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HDFC ERGO General Insurance Company Limited

Certificate of Insurance 2855207022027000000

Sarv Suraksha Plus (Group)

2855207022027000000

MR CHIRAG SIHOTIA
8TH FLOOR, TOWER-BGR, PLOT 1
MAHARAJA AGRASEN MARG, FILM CITY
GAUTAM BUDDHA NAGAR, UTTAR PRADESH,
201301
Contact No. 96XXXXXXX0

Date :12/12/2024

Dear MR CHIRAG SIHOTIA

Thank you for choosing HDFC ERGO as your preferred insurance partner.We welcome you to be a part of our family!

Your coverage of insurance under the Sarv Suraksha Plus (Group) policy reference no 2855207022027000000 i s confirmed on the basis of the information and declaration
provided by you.

The details of coverage are mentioned in the enclosed certificate of insurance.

We value your relationship with us and assure you our best services at all times and we look forward to serve you.
This information i s to update that we have received revised UIN for the product Sarv Suraksha Plus ( Group ) from IRDAI and are in process of making the necessary changes in
all the marketing documents and enrolment forms . In the interim you may find the earlier UIN: HDFHLGP21002V022122 in some documents. However the revised
UIN:HDFHLGP24020V032324 has been updated in the footer of your certificate of Insurance

Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.

Soft copy of the policy is valid for all purposes including claims.

For HDFC ERGO General Insurance Company Ltd.

Authorized Signature

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP24020V032324,HDFHLGA25036V012425. Policy Issuing/ Customer Happiness
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Center: D 301, 3rd Floor,
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Certificate of Insurance 2855207022027000000

Sarv Suraksha Plus (Group)

2855207022027000000

Certificate No. :2855 2070 2202 7000 000 Issuance Date : 12/12/2024
Period of Insurance : From 02/12/2024 14:06 hrs To 01/12/2025 Midnight
Invoice No. :207022027000000 Premium Frequency :Single
Proposer Name :Mr Chirag Sihotia
MR CHIRAG SIHOTIA HSN Code :997133 eIA :Not provided
8TH FLOOR, TOWER-BGR, PLOT 1 Customer Id :100551618595
MAHARAJA AGRASEN MARG, FILM CITY Master Policy No. :2999206870836200000
GAUTAM BUDDHA NAGAR, UTTAR PRADESH, 201301
Contact No. 96XXXXXXX0 Master Policy Holder :SOLVY TECH SOLUTIONS PVT
Name LTD
Customer UIN :29992068708362000009660397160

Email ID :[email protected]
Insured Person Details
Name of Insured Person Group member ID Relation with policy holder* Gender DOB 1st Policy Inception Pre-existing Disease
CHIRAG SIHOTIA 2024410046374753 Self Male 08/05/2002 02/12/2024 NO
*Relationship is relation of Insured with policyholder
Nominee Details
Nominee Name Nominee Relationship Appointee Name Appointee Relationship
Legal Heir Other
Schedule of Coverage
Co-payment /
Insured Name Coverages Sub Coverages Base Sum Insured Sum Insured Deductible/
Excess
Accident Death 100000 100000 0
Personal Accident Comatose 25000 25000 0
CHIRAG SIHOTIA
Disappearance 100000 100000 0
Stay Fit To Benefit Step Up 46900 46900 0

0
Special Conditions for Stay Fit To Benefit Add-on:
1 Program Details:
If Step count in a day Greater than 15,000 12,001 to 15,000 10,001 to 12,000 8,001 to 10,000 Upto 8,000
Points earned for that day 4 3 2 1 0

If total points accumulated in a policy month Greater than 110 91 to 110 71 to 90 51 to 70 31 to 50 0 to 30

% of monthly wellness rewards* 100% 80% 60% 30% 10% 0%
*Monthly wellness rewards = Sum Insured / 12
2 You can redeem your accumulated points (if eligible as per above table) under the Stay Fit To Benefit only post completion of a Policy month.
However, you shall be allowed to redeem your accumulated points upto 3 months post completion of a Policy Year.
3 Claims related to step count can be tracked and redeemed through HDFC ERGO’s digital platform only .
Link for App Download https://hdfcergo.onelink.me/ARLJ/kblm8ops "
4 Change in registered mobile number during the policy period will not be allowed.
5 In case you want to update the nominee details kindly write to [email protected]
For Claim/Policy related queries Please Contact us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make
changes/register and track claims.
If the premium is not realised the policy shall be void from inception.The stamp duty of Rs. 0/- paid vide Order No:(LOA/ENF-1/CSD/64/2024-25/ Validity Period Dt. 15/10/2024 to Dt. 31/12/2028, OW No. 4742 Dt
04/10/2024 GRN NO. MH007778466202425M, Dt. 10/09/2024, SBI Bank & DEFACE No. 0005045616202425, Dt. 03/10/2024) as prescribed by Government of Maharashtra Notification No. Mudrank
2017/C.R.97/M-1, Dt.09/01/2018Goods & Tax Registration No: 27AABCL5045N1Z8GST for this invoice is not payable under reverse charge basis. I/ 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
Branch :d-301, 3rd floor, neptune manget mall, near mangatram petrol pump l.b.s road, bhandup mumbai
For HDFC ERGO General Insurance Company Ltd.
Broker Name : ZOPPER INSURANCE BROKERS PRIVATE LIMITED
Broker Code : 200935072156

For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings " Duly Constituted Attorney

2855207022027000000

HDFC ERGO General Insurance Company Limited 1

Policy No.:2855207022027000000 This card is for identification purpose only.
Valid From: 02/12/2024 Renewal Date: 1 December
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Insured Name Member ID Date Of Birth Gender
with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
CHIRAG SIHOTIA 2024410046374753 08/05/2002 Male call our call centre. This card is valid till the time policy is active.

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

Email : [email protected]
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com

Sarv Suraksha Plus (Group)

Enrollment Form No :2855 2070 2202 7000 000

Period of Insurance : From 02/12/2024 14:06 hrs To 01/12/2025 Midnight
Invoice No. :207022027000000 Premium Frequency :Single
Proposer Name :Mr Chirag Sihotia
MR CHIRAG SIHOTIA HSN Code :997133 eIA :Not provided
8TH FLOOR, TOWER-BGR, PLOT 1 Customer Id :100551618595
MAHARAJA AGRASEN MARG, FILM CITY Master Policy No. :2999206870836200000
GAUTAM BUDDHA NAGAR, UTTAR PRADESH, 201301 Master Policy Holder :SOLVY TECH SOLUTIONS PVT
Contact No. 96XXXXXXX0 Name LTD

Email ID :[email protected]
Insured Person Details
Name of Relation with
Group member ID Gender DOB 1st Policy Inception
Insured Person policy holder*
CHIRAG SIHOTIA 2024410046374753 Self Male 08/05/2002 02/12/2024
*Relationship is relation of Insured with policyholder
Nominee Details
Nominee Name Nominee Relationship Appointee Name Appointee Relationship
Legal Heir Other
Schedule of Coverage
Co-payment /
Insured Name Coverages Sub Coverages Base Sum Insured Sum Insured Deductible/
Excess
Accident Death 100000 100000 0
Personal Accident Comatose 25000 25000 0
CHIRAG SIHOTIA
Disappearance 100000 100000 0
Stay Fit To Benefit Step Up 46900 46900 0

Declaration & Warranty on behalf of all Persons Proposed to be Insured

I/We hereby declare on my behalf and on behalf of all persons proposed to be insured that the above statements are true and complete in all respects to the best of my knowledge and that I/We am/are
authorized to propose on behalf of these other persons. I understand that the information provided b y me will form the basis of insurance policy, is subject to the Board approved under writing policy of the
Insurance company and that the policy will come into force only after full receipt to the premium chargeable.
I/We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the
risk acceptance by the company.
I/We declare and further consent to the company. Seeking medical information from any hospital who at any time has attended on the life to be insured/ proposer or from any past or present employer concerning
anything which affects the physical and mental health of the life to be assured/proposer and seeking information from any insurance company to which an application or insurance on the life to be assured/proposer
has been made for the purpose of underwriting the proposal and /or claim settlement.
I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposalunderwriting and/ or claims settlement and with any Governmental and/or
Regulatory Authority
Declaration & Warranty on behalf of Insurer:
Note: The liability of the company does not commence until the acceptance of the proposal has been formally intimated by the insured and full premium has been realized by the company.

