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Can an insured person request more than one E-opinion in a policy year under the HDFC ERGO Optima Restore policy?
No, an insured person cannot request more than one E-opinion in a policy year under the HDFC ERGO Optima Restore policy.
What are the regulatory requirements for claims under the HDFC ERGO Optima Restore policy?
The regulatory requirements for claims under the HDFC ERGO Optima Restore policy include mandatory NEFT for direct credit of the claim amount in the bank account and KYC requirements such as ID/Address proof and photograph.
Is baby food covered under the HDFC ERGO Optima Restore policy?
No, baby food is not covered under the HDFC ERGO Optima Restore policy as per List I of items for which coverage is not available.
Are diagnostic expenses covered under the HDFC ERGO Optima Restore policy?
Diagnostic expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses not related or not incidental to the current diagnosis and treatment are also excluded.
What is the Stay Active discount for an average step count above 10000 in a 1-year policy under the HDFC ERGO Optima Restore policy?
For an average step count above 10000 in a 1-year policy, the Stay Active discount is 2% at each time interval, with a maximum of 8% at the end of the year.
What is the importance of a legal heir certificate in the HDFC ERGO Optima Restore policy?
A legal heir certificate is important in the HDFC ERGO Optima Restore policy for claims processing in the event of the insured person's demise, ensuring that the rightful heir receives the claim amount.
What is the Daily Cash benefit for choosing Shared Accommodation under the HDFC ERGO Optima Restore policy?
The Daily Cash benefit for choosing Shared Accommodation is Rs. 800 per day, with a maximum of Rs. 4,800, except for the highest sum insured option, which offers Rs. 1,000 per day, with a maximum of Rs. 6,000.
Is the Co-Payment applicable to all sections of the HDFC ERGO Optima Restore policy?
No, the Co-Payment is not applicable to Section 3 (Preventive Health checkup), Section 1.h (Daily Cash for choosing shared Accommodation), and Section 1.i (E-Opinion in respect of a Critical Illness) in the HDFC ERGO Optima Restore policy.
Is the emergency air ambulance cover applicable for treatment required overseas under the HDFC ERGO Optima Restore policy?
No, the emergency air ambulance cover is not applicable for treatment required overseas under the HDFC ERGO Optima Restore policy. The insured person must be in India, and the treatment must be required in India only.
What is the procedure for notifying the insurer about an emergency treatment under the HDFC ERGO Optima Restore policy?
To notify the insurer about an emergency treatment under the HDFC ERGO Optima Restore policy, notice must be given within 24 hours after the treatment or hospitalization, accompanied by full particulars.
Is the Optima Wellbeing add-on available for all sum insured options in the HDFC ERGO Optima Restore policy?
Yes, the Optima Wellbeing add-on is available as an optional benefit for all sum insured options in the HDFC ERGO Optima Restore policy.
What is the role of the air ambulance provider in the Emergency Air Ambulance Cover under the HDFC ERGO Optima Restore policy?
The role of the air ambulance provider in the Emergency Air Ambulance Cover under the HDFC ERGO Optima Restore policy is to be registered in India and provide ambulance transportation in an airplane or helicopter subject to the maximum limit prescribed for emergency life-threatening health conditions.
What characteristics define a chronic condition in the HDFC ERGO Optima Restore policy?
A chronic condition is defined by characteristics such as needing ongoing or long-term monitoring, control or relief of symptoms, requiring rehabilitation or special training to cope with it, continuing indefinitely, or recurring.
Is the cost of an arm sling covered under the HDFC ERGO Optima Restore policy?
No, the cost of an arm sling is not covered under the HDFC ERGO Optima Restore policy.
How does the HDFC ERGO Optima Restore policy handle pre-existing diseases after the expiry of the waiting period?
Coverage for pre-existing diseases after the expiry of the 36-month waiting period is subject to the condition that the disease was declared at the time of application and accepted by the insurer.
What is the significance of the UIN in the HDFC ERGO Optima Restore policy?
The UIN (Unique Identification Number) in the HDFC ERGO Optima Restore policy, which is HLT/IPO21V042425, is significant as it uniquely identifies the specific insurance product. It helps in distinguishing the policy from other products and ensures that the policyholder is referring to the correct policy document.
