IMPORTANT
To,
syam prasad tamuku,
H.No 6-45-2
Gangamitta Street
Gummidipoondi,Thiruvallur,Tamil Nadu-601201
Mobile : 9666698979.
Dear Customer,
Re: Health Insurance Policy - P/700002/01/2019/035256
We are extremely thankful for availing health insurance from us and we enclose the policy along with the terms and
conditions.
The said policy has been prepared based on the details furnished by you in the proposal form (copy enclosed) and
the medical reports, wherever applicable. We shall thank you if you can verify the policy to ensure that all the details
are incorporated correctly as per the proposal. In case of any discrepancy noticed, please communicate the same to
us immediately. You will appreciate that it is the primary duty of the proposer to fill the proposal form and also to
make sure that the proposal contains all the details correctly so also the policy has incorporated the details correctly.
This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in
this policy. If there is suppression of any material fact in the proposal, the contract shall become null and void ab
initio.
We would like to mention that we have incorporated the name of the intermediary as indicated by you in the proposal
who will be of assistance to you.
The policy is subject to the condition of "free look period". As per this condition, a free look period of 15 days from
the date of receipt of the policy is available to you to review the terms and conditions of the policy. In case you are
not satisfied with the terms and conditions, you may seek cancellation of the policy and in such an event, we shall
allow refund of premium paid after adjusting the cost of pre-acceptance medical screening, if any, stamp duty
charges, and proportionate risk premium for the period on cover, provided no claim has been made until such
cancellation.
We wish you good health and we look forward to serve you in the days to come.
With kind regards,
Authorised Signatory
In case of a need for hospitalization, kindly prefer our network hospital (list is available in our website) for a quick
response to your claim request. Please stay in eligible room as stated in the policy, to avoid payment of
proportionate increased charges claimed by the hospitals, from your hand.
Sum insured of this Policy is meant for utilization till its expiry. Bearing this aspect in mind, we have no doubt, you
will choose appropriate hospital, room rent and treatment charges, etc.
Should you need any assistance, our customer care will be delighted to assist you, whose toll free no. is 1800-4252255/1800-102-4477.
However, the ultimate decision will be that of yours only.
PVS
Lakshmiprasad
CN=PVS Lakshmiprasad,
SERIALNUMBER=9e461d073974cff564ee9ba39dcb9f6c1b1fe484d
e3bff77fe99ff653e852cf9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=3fbc716070e67ba3c9fed3530e1e3d7e9732722433b0
b08c8ac802f047aae330, OU=Technical, O=STAR HEALTH AND
ALLIED INSURANCE COMPANY LIMITED, C=IN. Date :Sun Jan
20 14:29:34 IST 2019
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-4252255 / 1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
Family Health Optima Insurance Plan
Unique Identification No. IRDAI/HLT/SHAI/P-H/V.III/129/2017-18
Policy Schedule
Policy No.
: P/700002/01/2019/035256
Customer Code : AA0008107561
Customer Name : syam prasad tamuku
Previous Policy No.
:
GSTIN
SAC Code
: 27AAJCS4517L1ZY
: 997133/Accident and Health Insurance Services
Proposer Code
Proposer Name
Issuing Office Code
: 700002
Issuing Office Name
Address
: Online Business
: 349 Business Point, Unit No.204 / 205,2nd
Floor, Near Sai Service,
Western Express Highway,
Andheri (E), Mumbai -400069
Tel/Mobile
E-mail id
: 1800-425-2255
: online@starhealth.in
Place of Supply
:
Address
: 10549059
: syam prasad tamuku
: H.No 6-45-2
Gangamitta Street
Gummidipoondi,Thiruvallur,Tamil
Nadu-601201
Tel/Mobile
E-mail id
: 9666698979/9666698979/
: t_syamprasad@live.com
Proposer GSTIN : : 19/01/2019
Proposal date
Date of Inception of first policy
:
Renewal Year
:
19-JAN-19
Intermediary Code
NEW
Receipt No & Date :
1272037931 & 18/01/2019
: Rs 9571 /Premium
IGST @18% : Rs 1,723 /Total Premium : Rs 11294 /Total Premium In Words
: SO700002
Fulfiller Code
Stamp Duty : Re 1 /-
:
Name
:
Direct
Tel/Mobile
:
/
E-mail id
:
OL0000000001
: Rupees Eleven Thousand Two Hundred Ninety Four Only
Period of insurance
: From : 19/01/2019 01:50:56
Basic Floater Sum Insured : 300000
In words : Rupees: Three Lakhs Only
Limit of Coverage : Rs. 300000
Bonus: Rs. 0
To : Midnight of 18/01/2020
Scheme Description : 2A+2C
Recharge Benefit : Rs. 75000
Details of Insured Persons :
Sl.
