Star Health And Allied Insurance Company Limited

Date : 02-Sep-2023
To, IMPORTANT

ANIL KUMAR MISHRA,

110/153
RAM KRISHNA NAGAR
KANPUR
Kanpur City,Uttar Pradesh-208012
Mobile : 0/9450146227

Dear Customer,

Re: Health Insurance Policy - 11240390972605

We are extremely thankful to you for your renewal instructions and payment of premium. We enclose the
renewed policy based on our records. We would request you to kindly study the renewed policy carefully and
revert to us if there is any discrepancy to enable us to attend to the same.

Kindly note that the above request is very important and if we do not hear anything from you within
15 days, we would presume that the policy issued by us is in order and the contract is concluded.

We would like to mention that we have incorporated the name of the intermediary as indicated by you.

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 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.

However,the ultimate decision will be that of yours only.

Page 1 of 5

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 : L66010TN2005PLC056649 Email :[email protected]
CN=R Margabandhu,
Website :www.starhealth.in IRDAI Regn.no: 129
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15475488cdf

R Margabandhu 3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,

OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806ca65f89e15
179f5fe50a, OU=UNDERWRITING - Chief Risk Officer, O=STAR HEALTH AND
ALLIED INSURANCE COMPANY, C=IN. Date :Sat Sep 02 16:28:35 IST 2023
 Star Health And Allied Insurance Company Limited

Family Health Optima Insurance Plan

Unique Identification No. SHAHLIP23164V072223
POLICY SCHEDULE
Policy No. : 11240390972605 Previous Policy No : 11230125199604
Customer Code : 9758128 GSTIN : 09AAJCS4517L1ZW
Customer Name : ANIL KUMAR MISHRA SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 9758128 Issuing Office Code : 161122
Proposer Name : ANIL KUMAR MISHRA Issuing Office Name : Branch Office -Kanpur
Proposer Address : 110/153 Issuing Office Address : Garg Noronha Complex
RAM KRISHNA NAGAR 4th Floor, 17/9-A,The Mall
KANPUR Kanpur - 208001
Kanpur City Uttar Pradesh 208012 Kanpur Urban Uttar Pradesh
208001
Phone No : 0/9450146227 Phone No : 0512 - 4057795/0512 -
4057795
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : NO Place of Supply : Uttar Pradesh
Proposal date : 04-Sep-2018 Fulfiller Code : SH17012
Date of Inception : 04-Sep-2018
of first policy
Policy Category : Fifth Year Intermediary : BA0000233585
Collection No : 191175008747
Code
Collection Date : 02-Sep-2023

Premium : Rs. 28,519/-

Name : Mr.MAYANK
AGARWAL
CGST @ 9% : Rs. 2,567/-
Phone No :8960468018
:
SGST @ 9% Rs. 2,567/-
E-mail Id : mayankag1985@gmail.
com
Total Premium : Rs. 33,653/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Thirty Three thousand six hundred fifty
three only
PERIOD OF INSURANCE : From : 04-Sep-2023 00:00 To : Midnight Of 03-Sep-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Scheme Description (Family Size) :2A Basic Floater Sum Insured :Rs. 5,00,000/-
Bonus : Rs. 2,25,000/- Limit of Coverage : Rs. 7,25,000/- Recharge Benefit : Rs. 1,50,000/-
Details of Insured Persons :
Sl. Age in Relationship Inception
Name of the Insured Gender Date of Birth ID Card No
no. Yrs with Proposer date
ANIL KUMAR MISHRA
1 Male 01-Jul-1963 60 Self 9758128-1 04-Sep-2018

Pre Existing Disease : No PED Declared

SUSHILA MISHRA
2 Female 02-Aug-1966 57 Spouse 9758128-2 04-Sep-2018

Pre Existing Disease : No PED Declared

Entered by : SH66368 For Star Health and Allied Insurance Company Ltd.
Approved by : SH66368
IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
Email ID: [email protected]

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 : L66010TN2005PLC056649 Email :[email protected]
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11240390972605

Nominee Details:
Nominee Details for the Proposer Appointee Details
S.No Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 SUSHILA Spouse 57 100

MISHRA
Sector Classification:
Urban Social Informal Sector Informal Sector includes small scale, self-employed workers typically
at a low level of organisation and technology, with the primary
objective of generating employment and income, with
heterogeneous activities like retail trade, transport, repair and
maintenance, construction, personal and domestic services and
manufacturing, with the work mostly labour intensive, having often
unwritten and informal employer-employee relationship.
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).
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: [email protected], Fax No: 1800 425 5522.
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office -Kanpur on 02nd Day of September 2023.