What should be done if an insured person needs to send a notice to HDFC ERGO under the Optima Restore policy?
If an insured person needs to send a notice to HDFC ERGO under the Optima Restore policy, it should be delivered in writing to the address specified in the Schedule. No insurance agents, brokers, or other entities are authorized to receive any notice on behalf of HDFC ERGO.
Are treatments for external congenital diseases covered under the HDFC ERGO Optima Restore policy?
No, treatments for external congenital diseases, defects, or anomalies are not covered under the HDFC ERGO Optima Restore policy.
What is the definition of Permanent Paralysis of Limbs in the HDFC ERGO Optima Restore policy?
Permanent Paralysis of Limbs in the HDFC ERGO Optima Restore policy is defined as the total and irreversible loss of use of two or more limbs due to injury or disease of the brain or spinal cord. A specialist Medical Practitioner must opine that the paralysis will be permanent with no hope of recovery, and it must be present for more than 3 months.
What is the minimum number of in-patient beds required for a hospital in towns with a population of less than 10,00,000 under the HDFC ERGO Optima Restore policy?
The minimum number of in-patient beds required for a hospital in towns with a population of less than 10,00,000 is 10 beds.
What is the role of a fully equipped operation theatre in a Day Care Centre under the HDFC ERGO Optima Restore policy?
A fully equipped operation theatre is essential in a Day Care Centre as it allows for surgical procedures to be carried out, which is a requirement for the centre to be recognized under the policy.
What is the importance of a fully equipped operation theatre in a hospital under the HDFC ERGO Optima Restore policy?
A fully equipped operation theatre is important as it is a requirement for a hospital to be recognized under the HDFC ERGO Optima Restore policy, ensuring that surgical procedures can be carried out.
What is the customer care contact number for HDFC ERGO Optima Restore policy?
The customer care contact numbers for HDFC ERGO Optima Restore policy are 022 6234 6234 and 0120 6234 6234.
What is the coverage for Day Care Procedures under the HDFC ERGO Optima Restore policy?
Day Care Procedures are covered under the HDFC ERGO Optima Restore policy.
What is meant by 'Portability' in the context of the HDFC ERGO Optima Restore policy?
Portability in the HDFC ERGO Optima Restore policy refers to the facility that allows health insurance policyholders to transfer credits gained for pre-existing diseases and specific waiting periods from one insurer to another. This ensures continuity of benefits when switching insurers.
How can grievances be redressed under the HDFC ERGO Optima Restore policy?
Grievances can be redressed by contacting HDFC ERGO through their website, email, customer care numbers, fax, or by visiting any branch office. If not satisfied, the insured person may contact the grievance officer or approach the Insurance Ombudsman as per the HDFC ERGO Optima Restore policy.
Are day care procedures covered in the HDFC ERGO Optima Restore policy?
Yes, day care procedures are covered under the HDFC ERGO Optima Restore policy.
Can the restore benefit be used for the same illness in the HDFC ERGO Optima Restore policy?
No, the restore benefit cannot be used for the same illness in the HDFC ERGO Optima Restore policy.
Are pulse oximeter charges covered under the HDFC ERGO Optima Restore policy?
Yes, pulse oximeter charges are covered under the HDFC ERGO Optima Restore policy.
What is the procedure for submitting a claim for medical examinations under the HDFC ERGO Optima Restore policy?
To submit a claim for medical examinations under the HDFC ERGO Optima Restore policy, the insured person may be required to undergo an examination by the insurer's authorized medical practitioner, and the insurer will bear the cost.
What is the maximum number of times the Unlimited Restore Benefit can be utilized in a policy year under the HDFC ERGO Optima Restore policy?
The Unlimited Restore Benefit can be utilized unlimited times for all subsequent claims in a policy year under the HDFC ERGO Optima Restore policy.
Are admission kit charges subsumed into room charges under the HDFC ERGO Optima Restore policy?
Yes, admission kit charges are subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II.
Is organ donor treatment covered in the HDFC ERGO Optima Restore policy?
Yes, organ donor treatment is covered under the HDFC ERGO Optima Restore policy.
What is the maximum amount covered for ambulance expenses under the HDFC ERGO Optima Restore policy?