We are under no obligation to accept any proposal for insurance. The Proposer agrees that the receipt of the Proposal Form by HDFC ERGO General Insurance Company Limited along with the premium payment
does not tantamount to the acceptance of the Proposal for insurance b y HDFC ERGO General Insurance Company Limited and does not result in a concluded contract of insurance. The acceptance of the
Proposal for insurance shall be at the Company's sole and absolute discretion and upon full realization of the premium payment .
In the event of acceptance of the Proposal for insurance by HDFC ERGO General Insurance Company Limited, such acceptance shall be specifically intimated to the Proposer by HDFC ERGO General Insurance
Company Limited along with the date from which the insurance Cover shall become effective. HDFC ERGO General Insurance Company Limited shall not be liable for any claim in respect of an event giving rise to
a claim covered under the Policy of Insurance that has occurred prior to policy issuance i s not covered under this policy(Your proposal form will be considered after HDFCERGO General Insurance Company
Limited receives premium payment.)

Fraud Warning: This policy shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure of any material particulars by the Proposer.Any person who,
knowingly and with intent to fraud the insurance company or any other person, files a proposal for insurance containing any false information, or conceals or the purpose of misleading, Information concerning any
fact material thereto, commits a fraudulent insurance act, which will render the policy voidable at the sole discretion of the insurance company and result in a denial of insurance benefits.

Anti-Rebating Warning :As per Section 41 of the Insurance Act 1938,as amended, the practice of rebating is prohibited, as follows: No person shall allow or offer to allow, either directly or indirectly, as an
inducement to any person to take out or renew or continue an insurance policy in respect to any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any
rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus
or tables of the insurer. Violation of Section41 of the Insurance Act 1938, as amended, shall be punishable with a fine which may extend to Rs. 10Lakhs.

Disclaimer : Proposal Form and Policy Schedule have been generated basis details entered by proposer / insured on Online Platform (either on HDFCERGO.com or its affiliated Online Channels (IRDAI Licensed
Intermediaries). For any modification, kindly visit URL https://www.hdfcergo.com/customer-care/customer-support.html and register your service request or write to us at [email protected]
Branch :d-301, 3rd floor, neptune manget mall, near mangatram petrol pump l.b.s road, bhandup mumbai

Broker Name : ZOPPER INSURANCE BROKERS PRIVATE LIMITED

Broker Code : 200935072156
For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings

2855207022027000000

CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

This document provides key information about your policy. You are also advised to go through your policy
document.
Please Note: Benefits opted and mentioned in the policy schedule/certificate of insurance will only be
applicable.
Policy
Description (Please refer to applicable Policy Clause Number in next
S.No Title Clause
column)
Number
Name of Insurance
1 Sarv Suraksha Plus (Group) NA
Product/Policy
2 Policy number 2855207022027000000 NA
Type of Insurance
3 Both Indemnity and Benefit NA
Product/ Policy
• Individual Sum Insured -Where each member has a separate sum
4 Sum Insured NA
insured under the policy), or
• Floater Sum Insured-Where all members under the policy have a
single sum insured limit which may be utilized by any or all members

Note: For complete details of Sum Insured applicability, please refer

to your Policy Schedule/Certificate of Insurance
Policy Coverage Base Covers: Coverages in force for the Insured Persons shall be
5 (What the policy as per the plan opted
covers?)
Expenses in respect of:
1. Major Medical Illness : Lumpsum payout on first diagnosis of Section
listed Major Medical Illness during the Policy Period B.1.
2. Personal Accident: Lump Sum payment in the event of an Section
accident for the below listed perils B.2.
i. Accidental Death: Lump Sum payment in the event of an Accidental Section
Death due to an Accident B.2.A.I.
ii. Permanent Disablement: Lump Sum payment in the event of a listed Section
Permanent Disablement due to an Accident B.2.A.II.
iii. Temporary Total Disablement: Lump Sum payment in the event of a Section
Temporary Total Disablement due to an Accident B.2.A.III.
3. Emergency Medical Expenses: Hospitalization Expenses Section
following an Emergency B.3.
i. Emergency Medical Expenses – Accident only: Hospitalization Section
Expenses following an accident B.3.A.I.
ii. Emergency Medical Expenses – Illness only: Hospitalization Section
Expenses following an emergency illness B.3.A.II.

2855207022027000000

4. Loss of Income/EMI Protector: Income protection from the Section

below listed perils B.4.
i. Termination from Employment: Lumpsum payout if Insured is
Section
terminated from employment as per employer’s rules/regulations
B.4.I.
implemented by the employer in compliance of laws
ii. Loss of Income - Major Medical Illness: Income protection against Section
listed Major Medical Illnesses B.4.II.
iii. Loss of Income – Permanent Total Disablement: Income protection Section
against Permanent Total Disablement B.4.III.
5. Credit Shield: Loan protection in the event of an accident for the Section
below listed perils B.5.
i. Accidental Death: Loan protection in the event of an Accidental Section
Death due to an Accident B.5.a.I
ii. Permanent Disablement: Loan protection in the event of a listed Section
Permanent Disablement due to an Accident B.5.a.II
6. Property Coverage: Protects your property against below listed Section
perils B.6.
Section
7. Broken Bones: Lumpsum payout for fractures
B.7.
8. Dependent Child Education Benefit: Lump Sum payment to fund for
Section
child’s education in the event of an Accidental Death OR Permanent
B.8.
Disablement due to an Accident
9. Parental Care Benefit: Lump Sum payment for aging parents in the
Section
event of an Accidental Death OR Permanent Disablement due to an
B.9.
Accident
10. Mobility Extension: Coverage for specified mobility expenses in the
Section
event of a listed Permanent Disablement due to an Accident B.10.
Section
11. Hospital Cash: Per day payout for out of pocket expenses
B.11.
Section
i. Hospital Cash - Accident Only: Per day payout for out of pocket
B.11.a.I
expenses following an accident
.
Section
ii. Hospital Cash – Illness only: Per day payout for out of pocket
B.11.a.I
expenses following an Illness
I.
12. Chauffeur Benefit: Covers cost of transportation in the event of Section
certified Temporary Total/Partial Disablement B.12.
13. Accidental Hospitalization Expenses: Hospitalization Expenses Section
following an accident B.13.
14. Permanent Total Disablement – Illness: Lump Sum payment in the Section
event of Permanent Total Disablement due to an Illness B.14.
Section
15. Last Rites: Funeral expenses following an Accidental Death
B.15.
Optional Covers: Optional covers in force for the Insured Persons
shall be as opted and as specified in Policy Schedule / Certificate
of Insurance