Entered by : SH66368 For Star Health and Allied Insurance Company Ltd.
Approved by : SH66368

Authorised Signatory Page 3 of 5

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 : L66010TN2005PLC056649 Email :[email protected]
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 092309I001724529 Customer ID : 9758128
Invoice Date : 02-Sep-2023 Policy No. : 11240390972605
Recipient Supplier
GSTIN : GSTIN : 09AAJCS4517L1ZW
Name : ANIL KUMAR MISHRA Name : Star Health and Allied Insurance Co Ltd -
Branch Office -Kanpur
Address : 110/153 Address : Garg Noronha Complex
RAM KRISHNA NAGAR 4th Floor, 17/9-A,The Mall
KANPUR Kanpur - 208001
City : Kanpur City Pin Code : 208012 City : Kanpur Urban Pin Code : 208001

State : Uttar Pradesh Client : IND State : Uttar Pradesh Place of : Uttar Pradesh
Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Discount CGST @ 9%
Value 18% 9% 1% Value
HSN / SAC Description of
Code Service(s) F=C*
D=C* E=C* G= C * H=C+D+
A B C=A-B UTGST or
IGST CGST Cess E+ F + G
SGST

Insurance
997133 28,519.00 0 28,519.00 0 2,567.00 2,567.00 0 33,653.00
Services

Total Invoice Value (in Figures) : Rs. 33,653/-

Total Invoice Value (in Words) : Rupees Thirty Three thousand six hundred fifty three 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
"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."
E. & O.E
This is a digitally signed document and hence no physical signature is required

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: [email protected]

Entered by : SH66368 For Star Health and Allied Insurance Company Ltd.
Approved by : SH66368

Authorised Signatory Page 4 of 5

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 : L66010TN2005PLC056649 Email :[email protected]
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Annexure 1A
Forming part of Policy Number : 11240390972605

Covering Flu Vaccination Approved by ICMR under Health Check Up benefit and Home Care Treatment
Notwithstanding anything stated to the contrary in the within mentioned policy it is hereby agreed and declared
that this Policy would hereinafter provide the following covers without charging additional premium till 31.03.2024:

1. Cover for Flu Vaccine Approved by ICMR under Health check up benefit as per relevant clause with the same
limits and conditions provided therein.

2. Cover for Home Care Treatment as per the details provided herein.
Home care treatment : Payable up to 10% of the sum insured subject to maximum of Rs.5 lakhs in a policy year,
for treatment availed by the Insured Person at home, only for the specified conditions mentioned below, which in
normal course would require care and treatment at a hospital but is actually taken at home provided that:

a. The Medical practitioner advises the Insured person to undergo treatment at home

b. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for
each day through the duration of the home care treatment

c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is
maintained

d. Insured can avail ‘'Home Care Treatment'' service on cashless basis, if availed from the list of our Home Health
Care Network service providers given in our website ''www.starhealth.in”

List of Conditions covered under Home care treatment

1. Fever and Infectious diseases which can be managed as Inpatient

2. Uncomplicated Urinary tract infections but needing Parenteral Antibiotics
3. Asthma and COPD -Mild Exacerbations needing Home Nebulization
4. Acute Gastritis/Gastroenteritis
5. I.V. Chemotherapy [Where advised by the doctor]
6. Palliative Cancer care requiring medical assistance
7. Acute Vertigo
8. Diabetic foot and Cellulitis
9. IVDP[Cervical and Lumbar disc diseases]
10. Major Surgeries/Arthroplasties needing IV Antibiotics Post Discharge
11. Care for Brain and Spinal Injury Cases Post Discharge
12. Post CVA Care at Home after Discharge
13. Chronic Severe Refractory Asthma

Entered by : SH66368 For Star Health and Allied Insurance Company Ltd.
Approved by : SH66368

Authorised Signatory Page 5 of 5

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 : L66010TN2005PLC056649 Email :[email protected]
Website :www.starhealth.in IRDAI Regn.no: 129