The maximum amount covered for ambulance expenses is Rs. 2000 per hospitalisation.
Are baby charges subsumed into room charges under the HDFC ERGO Optima Restore policy?
Yes, baby charges, unless specified or indicated, are subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II.
What is the policy on renewal of the HDFC ERGO Optima Restore policy if the insured person has multiple policies and the claim amount exceeds the sum insured under a single policy?
If the claim amount exceeds the sum insured under a single policy, the insured person has the right to choose the insurer from whom they want to claim the balance amount under the HDFC ERGO Optima Restore policy.
What does 'Condition Precedent' mean in the HDFC ERGO Optima Restore policy?
In the HDFC ERGO Optima Restore policy, 'Condition Precedent' refers to a policy term or condition upon which the insurer's liability under the policy is conditional upon. This means that certain conditions must be met for the insurer to be liable for claims.
What is the definition of an Intensive Care Unit (ICU) according to the HDFC ERGO Optima Restore policy?
According to the HDFC ERGO Optima Restore policy, an Intensive Care Unit (ICU) is an identified section, ward, or wing of a hospital under the constant supervision of a dedicated medical practitioner(s). It is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition or require life support facilities. The level of care and supervision in an ICU is considerably more sophisticated and intensive than in ordinary and other wards.
What is the IRDAI registration number of HDFC ERGO General Insurance Company Limited?
The IRDAI registration number of HDFC ERGO General Insurance Company Limited is 146.
Are gloves covered under the HDFC ERGO Optima Restore policy?
No, gloves are not covered under the HDFC ERGO Optima Restore policy.
Are assisted reproduction services covered under the HDFC ERGO Optima Restore policy?
No, assisted reproduction services, including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, and ICSI, are not covered under the HDFC ERGO Optima Restore policy.
Are outpatient benefits covered under the HDFC ERGO Optima Restore policy?
Yes, outpatient benefits are covered under the Optima Wellbeing add-on in the HDFC ERGO Optima Restore policy.
What are pre-hospitalization medical expenses according to the HDFC ERGO Optima Restore policy?
Pre-hospitalization medical expenses, as per the HDFC ERGO Optima Restore policy, are the medical expenses incurred during the predefined number of days preceding the hospitalization of the insured person. These expenses must be for the same condition for which the insured person's hospitalization was required, and the in-patient hospitalization claim for such hospitalization must be admissible by the insurance company.
How is the 'Policy Period' determined in the HDFC ERGO Optima Restore policy?
The 'Policy Period' in the HDFC ERGO Optima Restore policy is determined by the period between the Commencement Date and the Expiry Date specified in the Schedule.
What is the contact email for the Insurance Ombudsman office in Chandigarh for the HDFC ERGO Optima Restore policy?
The contact email for the Insurance Ombudsman office in Chandigarh for the HDFC ERGO Optima Restore policy is bimalokpal.chandigarh@cioins.co.in.
Where is the office of the Insurance Ombudsman located in Chandigarh for the HDFC ERGO Optima Restore policy?
The office of the Insurance Ombudsman in Chandigarh for the HDFC ERGO Optima Restore policy is located at Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017. The contact number is 0172-2706468 and the email is bimalokpal.chandigarh@cioins.co.in.
What is the significance of the policy schedule in the Unlimited Restore Benefit under the HDFC ERGO Optima Restore policy?
The policy schedule is not directly related to the Unlimited Restore Benefit under the HDFC ERGO Optima Restore policy. The Unlimited Restore Benefit is an optional cover that provides an instant addition of 100% Basic Sum Insured on complete or partial utilization of your Restore benefit or Unlimited Restore benefit (as applicable) during the policy year.
What is the role of the insurer's authorized medical practitioner in the HDFC ERGO Optima Restore policy?
The insurer's authorized medical practitioner in the HDFC ERGO Optima Restore policy provides an independent opinion for processing claims, ensuring that the insured person's medical examination is conducted fairly and accurately.
What is the basic sum insured per person per policy year in the HDFC ERGO Optima Restore policy?
The basic sum insured per person per policy year in the HDFC ERGO Optima Restore policy ranges from Rs. 3.00 lakh to Rs. 100.00 lakh.