2855207022027000000

Section
1. Optional covers under Major Medical Illness
B.1.II.
Section
i. Cardiac Arrest
B.1.II.i.
Section
ii. Angioplasty
B.1.II.ii.
Section
iii. Molecular Gene Profiling test
B.1.II.iii.
Section
iv. Second Medical Opinion
B.1.II.iv.
Section
a. Second Medical Opinion – India B.1.II.iv.
a.
Section
b. Second Medical Opinion – Global B.1.II.iv.
b.
Section
2. Optional covers under Accidental Death B.2.A.I.i
ii.
Section
i. Burns B.2.A.I.i
ii.i.
Section
ii. Transportation of Mortal Remains B.2.A.I.i
ii.ii.
Section
iii. Renewal Premium Benefit B.2.A.I.i
ii.iii.
3. Optional covers under Emergency Medical Expenses Section
B.3.B.
Section
i. Emergency Medical Expenses Global
B.3.B.I.
Section
4. Optional covers under Loss of Income – Major Medical Illness
B.4.II.b.
Section
i. Cardiac Arrest B.4.II.b.i
.
5. Optional covers under Hospital Cash: Section
B.11.b.
Section
i. Companion benefit
B.11.b.i.
Section
ii. Hospital Cash - ICU B.11.b.ii
.

2855207022027000000

Section
iii. Hospital Cash – Global B.11.b.i
v.
Section
Other optional covers
C.
Section
1. Preventive Health Check-up
C.i.
Section
2. Medical Evacuation – India / Global
C.ii.
Section
3. Road Ambulance
C.iii.
6 Exclusions (what Exclusions specific to particular benefit
the policy does not Specific Exclusions applicable to Major Medical Illness
cover) i. Treatment arising from or consequent upon war or any act of
war(whether war be declared or not or caused during service in the
armed forces of any country), invasion, act of foreign enemy, civil war,
public defense, rebellion, revolution, insurrection, military or usurped
acts, nuclear weapons/materials, chemical and biological weapons,
radiation of any kind.
i. Accidental Death (We will pay the Sum Insured, if insured died due
to accidental injuries)
ii. Permanent Disablement (We will pay the Sum Insured, if insured
become permanently disable due to accidental injuries)
iii. Any Critical Illness or Surgical Procedure arising out of use, abuse
Section
or consequence or influence of any substance, intoxicant, drug,
B.1.
alcohol or hallucinogen
iv. Narcotics used by the Insured Person unless taken as prescribed
by a registered Medical Practitioner
v. Any Claim caused due to intentional self-injury, suicide or attempted
suicide.
vi. Any Critical Illness or Surgical Procedure caused by or arising from
or attributable to a foreign invasion, act of foreign enemies, hostilities,
(whether war be declared or not or while performing duties in the
armed forces of any country during war or at peace time), civil war,
public defence, rebellion, revolution, insurrection, military or usurped
power;
vii. Any claim caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or
from any nuclear waste from the combustion of nuclear fuel, nuclear,
chemical or biological attack.
viii. Working in underground mines, tunnelling or involving electrical
installations with high tension supply, or as jockeys or circus
personnel;
ix. Congenital External Anomalies or any complications or conditions
arising there from including any developmental conditions of the
Insured;

2855207022027000000

x. Whilst engaging in Adventure Sports.

xi. Involvement in naval, military or air force operation.
xii. Participation by the Insured Person in any flying activity, except as
a bona fide, passenger (fare paying or otherwise) of a recognized
airline on regular routes and on a scheduled time table.

Specific Exclusions applicable to the below mentioned sections

Section
a. Personal Accident
B.2;
Section
b. Loss of Income / EMI Protector – Permanent Total Disablement
B.4.III.;
Section
c. Credit Shield
B.5.;
Section
d. Broken Bones
B.7;
e. Dependent Child Education benefit 2.B.9
Section
f. Parental Care benefit
B.8;
Section
g. Mobility Extension
B.9
Section
h. Hospital Cash
B.10;
Section
i. Chauffeur Benefit
B.11;
i. The abuse or the consequences of the abuse of tobacco, intoxicants
or hallucinogenic substances such as drugs and alcohol, including
Section
smoking cessation programs and the treatment of nicotine addiction or
B.12;
alcohol addiction programs, any other substance abuse treatment or
services, or supplies.
ii. War or any act of war, invasion, act of foreign enemy(whether war
be declared or not or caused during service in the armed forces of any
country), civil war, public defence, rebellion, revolution, insurrection,
military or usurped acts, nuclear weapons/materials, chemical and
biological weapons, radiation of any kind
iii. Whilst engaging in aviation or ballooning, whilst mounting into,
dismounting from or travelling in any balloon or aircraft other than as a
passenger (fare paying or otherwise) in any duly licensed standard
type of aircraft anywhere in the world.
iv. Any loss suffered by the Insured on account of his participation as
the driver, co-driver or passenger during motor racing or trial runs or
rallies using a motorized vehicle or bicycle

2855207022027000000

v. Loss or damage caused by or arising from or in consequence of or

contributed to nuclear weapons material by or arising from or in
consequence of or contributed to by ionizing radiation or contamination
by radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel (including any self-sustaining process of
nuclear fission).
vi. Any Insured Person committing or attempting to commit a
breach of law with criminal intent, or intentional self-injury or
attempted suicide or suicide.
vii. From engaging in or participation in or involvement including but
not limited to naval, military or air force operation.
viii. From participation in Adventure sports
Specific Exclusions applicable to Temporary Total Disablement – Section
Illness Only and Hospital Cash – Illness Only B.2.III.
i. Investigation & Evaluation: Code Excl04
a. Expenses related to any admission primarily for diagnostic and
evaluation purposes only are excluded.
ii. Rest Cure, rehabilitation and respite care –Code – Excl05:
Expenses related to any admission primarily for enforced bed rest
and not for receiving treatment. This also includes:
a. Custodial care either at home or in a nursing facility for personal
care such as help with activities of daily living such as bathing,
dressing, moving around either by skilled nurses or assistant or
non-skilled persons.
b. Any services for people who are terminally ill to address physical,
social, emotional and spiritual needs.
iii. Obesity/Weight control: Code – Excl06: Expenses related to
the surgical treatment of obesity that does not fulfil all the below
conditions:
a. Surgery to be conducted is upon the advice of the doctor
b. The surgery/procedure conducted should be supported by clinical
protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI)
I. Greater than or equal to 40 or,
II. 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:
III. Obesity related cardiomyopathy
IV. coronary heart disease
V. severe sleep apnoea
VI. uncontrolled type2 diabetes
iv. Change-of-Gender treatments - Code – Excl07: Expenses
related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex.

