THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

New India Mediclaim Policy

UIN-NIAHLIP23187V052223

Policy Schedule

Current Policy No 31010034239500001131 Current Policy Period From:29/12/2023 12:00:01 AM

To:28/12/2024 11:59:59 PM
Previous Policy No 31010034229500001204 Previous Policy Period 29-DEC-22 to 28-DEC-23
Policyholder's Details
Policyholder Name KAUSHIK GHOSH Customer ID PO93957127
PAN Card No CKOPG8080Q
Mobile No/Phone No
Policyholder's address C/O MNC AUTOMATION PVT LTD, 47, Email id
DUPLEX - I, SWARNIM VIHAR, SECTOR
- 82

NOIDA ,UTTAR PRADESH, 201304

Name of the Nominee NIRANJAN GHOSH
Relation with the Policy FATHER
holder
GSTIN NA
Policy Issuing Office and Intermediary Details
Office Name and Code JHANDAWALAN (310100) Office Contact No 23528212
Office Email Id nia.310100@newindia.co.in Development Officer DIRECT BUSINESS (2D10673974)
Name of the Ms. KANCHANPREET KAUR
Agent/Intermediary (NIAAG00021893)
Office Address 7E, JHANDEWALAN EXTN. NEW DELHI- Contact No. of 9582809388 / NA
110055 Agent/Intermediary

,110055
E-mail id of Intermediary kanchanpreet61278@gmail.com,
Regional Office DELHI RO1 (310000) GSTIN 07AAACN4165C1ZT
Regional Contact No 01128754297/01123312889 SAC 997133 (Accident and health insurance
services)
Details Of TPA (Notice or Communication to be given in respect of claim)
Name of the TPA MDINDIA HEALTH INSURANCE TPA
PVT. LIMITED
Email-id of the TPA Address of the TPA S. NO. 46/1, E-SPACE, A-2 BUILDING,
customercare@mdindia.com 3RD FLOOR, PUNE-NAGAR ROAD,
VADGAONSHERI, PUNE-411014,,

Toll Free / Contact No of 18002097800

the TPA 18002097777 /
Fax of TPA 02025300003

Highlights of New India Mediclaim Policy*

* Automatic reinstatement of Sum Insured for 5 Lakhs Sum Insured & above. * Room rent and ICU Charges at 1% and 2% of Sum Insured per day
respectively.
* Health Check Up for every block of 3 claim free years up to a * Hospital Cash up to 1% of Sum Insured.
maximum of ` 5,000/-.
* Day one baby cover. * Ambulance charges up to 1% of Sum Insured.
* Cumulative Bonus 25% SI for claim free year. * Midterm inclusion of newly married spouse.
* Optional Cover I: No Proportionate Deduction. * Cataract claims, up to 20% of Sum Insured or ` 50,000 whichever
less, for each eye.
* Optional Cover II: Maternity Expenses Benefit for Sum Insured 5 * Ayurvedic / Homoeopathic / Unani treatments are covered up to 25%
Lakhs and Above. of the Sum Insured.
* Optional Cover III: Revision in Limit of Cataract (For 8 Lakhs & above * For Pre Existing Diseases Waiting period is 48 Months
Sum Insured).
* Optional Cover IV: For a Voluntary Co-Pay of 20% - (15% discount on * For specified diseases waiting period is 24 months
premium).

Signature Not
Verified
Digitally signed
by JAGATJAYEE
PANIGRAHI
Date: 2023.12.19 Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.
16:06:07 IST
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 1 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

* Optional Cover V: For Non-Payable Items * Please refer to policy document for detailed terms and conditions.
Important
*1.Date of Inception of first policy is the date from which the policyholder has been continuously obtaining health insurance cover in
India from any of the insurers without break subject to portability guidelines.
2.Enhanced Sum Insured under the policy will be subject to policy clauses 4.1,4.2 and 4.3
3. PED and specified diseases waiting periods for each of the merged policy shall be reckoned as per its date of inception of first policy.
* Please visit https://www.newindia.co.in for the list of network hospitals providing cashless facility. If network hospital is not
available in your city/location, please contact the concerned TPA." You are also requested to share your policy details when
you visit the network hospital.