What is the procedure for notifying the insurer about a claim under the HDFC ERGO Optima Restore policy?
To notify the insurer about a claim under the HDFC ERGO Optima Restore policy, the insured person or someone on their behalf must provide documentation, medical records, and information within 15 days of the insurer's request or discharge from hospitalization.
Is preventive health checkup covered under the HDFC ERGO Optima Restore policy?
Preventive health checkup is not applicable for the lowest sum insured option but is covered up to Rs. 1,500 to Rs. 5,000 for higher sum insured options.
Can you explain the 'Cumulative Bonus (Multiplier Benefit)' in the HDFC ERGO Optima Restore policy?
The 'Cumulative Bonus (Multiplier Benefit)' in the HDFC ERGO Optima Restore policy refers to any increase in the Sum Insured granted by the insurer without an associated increase in premium. This means that the policyholder can benefit from a higher coverage amount without paying extra premium.
What is the maximum amount payable for a Preventive Health Check-up under the 5 Lacs plan in the HDFC ERGO Optima Restore policy?
Under the 5 Lacs plan in the HDFC ERGO Optima Restore policy, the maximum amount payable for a Preventive Health Check-up is up to Rs. 2,000 per insured person at the end of each year at renewal.
What is the role of a specialist Medical Practitioner in confirming the diagnosis of Kidney Failure requiring Regular Dialysis in the HDFC ERGO Optima Restore policy?
In the HDFC ERGO Optima Restore policy, a specialist Medical Practitioner plays a crucial role in confirming the diagnosis of Kidney Failure requiring Regular Dialysis. The diagnosis must be confirmed by a specialist to validate the claim, ensuring that the condition is chronic and irreversible, necessitating regular renal dialysis or transplantation.
What is the standard waiting period for illnesses and treatments under the HDFC Ergo Optima Restore policy?
All illnesses and treatments are covered subject to a 30-day waiting period from the first policy commencement date, except for claims arising due to an accident.
What happens to the subsequent premium installments in the event of a claim under the HDFC ERGO Optima Restore policy?
In the event of a claim, all subsequent premium installments shall immediately become due and payable under the HDFC ERGO Optima Restore policy.
What is the email address for the Insurance Ombudsman office in Delhi for HDFC ERGO Optima Restore policy?
The email address for the Insurance Ombudsman office in Delhi is bimalokpal.delhi@cioins.co.in.
What is the 'Rehabilitation' benefit in the HDFC ERGO Optima Restore policy?
The 'Rehabilitation' benefit in the HDFC ERGO Optima Restore policy provides coverage for expenses related to rehabilitation therapies following an illness or injury, as per the policy terms.
What is the condition for the Aggregate Deductible to be applicable in the HDFC ERGO Optima Restore policy?
The Aggregate Deductible is applicable on an annual aggregate basis and can be opted only at inception of the Policy or at subsequent Renewals in the HDFC ERGO Optima Restore policy.
What is the company's responsibility if a claim is made during the Free Look Period?
If a claim is made during the Free Look Period, the company's responsibility is to process the claim as per the policy terms, and the insured is not entitled to a refund of the premium paid.
What is the refund percentage for canceling the HDFC ERGO Optima Restore policy up to 6 months?
For canceling the HDFC ERGO Optima Restore policy up to 6 months, the refund percentage is 70.0%.
What is the role of a fully equipped operation theatre in a hospital under the HDFC ERGO Optima Restore policy?
A fully equipped operation theatre allows for surgical procedures, ensuring that the hospital meets the policy's criteria for providing comprehensive in-patient and day care treatment.
What is the significance of the exclusions related to In-patient Benefits in the HDFC ERGO Optima Restore policy?
The significance of the exclusions related to In-patient Benefits in the HDFC ERGO Optima Restore policy is that they outline specific conditions under which the policy will not cover expenses, ensuring clarity and helping policyholders understand the limitations of their coverage.
Is there an unlimited restore benefit option in the HDFC ERGO Optima Restore policy?
Yes, there is an optional unlimited restore benefit available if opted for.
How is Dental Treatment defined in the HDFC ERGO Optima Restore policy?
Dental Treatment refers to treatment related to teeth or structures supporting teeth, including examinations, fillings, crowns, extractions, and surgery.