No.
Name of the Insured
Gender
Date of Birth
Age in
Yrs
Relationship
with Proposer
ID Card No
Pre-existing Disease
Inception Date
1
syam prasad tamuku
M
19/05/1975
43
SELF
10549059-1
No PED declared
19/01/2019
2
T LAVANYA
F
01/01/1976
43
SPOUSE
10549059-2
No PED declared
19/01/2019
3
T JOICE PRANAMIKA
F
30/08/2003
15
DEPENDANT
CHILD
10549059-3
No PED declared
19/01/2019
4
T SRUTHIKA
F
15/07/2006
12
DEPENDANT
CHILD
10549059-4
No PED declared
19/01/2019
Nominee Details
Appointee Details
Nominee Details for the proposer
S.No.
Name
Relationship
with proposer
Age
% of
the
claim
1
T LAVANYA
Spouse
41
100
Entered By
Appointee
Name
Age
Relationship
with Nominee
For Star Health and Allied Insurance Company Ltd.
: STAR_PORTAL
IRDAI Regn. No 129
Corporate Identity Number U66010TN2005PLC056649
Email ID : support@starhealth.in
Authorised Signatory
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 /
1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
2
of 6
Attached to and forming part of Policy No.
P/700002/01/2019/035256
Sector Classification
Urban
Please check whether the details given by you about the insured persons in the proposal form are incorporated correctly in the policy schedule. If
you find any discrepancy, please inform us within 15 days from the date of receipt of the policy, failing which the details relating
to the insured person given in the policy schedule are deemed to have been accepted by you.
Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio
(from inception).
Condition No. 3 regarding delay in payment of claim shall read as follows and not as stated in policy wordings:
"The Company shall pay interest as per Insurance Regulatory and Development Authority of India (Protection of Policyholders' Interests)
Regulations, 2017, in case of delay in payment of an admitted claim under the Policy"
THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC., ATTACHED.
Important
In the event of hospitalization of insured person, intimation should be given to the Company immediately, however, within 24 hrs from the time of
admission.
Toll Free No : 1800 425 2255 / 1800 102 4477
Email: support@starhealth.in, Fax No: 1800 425 5522 .
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Online Business on 19th Day of
January 2019.
Entered By
For Star Health and Allied Insurance Company Ltd.
: STAR_PORTAL
Authorised Signatory
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 /
1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
3
of 6
Star Health and Allied Insurance
Company Limited
Emergency Help Line No. 1800 425 2255 / 1800 102 4477
e-mail : support@starhealth.in Website : www.starhealth.in
Customer Identity Card
Please quote the Customer Id No. for assistance
Customer ID No.
This Card is valid until otherwise Cancelled.
This ID Card is invalid, if the insurance cover is not in force.
Immediate intimation to 'Star' through above Tel Nos. is a must
in case of Hospitalisation.
At the time of hospitalization, kindly submit any Government
Name : syam prasad tamuku
Date Of Birth
Gender
Star Health and Allied Insurance
Company Limited
Customer Identity Card
Customer Identity Card
Customer ID No.
