Policy 1

IMPORTANT
To, 17-DEC-23
Yashodhara
No 11, 1st floor,Balaji complex
27th cross Opp med plus
Bangalore,Bangalore,Karnataka -560073
Mobile : 9900913832.
Dear Customer,
Re: Health Insurance Policy - P/170000/01/2023/024320
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
"Let Star Health help you to become healthier and happier. Star Wellness Benefits includes Mind Body healing and other
Condition management programmes (Weight management, Diabetes etc. .. ) Visit www.starhealth.in / customer portal login and
start your journey with us to Better Health".
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 select the room as per your eligibility stipulated in your policy to avoid additional payment from your
pocket towards the proportionate increase which would invariably be charged by the hospital for the higher
room category occupied.
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 1800-425-
2255/1800-102-4477.
CN=R Margabandhu,
R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
However, the ultimate decision will be that of yours only. 75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Mon Aug 23 11:15:38 IST 2021
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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129
YOUNG STAR INSURANCE POLICY
SCHEDULE (Individual)
UNIQUE ID:SHAHLIP22036V042122
Policy No. : P/170000/01/2023/024320 Previous Policy No. :

Customer Code : AA0020307299 GSTIN : 27AAJCS4517L1ZY
Customer Name : Yashodhara SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 23514468 Issuing Office Code : 170000
Proposer's Name : Yashodhara Issuing Office Name : Zonal Office - Mumbai
Address : No 11, 1st floor,Balaji complex Address : 349 Business Point, Unit No.204 /
27th cross Opp med plus 205,2nd Floor, Near Sai Service,
Western Express Highway,
Bangalore,Bangalore,Karnataka- Andheri (E), Mumbai -400069.
560073
Phone No : /9900913832/ Phone No : 022-42563641 / 42563640
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : - Place of Supply : -
Proposal date : 17/12/2023 Fulfiller Code : SO170000
Date of Inception of first policy : 17-DEC-2023
Renewal Year : NEW
Intermediary Code : LC0000000335
Collection Number : 1071024822 Name : M/S.INDIA INFOLINE
Receipt Date : 17/12/2023
INSURANCE BROKERS
Premium :Rs 4,555 /-
LTD
IGST @18% : 820 /-
Phone No : 18602673000/7039050000
Stamp Duty :Rs 1 /- Total Premium :Rs 5,375 /-
E-mail Id : cs.insurance@indiainfoline
.com
Total Premium In Words : Rupees Five Thousand Three Hundred Seventy Five Only Installment Facility Optn :No
Premium Payment Frequency : Annual Installment Amount Rs. : 0

Period of Insurance : FROM 17/12/2023 00:00 TO : Midnight Of 16/12/2024 Term : 1 Year
Details of Insured Persons :
Sl. Age in Relationship ID Card No Plan Sum Insured Bonus

Pre Existing Disease Inception
Name of the Insured Sex Date of with Date
no. Yrs
Birth Proposer
1 Yashodhar M 01/01/1975 48 SELF 23514465-5 SILVER 500000 0 No PED declared 17/12/2023
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.
Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn. No 129

Corporate Identity Number U66010TN2005PLC056649
Email ID : [email protected]
2 of 6
Attached to and forming part of Policy No : P/170000/01/2022/024320
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).
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.
Sector Classification :
Urban
Toll Free No: 1800 425 2255/1800 102 4477 Email: [email protected], Fax No: 1800 425 5522
"CONSOLIDATED STAMP PAID VIDE CERTIFICATE NO.CSD/46/2021/1805 DT.24/05/2021"
Nominee Details
Nominee Details for the proposer Appointee Details
S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee
1 MALATHI Wife 43 100
In witness whereof the undersigned being authorised by and on behalf of the company has set his hand at Zonal Office - Mumbai on 17th Day
of December 2023.
Permanent Exclusion Details
Insured Name ID Card Permanent Exclusion Disease
3 of 6
Star Health and Allied Insurance
Company Limited
Emergency Help Line No. 1800 425 2255 / 1800 102 4477
e-mail : [email protected] Website : www.starhealth.in Customer Identity Card
Please quote the Customer Id No. for assistance Customer ID No. : 23514465-5
This Card is valid until otherwise Cancelled. Name : Yashodhar
This ID Card is invalid, if the insurance cover is not in force Date Of Birth : 01-JAN-75 Age : 48 Years
Immediate intimation to 'Star' through above Tel Nos. is a must
in case of Hospitalisation. Gender : Male Office Code : 170000
At the time of hospitalization, kindly submit any Government Valid From : 17-DEC-23 TA/SSM/SM Code : SO170000
approved photo ID Card. Agent/Broker/TE Code : LC0000000335
Corporate Identity Number: U66010TN2005PLC056649 IRDAI Regn. No:129
4 of 6
TAX Invoice
Invoice No. : 27E071Y22P004598 Customer ID : AA0020307299