What is the discount percentage for the time interval of 541-630 days for the step count range of 8001 to 10000 in the HDFC ERGO Optima Restore policy?
The discount percentage for the time interval of 541-630 days for the step count range of 8001 to 10000 in the HDFC ERGO Optima Restore policy is 0.41667%.
Are there any specific exclusions that apply to the HDFC ERGO Optima Restore policy?
Yes, any specific time-bound or lifetime exclusions applied by the insurer and specified in the schedule are not covered.
What is the time interval for calculating the discount in a 2-year policy under the HDFC ERGO Optima Restore plan?
The time interval for calculating the discount in a 2-year policy under the HDFC ERGO Optima Restore plan is divided into 91-180 days, 181-270 days, 271-360 days, 361-450 days, 451-540 days, 541-630 days, and 631-660 days.
What is the Unlimited Restore Benefit for the 5th claim in the HDFC ERGO Optima Restore policy?
The Unlimited Restore Benefit for the 5th claim in the HDFC ERGO Optima Restore policy is 5,00,000.
What happens if an insured person actively conceals a fact under the HDFC ERGO Optima Restore policy?
If an insured person actively conceals a fact, it is considered fraudulent. However, the company will not repudiate the claim or forfeit the policy benefits if the insured person can prove that the misstatement was true to the best of their knowledge and there was no deliberate intention to suppress the fact.
What long-term policy discounts are available under HDFC ERGO Optima Restore policy?
If the policy period is more than one year, a discount of 7.5% is offered for a 2-year tenure and 10% for a 3-year tenure, provided the premium is paid in advance as a single premium under the HDFC ERGO Optima Restore policy.
What is the CIN for HDFC ERGO General Insurance Company Limited?
The CIN for HDFC ERGO General Insurance Company Limited is U66030MH2007PLC177117.
What is the significance of the 'Sum Insured' in the HDFC ERGO Optima Restore policy?
The 'Sum Insured' in the HDFC ERGO Optima Restore policy represents the maximum amount that the insurance company will cover for the insured persons under the policy, subject to its terms, conditions, and exclusions.
What is the policy on renewal of the HDFC ERGO Optima Restore policy if the insured person has multiple policies covering the same risk?
If the insured person has multiple policies covering the same risk on an indemnity basis, they shall only be indemnified for the treatment costs in accordance with the terms and conditions of the chosen policy under the HDFC ERGO Optima Restore policy.
Does the HDFC ERGO Optima Restore policy cover alcohol swabs and scrub solution/sterillium charges?
Yes, alcohol swabs and scrub solution/sterillium charges are covered under the HDFC ERGO Optima Restore policy.
Who is covered under the HDFC ERGO Optima Restore policy?
Only those persons named as Insured Persons in the Schedule are covered under the HDFC ERGO Optima Restore policy. Additional eligible persons may be added during the policy period after acceptance and payment of additional premium.
Are expenses for investigations covered under post-hospitalisation under the HDFC ERGO Optima Restore policy?
Yes, expenses for investigations are covered under post-hospitalisation up to 180 days after discharge from the hospital.
What is the maximum amount a single claim can reach in a Policy Year under the HDFC ERGO Optima Restore policy?
A single claim in a Policy Year cannot exceed the sum of Basic Sum Insured and the Multiplier Benefit, if applicable, under the HDFC ERGO Optima Restore policy.
What is the maximum discount percentage for a 3-year policy in the HDFC ERGO Optima Restore plan?
The maximum discount percentage for a 3-year policy in the HDFC ERGO Optima Restore plan is 8%.
What is the policy on the renewal of policies with grace period under the HDFC ERGO Optima Restore policy?
The company shall condone a delay in renewal up to the grace period from the due date of renewal without considering such condonation as a break in policy.
Are glucometer and strips charges covered under the HDFC ERGO Optima Restore policy?
Yes, glucometer and strips charges are covered under the HDFC ERGO Optima Restore policy.
Does the application of loading mean that the illness/condition is covered from inception under the HDFC ERGO Optima Restore policy?
No, the application of loading does not mean that the illness/condition is covered from inception. Any waiting period as mentioned in the policy will be applied as applicable.