: 10549059-2
: 10549059-3
Name : T JOICE PRANAMIKA
Name : T LAVANYA
: 01-JAN-76
: Female
: 43 Years
IRDAI Regn. No:129
Star Health and Allied Insurance
Company Limited
Gender
Age
Office Code : 700002
Agent/Broker/TE Code : OL0000000001
Corporate
Identity
Number:
For Free
Medical
Advice
Call U66010TN2005PLC056649
Date Of Birth
: 19-MAY-75
: Male
Valid From : 19-JAN-19 TA/SSM/SM Code : SO700002
approved photo ID Card.
Customer ID No.
: 10549059-1
Age
Date Of Birth
: 43 Years
Gender
Office Code : 700002
: 30-AUG-03
: Female
Age
: 15 Years
Office Code : 700002
Valid From : 19-JAN-19 TA/SSM/SM Code : SO700002
Valid From : 19-JAN-19 TA/SSM/SM Code : SO700002
Agent/Broker/TE Code : OL0000000001
Agent/Broker/TE Code : OL0000000001
IRDAI Regn. No:129
IRDAI Regn. No:129
Star Health and Allied Insurance
Company Limited
Customer Identity Card
Customer ID No.
: 10549059-4
Name : T SRUTHIKA
Date Of Birth
Gender
: 15-JUL-06
: Female
Age
: 12 Years
Office Code : 700002
Valid From : 19-JAN-19 TA/SSM/SM Code : SO700002
Agent/Broker/TE Code : OL0000000001
IRDAI Regn. No:129
*This is a temporary ID card issued along with the policy. Original ID cards will be dispatched shortly.
Entered By
For Star Health and Allied Insurance Company Ltd.
: STAR_PORTAL
Authorised Signatory
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 /
1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
4
of 6
TAX Invoice
Invoice No.
27J272Y19P003474
Customer ID
Invoice Date
19/01/19
Policy No
AA0008107561
P/700002/01/2019/035256
Supplier
Recipient
:
-
GSTIN
:
27AAJCS4517L1ZY
Proposer Name
:
syam prasad tamuku
NAME
:
Star Health and Allied Insurance Co Ltd
- Online Business
Address
:
H.No 6-45-2
Gangamitta Street
Tel/Mobile
:
349 Business Point, Unit No.204 /
205,2nd Floor, Near Sai Service,
Western Express Highway,
Andheri (E), Mumbai -400069
City
:
Gummidipoondi,Thiruvallur,Tamil
Nadu-601201
City
:
ONLINE BUSINESS
State
:
Tamil Nadu
State
:
Maharashtra
Pincode
:
601201
Pincode
:
400069
Client Category
:
IND
Place of Supply
:
27 - Maharashtra
GSTIN
HSN /
SAC
Code
Description of
Service(s)
Total
Discount
A
B
997133
Insurance Services
10075
504
TaxableValue IGST @ 18% CGST @9%
C=A-B
9571
1723
Total Invoice Value (in Figures)
:
Rs. 11294
Total Invoice Value (in Words)
:
Rupees: Eleven thousand two
hundred ninety-four only
Amount of Tax Subject to reverse Charge :
D = C * IGST
E=C
*CGST
UT/SGST@9% Total Invoice Value
F = C *UTGST
or SGST
H = C + D + E+
F
Rs. 11294
No
Important Note:
The invoice is issued as per Section 31 of the CGST Act
In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Star Health and Allied Insurance Co Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken.
E. & O.E
This is a digitally signed document and hence no physical signature is required
IRDAI Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : stargst@starhealth.in
Entered By
For Star Health and Allied Insurance Company Ltd.
: STAR_PORTAL
Authorised Signatory
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 /
1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
5
of 6
Name Of the Product
Family Health Optima Insurance plan
Product UIN No.
IRDAI/HLT/SHAI/P-H/V.III/129/2017-18
Summary of Important Benefits
S.No
Sum Insured (in Rs.)
