International Travel Insurance
Voyager Group Travel Insurance
Policy Certificate Number: 173/4168/O/1400/31606/00
Powered by
ICICI Lombard General Insurance Company Limited
(A company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development
Authority of India (IRDAI) vide [Link].115)
Intermediary: PhonePe Insurance Broking Services Private Ltd. (IRDA/DB 822/20), IMD Code - 21BRG666, Phone - 022-
68727888. PhonePe Private Limited, Office -2, Floor 4, 5, 6, 7, Wing A, Block A, Salarpuria Softzone, Service Road, Green
Glen Layout, Bellandur, Bengaluru, Karnataka - 560103 Master Policy Number: 4168/O-PIBSPL/280286903/00/001,UIN:
ICITGBP22095V032122, CIN: L67200MH2000PLC129408.
Voyager Group Travel Insurance
Selected countries Number of passengers
Sri Lanka 1 Passenger(s)
Sum insured per Coverage start date Coverage end date
Policy Certificate Number
Traveller
173/4168/O/1400/31606/00 29/07/2024 01/08/2024
$ 250,000 00:00:00 23:59:59
Certificate Issue Date
28/07/2024
16:04:04
Policy Buyer's details
Premium Details
pavan kumar Dasari Net Premium Rs. 200.00
State GST Rs. 18.00
Email address
Central GST Rs. 18.00
pavankumardasari0705@[Link]
Integrated GST Rs. 0.00
Gross Premium Rs. 236.00
Who's Travelling
DASARI PAVAN KUMAR
DOB Passport No. Nominee name & relationship Medical History
07-May-2000 Y7707585 Legal Heir No medical conditions declared
Coverage Details
Hospitalisation expenses for Illness & Injury
Cover: USD 250,000 Per Traveller
Deductible: USD 100 Per Traveller (has to be borne first by the insured)
Reimbursement of expenses incurred in case of hospitalization due to illness contracted or any Injury due to an Accident during the policy period
Medical evacuation
Cover: USD 250,000 Per Traveller
Reimbursement of expenses for emergency transportation and evacuation services necessitated due to any Illness contracted or accidental
Injury sustained during the policy period.
Daily allowance in case of hospitalisation
Cover: USD 30/day; max 5 days Per Traveller
Deductible: 24 hours (has to be borne first by the insured)
Per day payout on hospitalization due to Illness contracted or any accidental Injury during the policy period
Repatriation of Remains
Cover: USD 5,000 Per Traveller
In the unfortunate event of the death of the insured, reimbursement of expenses incurred for transporting the remains of the deceased Insured
back to the Country/Place of Residence or for a local burial or cremation in the country/place where death has occurred.
Accidental Death
Cover: USD 20,000 Per Traveller
We shall pay a lump sum payout in case of death of the insured during the policy period.
Permanent Total Disability
Cover: USD 20,000 Per Traveller
We shall pay a lump sum payout in case of Permanent total disability of the insured during the policy period.
Permanent Partial Disability
Cover: USD 20,000 Per Traveller
We shall pay a lump sum payout in case of Permanent Partial disability of the insured during the policy period.
Loss of Checked-in Baggage
Cover: USD 500 Per Traveller
Pro-rated payout for pieces of baggage permanently lost whilst under the custody of common carrier vis-a-vis pieces of baggage that were
checked-in.
Delay of Checked-in Baggage
Cover: USD 100 Per Traveller
Deductible: 12 hours (has to be borne first by the insured)
Fixed payout in case the checked-in baggage is delayed beyond the period specified in policy certificate
Loss of Passport
Cover: USD 200 Per Traveller
A fixed benefit amount shall be given to the Insured is he/she loses or damages their original Passport
Personal Liability
Cover: USD 100,000 Per Traveller
Deductible: 5% Copay (has to be borne first by the insured)
Reimbursement of expenses towards payment of legal liability to a third party during the covered trip arising out of accidental death, bodily injury
or property damages to third party
Common Carrier/Public Carrier Delay
Cover: USD 250 Per Traveller
Deductible: 6 hours (has to be borne first by the insured)
We shall pay a fixed payout in case of a delay in departure of the scheduled Common Carrier
Trip Cancellation
Cover: USD 500 Per Traveller
Indemnification for financial loss (travel and accommodation) incurred on cancellation of trip due to unexpected events e.g. sickness, natural
calamities, terrorist attack etc.
Trip Interruption or Curtailment
Cover: USD 500 Per Traveller
Indemnification for the financial loss incurred in case your trip is interrupted and/or you need to curtail your trip due to unexpected events beyond
your control.