Is the cost of a sputum cup subsumed into room charges under the HDFC ERGO Optima Restore policy?
Yes, the cost of a sputum cup is subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II.
What is the role of the insured person's critical illness in the E-opinion benefit under the HDFC ERGO Optima Restore policy?
The insured person must suffer a critical illness during the policy period for the E-opinion benefit to be applicable under the HDFC ERGO Optima Restore policy.
Does the HDFC ERGO Optima Restore policy cover unproven treatments?
No, the HDFC ERGO Optima Restore policy does not cover expenses related to any unproven treatment, services, and supplies. Unproven treatments are those that lack significant medical documentation to support their effectiveness.
What is the process for submitting prescriptions for claims under the HDFC ERGO Optima Restore policy?
For claims under the HDFC ERGO Optima Restore policy, prescriptions must be submitted with the corresponding doctor's invoice, naming the insured person, listing the drugs prescribed, their price, and including a receipt for payment.
Which areas does the Insurance Ombudsman in Kolkata cover for HDFC ERGO Optima Restore policy?
The Insurance Ombudsman in Kolkata covers West Bengal, Sikkim, and the Andaman & Nicobar Islands for HDFC ERGO Optima Restore policy.
What is the CIN for HDFC ERGO General Insurance Company Limited?
The CIN for HDFC ERGO General Insurance Company Limited is U66030MH2007PLC177117.
Are email or internet charges covered under the HDFC ERGO Optima Restore policy?
No, email or internet charges are not covered under the HDFC ERGO Optima Restore policy.
What is the policy number for the HDFC ERGO Optima Restore policy?
The policy number for the HDFC ERGO Optima Restore policy is HDFHLIP20512V024225.
What is the utilization of Sum Insured for the 5th claim in the HDFC ERGO Optima Restore policy?
For the 5th claim in the HDFC ERGO Optima Restore policy, the utilization of Sum Insured is through Unlimited Restore.
What is the phone number for the Insurance Ombudsman office in Jaipur for HDFC ERGO Optima Restore policy?
The phone numbers for the Insurance Ombudsman office in Jaipur are 0141- 2740363/2740798.
How does the HDFC ERGO Optima Restore policy define OPD treatment?
The HDFC ERGO Optima Restore policy defines OPD treatment as the one where the insured visits a clinic, hospital, or associated facility like a consultation room for diagnosis and treatment based on the advice of a medical practitioner, without being admitted as a daycare or in-patient.
How is the Policy defined in the HDFC ERGO Optima Restore policy?
In the HDFC ERGO Optima Restore policy, the Policy is defined as your statements in the proposal form (which are the basis of this Policy), this policy wording (including endorsements, if any), Annexure 1, and the policy schedule (as the same may be amended from time to time).
What is the average step target required to achieve a 2% discount in a 3-year policy under the HDFC ERGO Optima Restore plan?
To achieve a 2% discount in a 3-year policy under the HDFC ERGO Optima Restore plan, the average step target should be between 5001 to 8000 steps.
What is the policy on the renewal of policies with claims experience under the HDFC ERGO Optima Restore policy?
No loading shall apply on renewals based on individual claims experience.
What is the importance of maintaining daily records in a hospital as per the HDFC ERGO Optima Restore policy?
Maintaining daily records of patients is crucial as it ensures that the hospital complies with the policy requirements and makes these records accessible to the insurance company's authorized personnel for verification and claims processing.
Can the Free Look Period be applied to renewals or porting/migrating the HDFC ERGO Optima Restore policy?
No, the Free Look Period is applicable only on new individual health insurance policies and not on renewals or at the time of porting/migrating the HDFC ERGO Optima Restore policy.
What is the time frame for submitting supporting documentation for a claim under the HDFC ERGO Optima Restore policy?
Supporting documentation for a claim under the HDFC ERGO Optima Restore policy must be provided within 15 days of the insurer's request or the insured person's discharge from hospitalization or completion of treatment.
What is the maximum amount payable for a preventive health check-up under the HDFC ERGO Optima Restore Family policy for a 15 Lacs plan?
For a 15 Lacs plan under the HDFC ERGO Optima Restore Family policy, the maximum amount payable for a preventive health check-up is Rs. 8,000 per policy at the end of each year at renewal.
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