2855207022027000000

v. Cosmetic or plastic surgery: Code – Excl08: 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. For this
to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
vi. Hazardous or Adventure Sports Code – Excl09– 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.
vii. Breach of Law: Code – Excl10 - Expenses for treatment
directly arising from or consequent upon any Insured Person
committing or attempting to commit a breach of law with criminal
intent.
viii. Excluded Providers - Code – Excl11 Expenses incurred
towards treatment in any hospital or by any Medical Practitioner
or any other provider specifically excluded by the Insurer and
disclosed in its website/notified to the policyholders are not
admissible. However, in case of life threatening situations or
following an Accident, expenses up to the stage of stabilization
are payable but not the complete claim.
ix. Treatment for Alcoholism, drug or substance abuse or any addictive
condition and consequences thereof. Code – Excl12
x. Treatments received in health hydros, nature cure clinics, spas or
similar establishments or private beds registered as a nursing home
attached to such establishments or where admission is arranged
wholly or partly for domestic reasons. Code – Excl13
xi. 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. Code – Excl14
xii. Expenses related to the treatment for correction of eye sight due to
3.B.I.9
refractive error less than 7.5 dioptres.Code – Excl15
xiii. Unproven Treatments – Expenses related to any unproven
treatment, services and supplies for or in connection with any
treatment. Unproven treatments are treatments, procedures or 3.B.I.10
supplies that lack significant medical documentation to support
their effectiveness.Code – Excl16
xiv. Sterility and Infertility –Code – Excl17 -Expenses related to
sterility and infertility. This includes:
a. Any type of contraception, sterilization

2855207022027000000

b. Assisted Reproduction services including artificial insemination and

advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
xv.Maternity: Code – Excl18
a. Medical treatment expenses traceable to childbirth(including
complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy;;
b. Expenses towards miscarriage (unless due to an accident)and
lawful medical termination of pregnancy during the Policy Period.
xvi. War or any act of war, invasion, act of foreign enemy, (whether
war be declared or not or caused during service in the armed
forces of any country), civil war, public defence, rebellion,
revolution, insurrection, military or usurped acts, Nuclear,
Chemical or Biological attack or weapons, radiation of any kind.
xvii. Any Insured Person committing or attempting to commit
intentional self-injury or attempted suicide or suicide..
xviii. Any Insured Person’s participation or involvement in naval,
military or air force operation.
xix. Investigative treatment for Sleep-apnoea, General debility or
exhaustion (“run-down condition”).
xx. Congenital external diseases, defects or anomalies,
xxi. Stem cell harvesting.
xxii. Investigative treatments for analysis and adjustments of spinal
subluxation, diagnosis and treatment by manipulation of the skeletal
structure or for muscle stimulation by any means except treatment of
fractures (excluding hairline fractures) and dislocations of the mandible
and extremities).
xxiii. Circumcisions (unless necessitated by Illness or Injury and
forming part of treatment).
xxiv. Any Convalescence, sanatorium treatment, private duty nursing
or long-term nursing care.
xxv. Vaccination including inoculation and immunisations (Except post
Animal bite treatment),
xxvi. Treatment taken on Outpatient basis
xxvii. Any treatment and associated expenses for alopecia, baldness
including corticosteroids and topical immunotherapy wigs, toupees,
hair pieces, any non-surgical hair replacement methods, Optometric
therapy.

Specific Exclusions applicable to Emergency Medical Expenses

2855207022027000000

i. The abuse or the consequences of the abuse of tobacco, intoxicants

or hallucinogenic substances such as drugs and alcohol, including
smoking cessation programs and the treatment of nicotine addiction or
alcohol addiction programs, any other substance abuse treatment or
services, or supplies.
ii. War or any act of war, invasion, act of foreign enemy(whether war
be declared or not or caused during service in the armed forces of any
country), civil war, public defence, rebellion, revolution, insurrection,
military or usurped acts, nuclear weapons/materials, chemical and
biological weapons, radiation of any kind
iii. Whilst engaging in aviation or ballooning, whilst mounting into,
dismounting from or travelling in any balloon or aircraft other than as a Section
passenger (fare paying or otherwise) in any duly licensed standard B.3.
type of aircraft anywhere in the world.
iv. Any loss suffered by the Insured on account of his participation as
the driver, co-driver or passenger during motor racing or trial runs or
rallies using a motorized vehicle or bicycle
v. Loss or damage caused by or arising from or in consequence of or
contributed to nuclear weapons material by or arising from or in
consequence of or contributed to by ionizing radiation or contamination
by radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel (including any self-sustaining process of
nuclear fission).
vi. Any Insured Person committing or attempting to commit a breach of
law with criminal intent, or intentional self-injury or attempted suicide or
suicide.
vii. From engaging in or participation in or involvement including but
not limited to naval, military or air force operation.
viii. Investigation &Evaluation: Code Excl04
a. Expenses related to any admission primarily for diagnostic and
evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to
the current diagnosis and treatment are excluded.
ix. Rest Cure, rehabilitation and respite care –Code – Excl05:
Expenses related to any admission primarily for enforced bed rest
and not for receiving treatment. This also includes:
a. Custodial care either at home or in a nursing facility for personal
care such as help with activities of daily living such as bathing,
dressing, moving around either by skilled nurses or assistant or
non-skilled persons.
b. Any services for people who are terminally ill to address physical,
social, emotional and spiritual needs.

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x. Obesity/Weight control:Code – Excl06: Expenses related to the

surgical treatment of obesity that does not fulfil all the below
conditions:
a. Surgery to be conducted is upon the advice of the doctor
b. The surgery/procedure conducted should be supported by clinical
protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI)
i. Greater than or equal to 40 or,
ii. 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:
1. Obesity related cardiomyopathy
2. coronary heart disease
3. severe sleep apnoea
4. uncontrolled type2 diabetes
xi. Change-of-Gender treatments - Code – Excl07:Expenses
related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex.
xii. Cosmetic or plastic surgery: Code – Excl08: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. For this
to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
xiii. Hazardous or Adventure SportsCode – Excl09– Expenses
related to any treatment necessitated due to participation as a
professional in Hazardous or Adventure sports , including but not
2.B.3.a
limited to, para-jumping, rock climbing, mountaineering, rafting,
motor racing, horse racing or scuba diving, hand gliding, sky
diving, deep sea diving.
xiv. Breach of Law: Code – Excl10 - Expenses for treatment
directly arising from or consequent upon any Insured Person
2.B.4.e
committing or attempting to commit a breach of law with criminal
intent.
xv. Excluded Providers - Code – Excl11 Expenses incurred
towards treatment in any hospital or by any Medical Practitioner
or any other provider specifically excluded by the Insurer and
disclosed in its website/notified to the policyholders are not
admissible. However, in case of life threatening situations or
following an Accident, expenses up to the stage of stabilization
are payable but not the complete claim.
xvi. Treatment for Alcoholism, drug or substance abuse or any
addictive condition and consequences thereof.Code – Excl12

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xvii. Treatments received in health hydros, nature cure clinics, spas or

similar establishments or private beds registered as a nursing home
attached to such establishments or where admission is arranged
wholly or partly for domestic reasons.Code – Excl13
xviii. 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.Code – Excl14
xix. Expenses related to the treatment for correction of eye sight due to
refractive error less than 7.5 dioptres.Code – Excl15
xx. Unproven Treatments – Expenses related to any unproven
treatment, services and supplies for or in connection with any
treatment. Unproven treatments are treatments, procedures or
supplies that lack significant medical documentation to support
their effectiveness.Code – Excl16
xxi. Sterility and Infertility –Code – Excl17 -Expenses related to
sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and
advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
xxii. Maternity: Code – Excl18
a. Medical treatment expenses traceable to childbirth (including
complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an accident) and
lawful medical termination of pregnancy during the Policy period.
xxiii. War or any act of war, invasion, act of foreign enemy, (whether
war be declared or not or caused during service in the armed
forces of any country), civil war, public defence, rebellion,
revolution, insurrection, military or usurped acts, Nuclear,
Chemical orBiological attack or weapons, radiation of any kind.
xxiv. AnyInsured Person committing or attempting to commit
intentional self-injury or attempted suicide or suicide..
xxv. AnyInsured Person’s participation or involvement in naval,
military or air force operation.
xxvi. Investigative treatment for Sleep-apnoea, General debility or
exhaustion (“run-down condition”).
xxvii. Congenital external diseases, defects or anomalies,
xxviii. Circumcisions (unless necessitated by Illness or Injury and
forming part of treatment).
xxix. Any Convalescence, sanatorium treatment, private duty nursing
or long-term nursing care.