Invoice Date : 17/12/23 Policy No : P/170000/01/2022/024320
Recipient Supplier
GSTIN : - GSTIN : 27AAJCS4517L1ZY

Proposer's : Yashodhar NAME : Star Health and Allied Insurance Co Ltd
Name - Zonal Office - Mumbai
Address : No 11, 1st floor,Balaji complex Address : 349 Business Point, Unit No.204 /
27th cross Opp med plus 205,2nd Floor, Near Sai Service,
Western Express Highway,
Andheri (E), Mumbai -400069.
City : Bangalore,Bangalore,Karnataka- City : MUMBAI
560073
State : Karnataka State : Maharashtra
Pincode : 560073 Pincode : 400069
Client Category : IND Place of Supply : 27 - Maharashtra
HSN / Description of Total Discount TaxableValue IGST @ 18% CGST @9% UT/SGST@9% CESS@1% Total Invoice Value
SAC Service(s) G=C*Cess H =C+D+E +F+G
Code A B C=A-B D = C * IGST E=C F=C
*CGST *UTGST or
SGST
997133 Insurance 4555 0 4555 820 Rs. 5375

Services
Total Invoice Value (in Figures) : Rs. 5375
Total Invoice Value (in Words) : Rupees: Five thousand three
hundred seventy-five only
Amount of Tax Subject to reverse Charge : 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 : [email protected]
5 of 6
Name Of the Product YOUNG STAR INSURANCE POLICY
Product UIN No. SHAHLIP22036V042122
Summary of Important Benefits
Benefit Limits (in Rs.) Refer to Policy
Particulars of Coverage / clause No.
S.No
Benefits
Individua Individual and Floater
Sum Insured (in Rs.) 300000/- 500000/- 1000000/- 1500000/- 2000000/- 2500000/- 5000000/- 7500000/- 10000000/-
Plan Type Silver Plan

1
Room Rent (Per Day) - Up to
2 *Hospitalization expenses will be
considered in proportion to the eligible Private Single A/c Room 1(A)
Room Rent
Surgeon, Anesthetist, Medical
3 Practitioner, Consultants, Specialist
Fees, Anesthesia, blood, oxygen,
operation theatre charges, Surgical Actual 1(B & C)
Appliances, Medicines and Drugs
4 Road Ambulance charges(per policy

period) Actuals
1(D)
5 Pre-Hospitalization Expenses Up to 60 days prior to admission 1(E)

6 Post-Hospitalization Expenses Up to 90 days from the date of discharge 1(F)
7 Day Care Procedure All day care procedure covered. 1(G)
8 Medical Opinion E -Medical Opinion" from the Company's expert panel. 1(H)
Sum Insured/policy type Rs3,00,000/- Rs5,00,000/- Rs10,00,000/- Rs15,00,000/-and above
9. Health Check Individual 1,500/- 2,000/- 3,000/- 3,500/- 1(I)
Floater N/A 3,000/- 4,000/- 5,000/-

10 Automatic Restoration of Basic Sum 1(J)
Once during policy period by 100%
Insured
11 Cumulative bonus The insured person will be eligible for Cumulative bonus calculated at 20% of basic sum insured 1(K)
for each claim free year subject to a maximum of 100% of the basic sum insured.
Additional Basic Sum Insured for Road 25% of the Sum Insured subject to a
12 1(L)
Traffic Accident (RTA) maximum of Rs10,00,000/-
13 Star Wellness Program Discount in the Renewal premium for healthy life style through wellness activities. 1(M)
14 Special Features 10% Discount at the time of renewal after 40years of age. Condition No.1
6 of 6

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IMPORTANT

Re: Health Insurance Policy - P/170000/01/2023/024320

With kind regards,

Policy No. : P/170000/01/2023/024320 Previous Policy No. :

Premium Payment Frequency : Annual Installment Amount Rs. : 0

Details of Insured Persons :

Sl. Age in Relationship ID Card No Plan Sum Insured Bonus

IRDAI Regn. No 129

Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

1 MALATHI Wife 43 100

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

Invoice No. : 27E071Y22P004598 Customer ID : AA0020307299

GSTIN : - GSTIN : 27AAJCS4517L1ZY

997133 Insurance 4555 0 4555 820 Rs. 5375

The invoice is issued as per Section 31 of the CGST Act

IRDAI Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : [email protected]

Plan Type Silver Plan

4 Road Ambulance charges(per policy

5 Pre-Hospitalization Expenses Up to 60 days prior to admission 1(E)

7 Day Care Procedure All day care procedure covered. 1(G)

Floater N/A 3,000/- 4,000/- 5,000/-

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