses or any treatment to change appearance is not covered unless it is required because of
an accident, Burn(s) or Disease like cancer

Cataract Surgery

Cataract treatment costs for each eye is covered after two years from policy start date.
The coverage is up to 25% of the sum insured or Rs. 40,000; whichever is lower for each
eye.

Modern Treatments
Following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in
a hospital up to 50% of Sum Insured:

Uterine Artery Embolization and HIFU (High intensity focused ultrasound)

Balloon Sinuplasty
 Deep Brain stimulation
Oral chemotherapy
Immunotherapy - Monoclonal Antibody to be given as injection
Intra vitreal injections
Robotic surgeries
Stereotactic radio surgeries
Bronchical Thermoplasty
Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
IONM - (Intra Operative Neuro Monitoring)
Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be
covered.

Day care treatments

Certain medical or surgical procedures, carried out under general or local anaesthesia, that require hospitalisation of less
than 24 hours. Such procedures are referred as Day Care Treatment or Day Care Procedures and are covered under
policy.

Ayush
Medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homeopathy systems of medicines in any AYUSH Hospital will be covered upto sum insured

Cumulative Bonus
For every claim free year, get rewarded with a 5% bonus in your sum insured upto a maximum of 50% of initial Sum
Insured for every consecutive year. In the event of claim, the cumulative bonus shall be reduced at the same rate.

Lifetime renewability
This policy comes with lifelong renewability, as long as the master policy exists and you renew on time. This means you
don't have to undergo any medical tests at the time of renewal

Even if you have crossed the age limit of 65

Even if you have acquired any disease in the previous year of the policy.

*Subject to policy T&C.

Co-Pay
Insurer will pay 95% of the admissible claim amount, you only need to pay 5% out of your pocket as co-pay for any claim.
Claim amount payable shall be after deduction of the co-payment.

Pre-existing illness

A pre-existing illness is typically one for which you have received treatment or diagnosis before you enrolled in a
new health plan. Conditions like diabetes, COPD, cancer, and sleep apnea, may be examples of pre-existing health
conditions. They tend to be chronic or long-term.
Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications will be excluded until
the expiry of 48 months of continuous coverage after the date of inception of the first policy, subject to the same
being declared at the time of application and accepted.

Waiting Period

First 30 Days Waiting Period

Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be
excluded except claims arising due to an accident.

24 Months Waiting Period

Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the
expiry of 24 months of continuous coverage
 Benign ENT disorders
Tonsillectomy
Adenoidectomy
Mastoidectomy
Tympanoplasty
Hysterectomy
All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps
Benign prostate hypertrophy
Cataract and age related eye ailments
Gastric/ Duodenal Ulcer
Gout and Rheumatism
Hernia of all types
Hydrocele
Non Infective Arthritis
Piles, Fissures and Fistula in anus
Pilonidal sinus, Sinusitis and related disorders
Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident
Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.
Varicose Veins and Varicose Ulcers
Internal Congenital Anomalies

48 Months Waiting Period

Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the
expiry of 48 months of continuous coverage.
Treatment for joint replacement unless arising from accident
Age-related Osteoarthritis & Osteoporosis
Pre-existing diseases declared at the time of policy inception

Cancellation
You can cancel the policy anytime provided that you have not made any claim. Premium will be deducted for the period of
coverage and the remaining premium will be refunded. Please see the refund amount below:

Up to 30 days - 75%
31 to 90 days - 50%
3 to 6 months - 25%
6 to 12 months - Nil

Important Notes and Exclusions

Expenses related to any admission primarily for diagnostics and evaluation purposes.
Rest Cure, rehabilitation and respite care, admission primarily for enforced bed rest and not for receiving treatment.
Obesity / Weight Control-Expenses related to the surgical treatment of obesity that does not fulfil all the below
conditions:
Surgery to be conducted is upon the advice of the Doctor
The surgery/Procedure conducted should be supported by clinical protocols
The member has to be 18 years of age or older and
Body Mass Index (BMI);
greater than or equal to 40 or
greater than or equal to 35 in conjunction with any of the following severe co-morbidities following
failure of less invasive methods of weight loss
Obesity-related cardiomyopathy
Coronary heart disease
Severe Sleep Apnea
Uncontrolled Type2 Diabetes
Change-of-Gender treatments - Expenses related to any treatment, including surgical management, to change
characteristics of the body to those of the opposite sex.
Cosmetic or plastic Surgery - Expenses for cosmetic or plastic surgery or any treatment to change appearance
unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to
remove a direct and immediate health risk to the insured certified by the attending Medical Practitioner.
 Hazardous or Adventure sports - Expenses related to any treatment necessitated due to participation as a
professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing,
mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
Breach of law - Expenses for treatment directly arising from or consequent upon any Insured Person committing or
attempting to commit a breach of law with criminal intent.
Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
Dietary supplements and substances that can be purchased without prescription, including but not limited to
Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization
claim or day care procedure
Refractive Error - Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5
dioptres.
Sterility and Infertility - Expenses related to sterility and infertility. This includes any type of sterilization, Assisted
Reproduction, Gestational, Surrogacy and Reversal of sterilization
Maternity Expenses - Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization) except ectopic pregnancy.
War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war,
rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and
detainment of all kinds.
Any expenses incurred on Domiciliary Hospitalisation and OPD treatment
Treatment taken outside the geographical limits of India

Kindly refer to the certificate wordings for exclusions and Terms/Conditions.

80D Certificate
Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment)
Act,1986 Certificate No GAS-PP-22-2000424 Group Arogya Sanjeevani Policy - Aditya Birla Health Insurance Co. Limited
Certificate

Type of certificate INDIVIDUAL Issue Office Head Office

care.
Email healthinsurance@adityabirlacapital. Phone Number 1800-270-7000
com

5th Floor, Modi Business Centre,

Kasarvadavali, Near Hypercity
Address
Mall, Thane, Maharashtra -
400615

This is to certify that SATYA RISHI TEJA JANGA has paid Rs. 1967.00 (Total Premium : Indian Rupees One Thousand Nine
Hundred Sixty Seven Rupees Only) towards Premium for Hospitalisation Insurance vide Certificate No: GAS-PP-22-2000424 for
the Period 30/05/2022 To 29/05/2023 issued on 30/05/2022

Payment received through Phonepe by Aditya Birla Health Insurance Co. Limited, Receipt No: R72776423 Receipt Date: 30/05
/2022

The stamp duty of INR 1.00 /- paid vide MH003394929202122E dated 09/07/2021 & MH003394929202122E dated 09/07/2021,
received from Stamp Duty Authorities vide Receipt No./GRASS DEFACE NO 0001811011202122 dated 20/07/2021 &
0001811011202122 dated 20/07/2021, payment has been made vide Letter of Authorisation No.CSD/94/2021/2542 dated 26/07
/2021 from Main Stamp Duty Office.

Note :- This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in case of Cancellation of
the Certificate or any alteration in the Insurance affecting the Premium.

Date : 30/05/2022 Place : Thane, Maharashtra For and on behalf of

Aditya Birla Health Insurance Co. Limited
IRDA Regn. No 153
Corporate Identity Number : U66000MH2015PLC263677
Email ID : [email protected]

This is an electronically generated document and does not require a signature.