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xxx. Vaccination including inoculation and immunisations (Except post

Animal bite treatment),
xxxi.Non-Medical expenses such as Food charges (other than
patient’s diet provided by hospital), laundry charges, attendant
charges, ambulance collar, ambulance equipment, baby food,
baby utility charges and other such items. Full list of Non-Medical
expenses is attached and also available at www.hdfcergo.com.
xxxii. Any treatment and associated expenses for alopecia, baldness
including corticosteroids and topical immunotherapy wigs, toupees,
hair pieces,any non-surgical hair replacement methods, Optometric
therapy.
xxxiii. Any treatment or part of a treatment that is not of a Reasonable
and Customary charge, not Medically Necessary; treatments or drugs
not supported by a prescription.
xxxiv. Expenses for Artificial limbs and/or device used for
diagnosis or treatment (except when used
intra-operatively).prosthesis, corrective devices external durable
medical equipment of any kind, wheelchairs, crutches, and
oxygen concentrator for bronchial asthma/ COPD conditions, cost
of cochlear implant(s) unless necessitated by an Accident.
Exhaustive list of Non-Medical expenses attached and also
available on www.hdfcergo.com

Specific Exclusions applicable to Loss of Income / EMI Protector –

Termination from Employment

i. The Company shall not be liable to make any payment under this
Section in the event of termination, dismissal, temporary suspension or
retrenchment from employment of the Insured being attributed to any
Section
dishonesty or fraud or poor performance on the part of the Insured or
B.4.I.
his willful violation of any rules of the employer or laws for the time
being in force or any disciplinary action against the Insured by the
employer.
ii. Claim in connection with or in respect of:
a. Self employed persons;
b. unemployment from a job which is casual, temporary, seasonal or
contractual in nature or any claim relating to an employee not on the
direct rolls of the employer;
c. Any voluntary unemployment;
d. Unemployment at the time of inception of the Policy Period or
arising within the first 90 days of inception of the Policy Period.
iii. Any unemployment from a job under which no salary or any
remuneration is provided to the Insured
iv. Any suspension from employment on account of any pending
enquiry being conducted by the employer/ Public Authority

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v. Any unemployment due to resignation, retirement whether voluntary

or otherwise
vi. Termination from employment while the Insured Person is under
probation.

Specific Exclusions applicable to Loss of Income / EMI Protector –

Major Medical Illness

i. Treatment arising from or consequent upon war or any act of

war(whether war be declared or not or caused during service in the
armed forces of any country), invasion, act of foreign enemy, civil war,
public defense, rebellion, revolution, insurrection, military or usurped
acts, nuclear weapons/materials, chemical and biological weapons,
radiation of any kind.
ii. Any Illness, sickness or disease other than those opted and
specified as Major Medical illnesses under this Cover.
iii. Any Critical Illness or Surgical Procedure arising out of use, abuse
or consequence or influence of any substance, intoxicant, drug,
alcohol or hallucinogen
iv. Narcotics used by the Insured Person unless taken as
prescribed by a registered Medical Practitioner
v. Any Claim caused due to intentional self-injury, suicide or attempted
suicide.
vi. Any Critical Illness or Surgical Procedure caused by or arising from
or attributable to a foreign invasion, act of foreign enemies, hostilities,
(whether war be declared or not or while performing duties in the Section
armed forces of any country during war or at peace time), civil war, B.4.II.
public defence, rebellion, revolution, insurrection, military or usurped
power;
vii. Any claim caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or
from any nuclear waste from the combustion of nuclear fuel, nuclear,
chemical or biological attack.
viii. Working in underground mines, tunnelling or involving electrical
installations with high tension supply, or as jockeys or circus
personnel;
ix. Congenital External Anomalies or any complications or conditions
arising there from including any developmental conditions of the
Insured;
x. Whilst engaging in Adventure Sports.
xi. Involvement in naval, military or air force operation.
xii. Participation by the Insured Person in any flying activity, except as
a bona fide, passenger (fare paying or otherwise) of a recognized
airline on regular routes and on a scheduled time table.

2855207022027000000

xiii. Loss of job due to retirement whether voluntary or otherwise

Specific Exclusions applicable to Loss of Income / EMI Protector – Section
Permanent Total Disablement B.4.III.
i. Loss of job due to retirement whether voluntary or otherwise
Specific Exclusions applicable to Property Coverage
i. Your deliberate, wilful or intentional act or ommission, or of anyone
on Your behalf, or with Your connivance.
ii. War, invasion, act of foreign enemy hostilities or war-like operations
(whether war is declared or not), civil war, mutiny, civil commotion
amounting to a popular rising, military rising, rebellion, revolution,
insurrection or military or usurped power.
iii. Ionising radiation or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from combustion of nuclear fuel, or the
radioactive, toxic, explosive or other hazardous properties of any
explosive nuclear assembly or nuclear component that is part of it.
iv. Pollution or contamination, unless
a. the pollution or contamination itself has resulted from an Insured Section
Event, or B.6.
b. an Insured Event itself results from pollution or contamination.
v. Loss, damage or destruction to any electrical/electronic machine,
apparatus, fixture, or fitting by over-running, excessive pressure, short
circuiting, arcing, self- heating or leakage of electricity from whatever
cause (lightning included). This exclusion applies only to the particular
machine so lost, damaged or destroyed.
vi. Loss or damage to bullion or unset precious stones, manuscripts,
plans, drawings, securities, obligations or documents of any kind,
coins or paper money, cheques, vehicles, and explosive substances
unless otherwise expressly stated in the policy.
vii. Loss of any Insured Property which is missing or has been mislaid,
or its disappearance cannot be linked to any single identifiable event.
viii. Loss or damage to any Insured Property removed from Your Home
to any other place.
ix. Loss of earnings, loss by delay, loss of market or other
consequential or indirect loss or damage of any kind or description
whatsoever.
x. Any reduction in market value of any Insured Property after its repair
or reinstatement.

2855207022027000000

xi. Any addition, extension, or alteration to any structure of Your Home

Building that increases its Carpet Area by more than 10% of the
Carpet Area existing at the Commencement Date or on the date of
renewal of this Policy, unless You have paid additional premium and
such addition, extension or alteration is added by Endorsement.
xii. Costs, fees or expenses for preparing any claim.