1,00,000 2,00,000 3,00,000 4,00,000 5,00,000
1
Room Rent (Per Day) - Up to
*Hospitalization expenses will be considered in
proportion to the eligible Room Rent
2
Surgeon, Anesthetist, Medical
Consultants, Specialist Fees
3
AnesthesiaBlood,Oxygen,Operation theatre
charges, Medicines and Drugs
4
Cataract treatment
5
Emergency Ambulance
2,000
2,000
5,000
5,000
Practitioner,
Limit Per Eye (Up to)
Refer to
Policy
clause No.
Benefit Limits (in Rs.)
Particulars of Coverage / Benefits
12,000
10,00,000 15,00,000 20,00,000
25,00,000
Single Standard A/C Room
1(A)
Actual
1(B)
Actual
1(C)
12,000
25,000
30,000
40,000
50,000
50,000
50,000
50,000
Limit Per policy period (Up to) 12,000 12,000
35,000
45,000
60,000
75,000
75,000
75,000
75,000
750
750
750
750
750
750
1,500
1,500
1,500
1,500
1,500
Limit Per hospitalization
Limit Per policy period
750
750
750
1,500
1,500
1,500
N/A
N/A
N/A
1,500
1(C)
1(D)
6
Air Ambulance
7
Pre-Hospitalization
60 days 60 days 60 days 60 days
60 days
60 days
60 days
60 days
60 days
1(F)
8
Post-Hospitalization
90 days 90 days 90 days 90 days
90 days
90 days
90 days
90 days
90 days
1(G)
9
Day Care Treatments / Procedures
10
Domiciliary Hospitalization
11
Organ Donor Expenses (per policy period)
12
Cost of Health Checkup (Available after every claim
free year) Up to
N/A
13
Coverage for New Born Baby
10% of the Sum Insured or maximum of Rs.50,000/- whichever is less in a policy year (Available
if the mother is covered under the policy for a continuous period of 12 months)
14
Emergency Domestic Medical Evacuation
(Per Hospitalization) Up to
5,000
5,000
5,000
5,000
7,500
7,500
7,500
10,000
10,000
1(L)
15
Compassionate Travel Up to
N/A
N/A
N/A
N/A
N/A
5,000
5,000
5,000
5,000
1(M)
16
Repatriation of Mortal Remains (Per Policy Period)
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
1(N)
17
Treatment in Preferred
(Lum-sum benefit)
18
Shared Accommodation ( BenefitAmount Per Day)
19
AYUSH Treatment (Ayurveda, Unani, siddha and
Homeopathy Systems of medicines) Up to
20
Second Medical Opinion
21
Assisted Reproduction Treatment (Limit for every
block of 36 months and payable on renewal)
N/A
N/A
23
Automatic Restoration of Sum Insured
N/A
N/A
24
Additional Sum Insured for Road Traffic Accident
(Once in a Policy Period)
Network
N/A
Covered up to 10% of the Sum Insured per policy period
1
All Day Care Procedures
1(H)
Covered for a period exceeding three days
10% of the Sum insured subject to maximum of Rs.1,00,000/-whichever is less
Hospitals
N/A
1,000
750
1,500
2,000
2,500
3,000
1(I)
3,500
1% of the Sum Insured subject to a maximum of Rs.5,000/- is payable per policy period
N/A
10,000
N/A
800
10,000 10,000
1(J)
1(K)
1(O)
800
800
800
800
1,000
1,000
1(P)
10,000
15,000
15,000
15,000
20,000
20,000
1(Q)
Available from a Doctor in the Company's network of medical practitioners,Mail:"e-medicalopinion@
starhealth.in"
N/A
1(E)
N/A
1,00,000
2,00,000
2,00,000
2,00,000
2,00,000
Available for three times per policy period and 100% of the Sum Insured at
each time
25% of the Sum Insured subject to a maximum of 5,00,000
1(R)
1(S)
1 (T)
1(V)
N/A = Benefits not available to the respective Sum Insured.
Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.
Entered By
For Star Health and Allied Insurance Company Ltd.
: STAR_PORTAL
Authorised Signatory
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 /
1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
6
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