Missed Flight Connection
Cover: USD 500 Per Traveller
Deductible: 6 hours (has to be borne first by the insured)
We shall reimburse for official cancellation charges and additional cost incurred to proceed with your planned trip in case you fail to access a
connecting flight or connecting Common Carrier due to a delayed arrival of the previous Common Carrier
Home Burglary Insurance
Cover: INR 100,000 Per Traveller
Indemnification for financial loss or damage due to burglary/attempted burglary at your residence while you are on a covered trip
Hijack Distress Compensation
Cover: USD 50 per day, max upto 7 days Per Traveller
Deductible: 12 hours (has to be borne first by the insured)
Per day payout payable in the event of an Hijack of the Common Carrier/Public Carrier in which the insured is travelling as a fare paying
passenger.
Fire and Allied Perils (Home Building & Contents)
Cover: INR 300,000 Per Traveller
Indemnification for financial loss or damage due to specific perils at your residence during the policy period.
Financial Emergency Cash Allowance
Cover: USD 500 Per Traveller
Lump sum payout in case you are left with no travel funds following an incident of theft, robbery, larceny etc. during the policy period.
Compassionate Visit
Cover: USD 750 Per Traveller
Deductible: 5 days of hospitalization (has to be borne first by the insured)
Reimbursement of Cost of visit (travel and accommodation) of a family member/friend to the insured's place of hospitalization for a specified
duration if deemed necessary by the treating medical practitioner.
Bounced Bookings of Airlines or Hotel
Cover: USD 500 Per Traveller
Deductible: USD 250 Per Traveller (has to be borne first by the insured)
Reimbursement of additional expenses incurred for alternative arrangements respectively in the event of bounced booking of the confirmed
Common Carrier/Public Carrier and/or confirmed pre-paid accommodation.
Loss of Baggage and Personal Effects
Cover: USD 1,000 Per Traveller
Deductible: USD 100 Per Traveller (has to be borne first by the insured)
Reimbursement for loss of your baggage and personal effects due to theft, burglary, larceny, robbery, hold-up or any such similar events during
the policy period.
Escort of Minor Children
Cover: USD 2,500 Per Traveller
Deductible: 5 days of hospitalization (has to be borne first by the insured)
Reimbursement of expenses towards arranging the return of minor child back to city of residence in the unfortunate event of the insured's death
or hospitalization for a specified duration while on a covered trip.
Declaration
I, on behalf of all the insured [as stated by me], understand that this policy has been issued, purely
based on the information vis-??-vis declaration, as provided by me to the Group Organiser . I, further
understand that the policy shall not be valid from its inception [void ab initio], if any of such information
provided by me,is found to be incorrect. I fully understand that this policy shall not cover any pre-existing
medical condition(s)/injury(ies)/illness(es)/deformity(ies), complication(s) and likewise, arising from
them, whether declared or undeclared.
Terms and conditions
1. Proposed rates are for a single trip policy with max trip duration of 180 days.
2. The policy is valid only for the customers of "PhonePe" who travel from India to Overseas only.
3. The Person should be between 1 to 70 yrs of age and should hold a valid bank account in India
4. Any claim due to or arising out of pre-existing medical condition/ailment whether declared or undeclared is not covered
under the policy.
5. Limit of covered expenses
Sub-limit A - For policies with sum insured over US$ 100,000, the benefit of medical expenses is restricted to US$ 100,000
per sickness or accident leading to one or more hospitalizations. Other conditions applicable as per the policy wordings.
Sub-limit B - For persons aged 51 years and above, following limits are applicable on any one Illness and/or Injury
Hospital room and boarding: Maximum USD 1800/day upto 30 days
Intensive care unit: Maximum USD 3250/day upto 7 days
Surgery: Maximum upto USD 15,000
Anaesthetist services: Upto 25% of surgical treatment
Medical practitioner???s visit fees: Max USD 100/day upto 10 visits
Diagnostic services: maximum upto USD 1000
Ambulance services: maximum upto USD 500
Misc expenses: maximum upto USD 2000
Important notes
1. Insurance cover will start only on receipt of full premium stated in PART I of the Policy Schedule by ICICI Lombard General
Insurance Company Limited.
2. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate.
3. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical
installations on high tension lines unless otherwise covered and stated in the Policy Schedule.
4. Major exclusions: Intentional self-injury, suicide or attempted suicide whilst under the influence of intoxicating liquor or drugs,
any loss arising from an act of breach of law with or without criminal intent. Please refer to the Policy wordings for a
complete list of exclusions.
Detailed Policy wordings
Detailed policy wording can be found here
Assistance
For any endorsements such as name correction or change in nominee details, you can contact us at Toll Free Number 1800-
2666 or Email us at customersupport@[Link] or visit our nearest branch.
In USA & Canada (Toll Free): +1 844 871 1200;
Rest of The World (Call Back Facility): +91 124 449 8778
National Toll Free Number: 1800 102 5721
Fax Number: +91 124 4006674
Email Address: icicilombard@[Link]
This is an electronically generated document and does not require a [Link] stamp duty of Rs.1.00 has been paid in cash or by demand draft or by
pay order, vide Receipt/Challan no. CSD45120223802 dated 05/09/2022.