Specific Exclusions applicable to Accidental Hospitalization Expenses

i. The abuse or the consequences of the abuse of tobacco, intoxicants

or hallucinogenic substances such as drugs and alcohol, including
smoking cessation programs and the treatment of nicotine addiction or
alcohol addiction programs, any other substance abuse treatment or
services, or supplies.
ii. War or any act of war, invasion, act of foreign enemy(whether war
be declared or not or caused during service in the armed forces of any
Section
country), civil war, public defence, rebellion, revolution, insurrection,
B.13.
military or usurped acts, nuclear weapons/materials, chemical and
biological weapons, radiation of any kind
iii. Whilst engaging in aviation or ballooning, whilst mounting into,
dismounting from or travelling in any balloon or aircraft other than as a
passenger (fare paying or otherwise) inany duly licensed standard
type of aircraft anywhere in the world.
iv. Any loss suffered by the Insured on account of his participation as
the driver, co-driver or passenger during motor racing or trial runs or
rallies using a motorized vehicle or bicycle
v. Loss or damage caused by or arising from or in consequence of or
contributed to nuclear weapons material by or arising from or in
consequence of or contributed to by ionizing radiation or contamination
by radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel (including any self-sustaining process of
nuclear fission).
vi. From engaging in or participation in or involvement including but not
limited to naval, military or air force operation.
vii. From participation in Adventure sports
viii. Investigation & Evaluation: Code Excl04
a. Expenses related to any admission primarily for diagnostic and
evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to
the current diagnosis and treatment are excluded.
ix. Rest Cure, rehabilitation and respite care –Code – Excl05:
Expenses related to any admission primarily for enforced bed rest
and not for receiving treatment. This also includes:

2855207022027000000

a. Custodial care either at home or in a nursing facility for personal

care such as help with activities of daily living such as bathing,
dressing, moving around either by skilled nurses or assistant or
non-skilled persons.
Any services for people who are terminally ill to address physical,
social, emotional and spiritual needs.
x. Cosmetic or plastic surgery: Code – Excl08: 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. For this
to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
xi. Breach of Law: Code – Excl10 - Expenses for treatment directly
arising from or consequent upon any Insured Person committing
or attempting to commit a breach of law with criminal intent.
xii. Excluded Providers - Code – Excl11 Expenses incurred
towards treatment in any hospital or by any Medical Practitioner
or any other provider specifically excluded by the Insurer and
disclosed in its website/notified to the policyholders are not
admissible. However, in case of life threatening situations or
following an Accident, expenses up to the stage of stabilization
are payable but not the complete claim.
xiii. Treatment for Alcoholism, drug or substance abuse or any
addictive condition and consequences thereof. Code – Excl12
xiv. Treatments received in health hydros, nature cure clinics, spas or
similar establishments or private beds registered as a nursing home
attached to such establishments or where admission is arranged
wholly or partly for domestic reasons. Code – Excl13
xv. 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.
Code – Excl14
xvi. Unproven Treatments – Expenses related to any unproven
treatment, services and supplies for or in connection with any
treatment. Unproven treatments are treatments, procedures or
supplies that lack significant medical documentation to support
their effectiveness.Code – Excl16
xvii. Congenital external diseases, defects or anomalies,
xviii. Stem cell harvesting.
xix. Any Convalescence, sanatorium treatment, private duty nursing or
long-term nursing care.
xx. Treatment taken on Outpatient basis

2855207022027000000

xxi. Any treatment and associated expenses for alopecia, baldness

including corticosteroids and topical immunotherapy wigs, toupees,
hair pieces, any non-surgical hair replacement methods, Optometric
therapy.

Specific Exclusions applicable to Permanent Total Disablement –

Illness

i. Treatment arising from or consequent upon war or any act of

ii. Any Illness, sickness or disease other than those opted and
specified as Major Medical illnesses under this Cover.
iii. Any Critical Illness or Surgical Procedure arising out of use, abuse
or consequence or influence of any substance, intoxicant, drug,
alcohol or hallucinogen
iv. Narcotics used by the Insured Person unless taken as
prescribed by a registered Medical Practitioner
v. Any Claim caused due to intentional self-injury, suicide or attempted
suicide.
vi. Any Critical Illness or Surgical Procedure caused by or arising from
or attributable to a foreign invasion, act of foreign enemies, hostilities,
(whether war be declared or not or while performing duties in the
armed forces of any country during war or at peace time), civil war,
public defence, rebellion, revolution, insurrection, military or usurped
power;
vii. Any claim caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or
from any nuclear waste from the combustion of nuclear fuel, nuclear,
chemical or biological attack.
viii. Working in underground mines, tunnelling or involving electrical
installations with high tension supply, or as jockeys or circus
personnel;
ix. Congenital External Anomalies or any complications or conditions
arising there from including any developmental conditions of the
Insured;
x. Whilst engaging in Adventure Sports.
xi. Involvement in naval, military or air force operation.
xii. Participation by the Insured Person in any flying activity, except as
a bona fide, passenger (fare paying or otherwise) of a recognized
airline on regular routes and on a scheduled time table.

2855207022027000000

xiii. Treatment of Obesity and any weight control program.

xiv. Congenital external diseases, defects or anomalies Pregnancy
(including voluntary termination), miscarriage (except as a result of an
Accident or Illness), maternity or birth (including caesarean section)
except in the case of ectopic pregnancy.
xv. treatment to treat infertility any fertility, sub-fertility or assisted
conception procedure,
xvi. Sterility, treatment whether to affect infertility, surrogate or
vicarious pregnancy, birth control, contraceptive supplies or services
including complications arising due to supplying services.
xvii. Investigative treatment for analysis and adjustments of spinal
subluxation, diagnosis and treatment by manipulation of the skeletal
structure or for muscle stimulation by any means except treatment of
fractures (excluding hairline fractures) and dislocations of the mandible
and extremities).
xviii. Circumcisions (unless necessitated by Illness or Injury and
forming part of treatment); treatment for correction of vision due to
refractive error, aesthetic or change-of-life treatments of any
description and sex transformation operations.
xix. Plastic surgery or cosmetic surgery or treatments to change
appearance unless necessary as a part of Medically Necessary
Treatment certified by the attending Medical Practitioner for
reconstruction following an Accident, cancer or burns.
xx. Experimental , investigational or Unproven treatments, devices
and pharmacological regimens.
xxi. Treatment rendered by a Medical Practitioner which is outside his
discipline or the discipline for which he is licensed; treatments
rendered by a Medical Practitioner who is a member of an Insured
Person's family, or stays with him

Specific Exclusions applicable to Last Rites

i. Treatment arising from or consequent upon war or any act of

war(whether war be declared or not or caused during service in the
armed forces of any country), invasion, act of foreign enemy, civil war, Section
public defense, rebellion, revolution, insurrection, military or usurped B.15.
acts, nuclear weapons/materials, chemical and biological weapons,
radiation of any kind.
ii. Any Illness, sickness or disease other than those opted and
specified as Major Medical illnesses under this Cover.
iii. Any Critical Illness or Surgical Procedure arising out of use, abuse
or consequence or influence of any substance, intoxicant, drug,
alcohol or hallucinogen
iv. Narcotics used by the Insured Person unless taken as prescribed
by a registered Medical Practitioner