Insured Persons details (Cumulative Bonus Buffer is applicable for 1 L Sum Insured persons.)
S. No Name of the insued Date of Sex Relation Sum insured Cumulative *Date of inception Pre Existing Disease
(Member ID) birth(Age) Bonus Buffer of first policy
1 Kaushik 31/12/1991( M Proposer 100000 0 29/12/2021
Ghosh(PO9395 31)
7127)

Optional Cover Table

Policy Level - Optional Cover - 1 Not Opted Member Level - Optional Cover - III Not Opted
(No Proportionate Deduction) for 2L SI & (Revision in Cataract Limit)
above
Member Level - Optional Not Opted Policy Level - Optional Not Opted Member Level - Optional Not Opted
Cover - II Cover - IV Cover V (For Non-Medical
(Maternity Benefit) (Voluntary Co-pay of 20%) Items)

Premium Details
Sl. No. Name of Basic Premium Premium Premium Discount Premium Discount Total
Insured Premium for for for for for Premium
Optional Optional Optional Optional Optional
Cover I Cover II Cover III Cover IV Cover V
1 KAUSHIK 3269 0 0 0 0 0 0 3269
GHOSH
Total Gross 3269
Premium(Without
GST)
CGST(@9%) 0
SGST(@9%) 0
Net Premium in Words(RUPEES THREE THOUSAND EIGHT HUNDRED FIFTY-SEVEN ONLY) IGST 588
Total GST 588
Net Premium(With 3857
GST)

Previous Year Policy Details

Sl. No. Previous Policy Name of From Date To Date Sum Insured CB Amount Pre-existing
No Insured Diseases
1 310100342295 KAUSHIK 29/12/2022 28/12/2023 100000 0 N
00001204 GHOSH

*This Policy is subject to terms and conditions of New India Mediclaim.

In WITNESS WHEREOF,the undersigned being duly authorized by the Insurers and on behalf of the Insurers has(have) hereunder set
his/her(their) hand(s) on this 29th day of December 2023.
at ______________ this _______________ day of _______________ 20

Date of Issue: 19/12/2023

FOR AND ON BEHALF OF

THE NEW INDIA ASSURANCE COMPANY LIMITED
DULY CONSTITUTED ATTORNEY(S)

Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 2 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 3 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Insurer Office Code : JHANDAWALAN (310100)

Address : 7E, JHANDEWALAN EXTN. NEW DELHI-110055

,110055
Telephone : 23528212
Fax :

New India Mediclaim

PREMIUM CERTIFICATE FOR THE PURPOSE OF DEDUCTION UNDER SECTION 80 D OF INCOME TAX ( AMENDMENT ) ACT 1986

This is to certify that Mr./Mrs. KAUSHIK GHOSH has paid ` 3857 towards premium for New India Mediclaim for the period
29/12/2023 12:00:01 AM to 28/12/2024 11:59:59 PM

Policy no. : 31010034239500001131

Receipt no. & date : 31010081230000002195
19/12/2023

Date of Issue: 19/12/2023

Authorized Signatory For and on behalf of
The New India Assurance Company
Limited
(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)

Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 4 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 5 of 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMPORTANT

This policy is subject to the terms and conditions contained in the policy document (Clauses).

This policy is governed by Health Insurance Regulations 2016 issued by Insurance Regulatory
Development Authority of India on 12.07.2016.

This policy is also governed by IRDAI (Protection of Policyholders' Interest) Regulations, 2017.

This Schedule comes attached with the policy document (Clauses). If not attached, please ask for the
same.

Health Insurance Regulation 2016 and IRDAI (Protection of Policyholders' Interest) Regulations, 2017 are
available on the website of IRDAI.

Beware of spurious calls offering alluring benefits. Never share any policy details with unknown callers.
Call 1800-209-1415 for any enquiry or contact the nearest operating office of New India Assurance Co Ltd.

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.

Tax Invoice No : 31010023E0007433

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 31010034239500001131Document generated by 26277 at 19/12/2023 16:06:05 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.

Page 6 of 6