Group Activ Secure - Certificate of Insurance
Aditya Birla Health Insurance Aditya Birla Health Insurance
Company Limited, 10th Company Limited, 7th floor, C
Policy Issuing Office Floor, R-Tech Park, Nirlon Policy Servicing Office building, Modi Business Centre,
Compound, Goregaon-East, Kasarvadavali, Mumbai, Thane
Mumbai-400063 West 400 615
Master Policy Number 3-62-23-0000847-000 Certificate Number GFB-62-23-4113690-000
Master Policyholder
Aditya Birla Finance Ltd
Name
Product Name Group Activ Secure Member Id PT98004970
Plan Name Plan B
R BANUMATHY
P NO 52 and 53 EVERGREEN
APTS A BLOCK S1 2ND
Name of Insured FLOOR LAKSHMI AVENUE
Person and Residential 1ST CROSS ST Unique Identification
1475235
Address of Insured MADHANANDHAPURAM Number
Person PORUR
CHENNAI,,,Sriperumbudur,Ka
nchipuram,INDIA,TAMIL
NADU,600116
Mobile Number 7358280848 Email Id banumathy1992@gmail.com
Inception date & Time of Master Policy 00:01 hrs 01/06/2023
Expiry Date & Time of Master Policy 23:59 on 31/05/2028
Period of Insurance 5 Years
Start Date 00:01 hrs 03/10/2023
End Date 23:59 on 02/10/2028
Insured Person Detail
Nominee
Insured Person Date of Birth Gender Nominee Sum Insured
Relationship
SIVARAMAKRISHN As Per Coverage
R BANUMATHY 23/10/1992 Female Spouse
AN Details
Group Activ Secure -
Capital Sum Insured/ Sum Insured (Rs)
Personal Accident
Section A: Basic Covers
1000000
Accidental Death Cover (AD)
1000000
Permanent Total Disablement (PTD)
Section B: Optional Covers
200000
Education Fund for Children In case of Accidental Death or Permanent Total Disablement due to accident, we will pay lump
sum amount up to 2% of sum insured or Rs 200,000/-
75000
Salaried
Loss of Job
In case of Permanent Total Disablement due to accident, we will pay lump sum amount up to 5%
of sum insured or Rs 75000/- whichever is less
Group Activ Secure -
Sum Insured (Rs)
Critical Illness
863601
Group 11 CIs
Critical Illness Benefit
Initial Waiting Period -90 Days
Grievance Redressal
In case of a grievance, the Insured Person/ Policyholder can contact Us with the details through our website:
www.adityabirlacapital.com,Email:care.healthinsurance@adityabirlacapital.com or Toll Free : 1800 270 7000. Address: Any of Our
Branch office or Corporate office. For senior citizens, please contact respective branch office of the Company or call at 1800 270
7000 or write an e- mail at seniorcitizen.healthinsurance@adityabirlacapital.com. The Insured Person can also walk-in and
approach the grievance cell at any of Our branches. If in case the Insured Person is not satisfied with the response, then they
can contact Our Head of Customer Service at the following email carehead.healthinsurance@adityabirlacapital.com. If the Insured
Person is still not satisfied with Our redressal, he/she may approach the nearest Insurance Ombudsman. The contact details of
the Ombudsman offices are provided on Our website and in the Policy.
Policy Exclusions
Plan B <As per Quote & Policy Wordings>
Premium Details
Particulars Amount
Net Premium 12695.81
CGST (9%) NA
SGST / UTGST (9%) NA
IGST (18%) 2285.25
Total Premium 14981.06
Premium payment mode RTGS/NEFT
GST Registration No.: 27AANCA4062G1ZN Category: General Insurance SAC Code: 997133
Authorized Signatory
Claim Process
Address for Aditya Birla Health Insurance Company Limited, 5th floor, C building, Modi
Please contact us
Correspondence Business Centre, Kasarvadavali, Mumbai, Thane West - 400615
through any of these
Contact Number 1800 270 7000
Modes
Email ID care.healthinsurance@adityabirlacapital.com
Stamp Duty -The stamp duty has been paid vide MH016945204202223E & 18/03/2023, received from Stamp Duty Authorities vide
Receipt No. 0008817681202223 & 31/03/2023, payment has been made vide Letter of Authorization No. LOA/CSD/678/2023/2013 &
10/04/2023 from Main Stamp Duty Office.
Master Policy Number: 3-62-23-0000847-000 Certificate GFB-62-23-4113690-000
Date 03/10/2023 Place: Mumbai
Authorized Signatory
Note Amount is inclusive of all taxes and cesses as applicable. This certificate must be surrendered to the Insurance
Company for issuance of fresh certificate in case of cancellation of Master Policy or any alteration in the insurance
affecting the premium.
Important –
1) In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever, insurance provided under
this document automatically stands cancelled from the inception irrespective of whether a separate communication is sent or
Pre Existing Disease
Member Name Relationship Pre Existing Disease
R BANUMATHY Self NA
Policy No: 3-62-23-0000847-000 COI No. GFB-62-23-4113690-000
Coverage Start Date: 03/10/2023 Coverage End Date: 02/10/2028
Name Membership No. Relationship DOB
R BANUMATHY PT98004970 Self 23/10/1992
• This card is only identification and is not an authorization to proceed with the treatment or guarantee for payment.
• In case photo less identity cards issued to beneficiaries, acceptable proof of identity such as Aadhar Card/Passport/Driver
License /Ration Card/Voters ID/ PAN Card should be presented at the hospital.
• This non-transferable identification card is valid at selected Network Hospitals & will enable Card Holder to avail cashless
hospitalization only on pre-authorization by Aditya Birla Health Insurance Co. Ltd
• For latest updated network hospital list, log on to https://www.adityabirlahealth.com/healthinsurance/#!/provider-search