2855207022027000000

v. Any Claim caused due to intentional self-injury, suicide or attempted

suicide.
vi. Any Critical Illness or Surgical Procedure caused by or arising from
or attributable to a foreign invasion, act of foreign enemies, hostilities,
(whether war be declared or not or while performing duties in the
armed forces of any country during war or at peace time), civil war,
public defence, rebellion, revolution, insurrection, military or usurped
power;
vii. Any claim caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or
from any nuclear waste from the combustion of nuclear fuel, nuclear,
chemical or biological attack.
viii. Working in underground mines, tunnelling or involving electrical
installations with high tension supply, or as jockeys or circus
personnel;
ix. Congenital External Anomalies or any complications or conditions
arising there from including any developmental conditions of the
Insured;
x. Whilst engaging in Adventure Sports.
xi. Involvement in naval, military or air force operation.
xii. Participation by the Insured Person in any flying activity, except as
a bona fide, passenger (fare paying or otherwise) of a recognized
airline on regular routes and on a scheduled time table.
Section
7 Waiting Periods Waiting Periods applicable to specific benefits
B.1.
• Time period
Waiting Periods applicable to Major Medical Illness
during which
specified disease / Initial Waiting Period (default): 90 days
treatments are not Pre-Existing disease waiting period (default): 3 years
covered Survival Period (default): 7 days
Survival Period (options): 0/15/30 days
Section
Waiting Periods applicable to Personal Accident – Temporary Total
• It is counted from B.2.A.II
Disablement (Illness only)
the beginning of the I.
policy coverage Initial Waiting Period: 30 days
Specific Disease / Procedure Waiting Period: 24 months
Pre-Existing disease waiting period (default): 3 years
Pre-Existing disease waiting period (options): 0/1/2 years
Waiting Periods applicable to Loss of Income / EMI Protector - Major Section
Medical Illness B.4.II.
Pre-Existing disease waiting period: 3 years
Survival Period (default): 7 days
Survival Period (options): 0/15/30 days

2855207022027000000

Section
Waiting Periods applicable to Hospital Cash – Illness only B.11.a.
II.
Initial Waiting Period: 30 days
Specific Disease / Procedure Waiting Period: 24 months
Pre-Existing disease waiting period (default): 3 years
Pre-Existing disease waiting period (options): 0/1/2 years

Section
Waiting Periods applicable to Permanent Total Disablement – Illness
B.14.
Initial Waiting Period: 90 days
Pre-Existing disease waiting period (default): 3 years
Pre-Existing disease waiting period (options): 0/1/2 years
Survival Period (default): 7 days
Survival Period (options): 0/15/30 days
Financial Limits of
8 Financial limits specific to covers
coverage
Sub-limits Sub limits specific to particular covers
(It is a predefined Sub-limits applicable to Personal Accident
limit and the
Section
insurance company
Comatose: 25% of Accidental Death SI B.2.A.I.
will not pay any
b.
amount in excess of
this limit
Co-payments Co-payment specific to particular covers

(It is a specified Section

Emergency Medical Expenses: 5% / 10% / 15% / 20% / 25%
amount/percentage B.3.
of the admissible Section
Accidental Hospitalization Expenses: 5% / 10% / 15% / 20% / 25%
claim amount to be B.13.
paid by
policyholder/insured
)
Deductible Deductible specific to particular covers

It is a specified
Personal Accident:
amount:
Section
Weekly deductible under Temporary Total Disablement: 1 / 2 / 3 / 4
B.2.A.II
weeks
I.
• up to which an
insurance company
will not pay any
claim, and

2855207022027000000

• which will be Section

deducted from total Hospital Cash: B.11.b.i
claim amount (if ii.
claim amount is
Time deductible options: 1 / 2 / 3 / 4 / 5 / 7 days
more than the
specified amount)

Section
Sum Insured Limits Sum Insured specific to particular base covers
B.

Financial limits applicable to Major Medical Illness

a. SI: 10k to 5cr

Financial limits applicable to optional covers under Major Medical Section

Illness B.1.
a. Cardiac Arrest SI: 10k to 5cr
b. Angioplasty SI: 10k to 5L
c. Molecular gene profiling test SI: 5k to 30k
d. Second medical opinion
i. Second medical opinion (India) SI: 5k to 20k
ii. Second medical opinion (Global) SI : 2x of Second medical opinion
(India) SI

Section
Financial limits applicable to Personal accident
B.2.
a. Accidental Death SI: 10k to 50cr
b. Permanent Disablement (Table A to E) SI: 10k to 50cr
c. Temporary Total Disablement
i. Temporary Total Disablement – Accident only SI: 500 to 1L upto 104
weeks
ii. Temporary Total Disablement – Illness only SI: 500 to 1L upto 104
weeks

Financial limits applicable to optional covers under Accidental Death

a. Burns SI: 10k to 10L
b. Transportation of Mortal Remains SI: 500 to 10k
c. Renewal Premium Benefit SI: 50 to 2.5L

Section
Financial limits applicable to Emergency Medical Expenses
B.3.
a. Emergency Medical Expense – Global SI: 10L to 25L

Section
Financial limits applicable to Loss of Income / EMI Protector
B.4.
a. Termination from employment SI: 1k to 50L

2855207022027000000

b. Loss of Income – major medical illness SI: 1k to 50L

c. Loss of Income – Permanent Total Disablement SI: 1k to 50L

Financial limits applicable to Loss of Income / EMI Protector

a. Cardiac Arrest SI: 1k to 50L

Section
Financial limits applicable to Credit Shield
B.5.
a. Accidental Death & Permanent Total Disablement SI: 10k to 5cr

Section
Financial limits applicable to Property Coverage
B.6.
a. Fire and allied perils SI: 10k to 10cr
b. Burglary SI: 10k to 10cr

Section
Financial limits applicable to Broken Bones
B.7.
a. SI: 5k to 25L

Section
Financial limits applicable to Dependent Child Education benefit
B.8.
a. SI: 10k to 10L

Section
Financial limits applicable to Parental Care benefit
B.9.
a. SI: 10k to 25L

Section
Financial limits applicable to Mobility Extension
B.10.
a. Mobility Extension – Benefit SI: 10k to 10L
b. Mobility Extension – Indemnity SI: 5L to 10L

Section
Financial limits applicable to Hospital Cash
B.11.
a. Hospital Cash Accident Only SI: 500 to 20k per day
b. Hospital Cash illness Only SI: 500 to 20k per day

Financial limits applicable to options under Hospital Cash

a. Companion Benefit SI: 0.5x / 1x
b. Hospital Cash ICU SI: 2x / 3x / 4x / 5x / 10x
c. Hospital Cash Global SI: 2x / 3x / 5x
x = SI selected in Hospital Cash

Section
Financial limits applicable to Chauffeur benefit
B.12.
a. SI: 250 to 1k per day

2855207022027000000

Section
Financial limits applicable to Accidental Hospitalization Expenses
B.13.
a. SI: 10k to 25L

Financial limits applicable to Accidental Hospitalization Expenses

a. Hospitalization Expenses Global – 10L to 25L

Section
Financial limits applicable to Permanent Total Disablement - Illness
B.14.
a. SI: 10k to 5cr

Section
Financial limits applicable to Last Rites
B.15.
a. SI: 1k to 1L

Section
Sum Insured limits specific to particular optional covers
C.
Section
Financial limits applicable to Medical Evacuation
C.ii.
a. SI: 1L to 5L

Section
Financial limits applicable to Road Ambulance
C.iii.
a. SI: 500 to 20k
Claims / Claims Details of procedure to be followed for cashless service as well as for Section
9
procedure reimbursement of claim including pre and post hospitalization. E
Turn Around Time (TAT) for claims settlement:
For Cashless Process :
i. TAT for preauthorization of cashless facility: Decision on cashless
authorization to be provided within 1 hour from the time of receipt of
request.
ii. TAT for cashless final bill authorization: Within 3 hours of the receipt
of discharge authorization request from the hospital.

For Reimbursement Process :

i. TAT for Claim settlement – 30 days from the time the last necessary
document is received.
(Note: In case of internal verification, the final stand will be confirmed
within 45 days from the time the last necessary document is received
by us)

Provide the details /web link for following:

https://www.hdfcergo.com/locators/cashless-hospitals-networks
Helpline number :
https://www.hdfcergo.com/customercare/grievances

2855207022027000000

Call - : 022 6234 6234 / 0120 6234 6234

Hospitals which are excluded or from where no claims will be accepted
by insurer
http://www.hdfcergo.com/docs/default-source/documents/excluded-hospital1.pdf

Downloading/getting claim form

https://www.hdfcergo.com/download/claim-form
10 Policy Servicing Call center number : Section
022 6234 6234 / 0120 6234 6234 Or visit help section on D.12.
www.hdfcergo.com
Details of Company officials:
Customer Happiness Center: D-301, 3rd Floor, Eastern Business
District LBS Marg, Bhandup (West), Mumbai - 400 078.
11 Grievances/Compla In case of any grievance the insured person may contact the Company Section
ints through: D.12.
- Website: www.hdfcergo.com
- Contact Details for Senior Citizen: 022 – 6242 – 6226
- E-mail: [email protected]
- Contact Details for Senior Citizen: 022 – 6242 – 6226
- E-mail specific for Senior citizens :
[email protected]
Insured Person may contact the Grievance officer at Section
[email protected] D.12.
For updated details of grievance officer, kindly refer the link:
- link: https://www.hdfcergo.com/customer-voice/grievances
Ombudsman:
https://bimabharosa.irdai.gov.in/.
Things to Free Look cancellation: You may cancel the insurance policy if Section
12
remember you do not want it, within 30 days from the beginning of the policy. D.7.
Process for free look cancellation:
1. The Free Look Period shall be applicable on new individual health
insurance policies and not on renewals or at the time of
porting/migrating the policy.
2. The insured person shall be allowed free look period of 30 days
from date of receipt of the policy document to review the terms and
conditions of the policy, and to return the same if not acceptable.
Policy renewal: Except on grounds of fraud, moral hazard or
Section
misrepresentation or non-cooperation, renewal of your policy
D.3.
shall not be denied, provided the policy is not withdrawn.
Migration and Portability: When your policy is due for renewal,
you may migrate to another policy with us or port your policy to
another insurer.

2855207022027000000

Process for migration: The Insured Person will have the option to
migrate the Policy to other health insurance products/plans
offered by the Company by applying for Migration of the policy NA
atleast 30 days before the policy renewal date as per IRDAI
guidelines on Migration.
Process for portability: The Insured Person will have the option to
port the Policy to other insurers by applying to such Insurer to port
Section
the entire policy along with all the members of the family, if any, at
D.11.
least 45 days before, but not earlier than 60 days from the policy
renewal date as per IRDAI guidelines related to Portability.
Change in Sum Insured: Sum Insured can be changed
(increased/ decreased) only at the time of renewal, subject to
underwriting by the company. For increase in SI, the waiting
period if any shall start afresh only for the enhanced portion of the
sum insured.
Moratorium Period: After completion of five continuous
years under the policy no look back to be applied. This
period of five years is called as moratorium period. The
moratorium would be applicable for the sums insured of
Section
the first policy and applicable for the sums insured of the
D.8.
first policy and subsequently completion of five
continuous years would be applicable from date of
enhancement of sums insured only on the enhanced
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.
Please disclose all pre-existing disease/s or condition/s and fill in the
13 Your Obligations complete details in the proposal form before buying a policy.
Non-disclosure may affect the claim settlement.

Note:
1. Web-link of the product documents: https://www.hdfcergo.com/download >>
2. In case of any conflict, the terms and conditions mention in the policy document shall prevail.
Declaration by the Policy Holder;
I have read the above and confirm having noted the
Place:
(Signature of the Policyholder)
Date:

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Your Policy Is Ready To Download - Policy

Uploaded by

Your Policy Is Ready To Download - Policy

Uploaded by

HDFC ERGO General Insurance Company Limited

Certificate of Insurance 2855207022027000000

Sarv Suraksha Plus (Group)

Dear MR CHIRAG SIHOTIA

The details of coverage are mentioned in the enclosed certificate of insurance.

For HDFC ERGO General Insurance Company Ltd.

Sarv Suraksha Plus (Group)

If total points accumulated in a policy month Greater than 110 91 to 110 71 to 90 51 to 70 31 to 50 0 to 30

HDFC ERGO General Insurance Company Limited 1

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

Sarv Suraksha Plus (Group)

Enrollment Form No :2855 2070 2202 7000 000

Declaration & Warranty on behalf of all Persons Proposed to be Insured

Broker Name : ZOPPER INSURANCE BROKERS PRIVATE LIMITED

CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

Note: For complete details of Sum Insured applicability, please refer

4. Loss of Income/EMI Protector: Income protection from the Section

x. Whilst engaging in Adventure Sports.

Specific Exclusions applicable to the below mentioned sections

v. Loss or damage caused by or arising from or in consequence of or

v. Cosmetic or plastic surgery: Code – Excl08: Expenses for

b. Assisted Reproduction services including artificial insemination and

Specific Exclusions applicable to Emergency Medical Expenses

i. The abuse or the consequences of the abuse of tobacco, intoxicants

x. Obesity/Weight control:Code – Excl06: Expenses related to the

xvii. Treatments received in health hydros, nature cure clinics, spas or

xxx. Vaccination including inoculation and immunisations (Except post

Specific Exclusions applicable to Loss of Income / EMI Protector –

v. Any unemployment due to resignation, retirement whether voluntary

Specific Exclusions applicable to Loss of Income / EMI Protector –

i. Treatment arising from or consequent upon war or any act of

xiii. Loss of job due to retirement whether voluntary or otherwise

xi. Any addition, extension, or alteration to any structure of Your Home

Specific Exclusions applicable to Accidental Hospitalization Expenses

i. The abuse or the consequences of the abuse of tobacco, intoxicants

a. Custodial care either at home or in a nursing facility for personal

xxi. Any treatment and associated expenses for alopecia, baldness

Specific Exclusions applicable to Permanent Total Disablement –

i. Treatment arising from or consequent upon war or any act of

xiii. Treatment of Obesity and any weight control program.

Specific Exclusions applicable to Last Rites

i. Treatment arising from or consequent upon war or any act of

v. Any Claim caused due to intentional self-injury, suicide or attempted

(It is a specified Section

• which will be Section

Financial limits applicable to Major Medical Illness

Financial limits applicable to optional covers under Major Medical Section

Financial limits applicable to optional covers under Accidental Death

b. Loss of Income – major medical illness SI: 1k to 50L

Financial limits applicable to Loss of Income / EMI Protector

Financial limits applicable to options under Hospital Cash

Financial limits applicable to Accidental Hospitalization Expenses

For Reimbursement Process :

Provide the details /web link for following:

Call - : 022 6234 6234 / 0120 6234 6234

Downloading/getting claim form

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