Policy Doc

Star Health And Allied Insurance Company Limited
Date : 01-Sep-2023
To, IMPORTANT
VASANT RAGHO KHILARE,

Sr No-111/15K, Jai Ganesh Colony,
Sutardara, Paud Road
Near Datta Temple, Kothrud
Pune City Tehsil,Maharashtra-411038
Mobile : 98XXXXXX66
Dear Customer,
Re: Health Insurance Policy - 11240390362000
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 abinitio.
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,
Authorized 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.
However,the ultimate decision will be that of yours only.
Page 1 of 8
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 Comprehensive Insurance Policy

(Floater)
Unique Identification No. SHAHLIP22028V072122
POLICY SCHEDULE
Policy No. : 11240390362000 Previous Policy No :
Customer Code : PI0004029749 GSTIN : 27AAJCS4517L1ZY
Customer Name : VASANT RAGHO KHILARE SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : PI0004029749 Issuing Office Code : 171112
Proposer Name : VASANT RAGHO KHILARE Issuing Office Name : Branch Office - Navi Mumbai
Proposer Address : Sr No-111/15K, Jai Ganesh Colony, Issuing Office Address : T-761, 6th Floor,Tower no 3,
Sutardara, Paud Road Above Vashi Railway
Near Datta Temple, Kothrud Station,International Infotech
Pune City Tehsil Maharashtra Park
411038 Vashi
Thane Tehsil Maharashtra
Phone No : 98XXXXXX66 Phone No : 022-41121411/12/44
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : NO Place of Supply :
Proposal date : 01-Sep-2023 Fulfiller Code : SO171112
Date of Inception : 01-Sep-2023
of first policy
Policy Category : New Intermediary : BA0000723248
Collection No : 191103009220
Code
Collection Date : 01-Sep-2023
Premium : Rs. 28,560/-

Name : ANUPAM GADRE
CGST @ 9% : Rs. 2,570/-

Phone No :9869679431/986967943
1
:
SGST @ 9% Rs. 2,570/-
E-mail Id : anupam.gadre@gmail.
com
Total Premium : Rs. 33,700/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Thirty Three thousand seven hundred only
PERIOD OF INSURANCE : From : 01-Sep-2023 16:59 To : Midnight Of 31-Aug-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. 0/-
Sum Insured Under Section 1 (Health) Rs. 5,00,000/-
Capital Sum Insured Under Section 10 (For Accidental Death & Permanent Total Disablement) : Rs. 5,00,000/-
For VASANT RAGHO KHILARE Only.
Details of Insured Persons :
Sl. Age in Relationship Buy Back PED

Name of the Insured Gender Date of Birth ID Card No Inception date
no. Yrs with Proposer Opted
VASANT RAGHO KHILARE
1 Male 01-Apr-1964 59 Self PI0004029749 No 01-Sep-2023
Pre Existing Disease : No PED Declared

SHANTA KHILARE ME043459478
2 Female 01-Jun-1967 56 Spouse No 01-Sep-2023
6
Pre Existing Disease : No PED Declared
Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDA Regn.No.129
Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 8
Email ID: [email protected]
Attached to and forming part of Policy No: 11240390362000
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 RAHUL KHILARE Son 27 100
Sector Classification:
Urban
''CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT. 28/MAR/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.
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 - Navi Mumbai on 01st Day of September 2023.
Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Policy No : 11240390362000 Type of Policy : Star Comprehensive Revised -

2019
Issue Office : 171112-Branch Office - Navi Mumbai
Address : T-761, 6th Floor,Tower no 3,

Above Vashi Railway Station,International Infotech Park
Vashi
Thane Tehsil Maharashtra 400705
Tel / Fax : 022-41121411/12/44
Email : [email protected]
This is to certify that VASANT RAGHO KHILARE has paid Rs 33,700/- (Total Premium : Indian Rupees Thirty
Three thousand seven hundred only ) towards Premium for Hospitalization Insurance vide Policy No:
11240390362000 for the Period 01-Sep-2023 To 31-Aug-2024 issued on 01-Sep-2023.
Payment received by Payment Gateway vide Receipt No: 191103009220/1 Receipt Date: 01-Sep-2023
Note :- This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in
case of Cancellation of the Policy or any alteration in the Insurance affecting the Premium.
Date : 01-Sep-2023 For and on behalf of
Place : Branch Office - Navi Mumbai Star Health and Allied Insurance Company Ltd.
IRDA Regn.No.129
Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory
Email ID: [email protected]
Star Health and Allied Insurance

Company Limited
Customer Identity Card
Policy No : 11240390362000
Name DOB Gender Customer id

VASANT RAGHO KHILARE
01-Apr-1964 Male PI0004029749
SHANTA KHILARE
01-Jun-1967 Female ME0434594786
Valid From : 01-Sep-2023 Agent/Broker/TE Code : BA0000723248
Office Code : 171112 TA/SSM/SM Code : SO171112
IRDAI Regn.No:129
Emergency Help Line No.1800 425 2255/1800 102 4477
e-mail : [email protected] Website : www.starhealth.in
Please quote the Customer Id No. for assistance
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 hospitalisation,kindly submit any Government approved photo ID

Card.
Corporate Identity Number : L66010TN2005PLC056649
*This is a temporary ID card issued along with the policy. Original ID card will be dispatched shortly.
Tax Invoice
Invoice No. : 982309I000130358 Customer ID : PI0004029749
Invoice Date : 01-Sep-2023 Policy No. : 11240390362000
Recipient Supplier
GSTIN : GSTIN : 27AAJCS4517L1ZY
Name : VASANT RAGHO KHILARE Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Navi Mumbai
Address : Sr No-111/15K, Jai Ganesh Colony, Address : T-761, 6th Floor,Tower no 3,
Sutardara, Paud Road Above Vashi Railway Station,International
Infotech Park
Near Datta Temple, Kothrud Vashi
City : Pune City Pin Code : 411038 City : Thane Tehsil Pin Code : 400705
Tehsil
State : Maharashtra Client : IND State : Maharashtra Place of :

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 28,560.00 0 28,560.00 0 2,570.00 2,570.00 0 33,700.00
Services
Total Invoice Value (in Figures) : Rs. 33,700/-

Total Invoice Value (in Words) : Rupees Thirty Three thousand seven hundred 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]
Name Of the Product Star Comprehensive Insurance Policy

Product UIN No. SHAHLIP22028V072122
Summary of Important Benefits
Particulars of Coverage / Refer to Policy
S.No Benefit Limits (in Rs.)
Benefits clause No.
Sum Insured (in Rs.) 5,00,000 7,50,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 75,00,000 1,00,00,000
Room Rent (Per Day) - Up to

*Hospitalization expenses will be
1. Private Single A/c Room II.Section 1(A)
considered in proportion to the
eligible Room Rent
Surgeon, Anesthetist, Medical
Practitioner, Consultants, Specialist
II. Section 1(B &
2. Fees, Anesthesia, blood, oxygen, Actual
C)
operation theatre charges, Surgical
Appliances, Medicines and Drugs
Road Ambulance charges(per
3. Actual II.Section 1(D)
policy period)
4. Air Ambulance charges Up to Rs.2,50,000/- per hospitalization not exceeding Rs.5,00,000/- per policy period II.Section 1(E)
5. Pre-Hospitalization Expenses Up to 60 days prior to admission II.Section 1(F)
6. Post-Hospitalization Expenses Up to 90 days from the date of discharge II.Section 1(G)
Up to Up to
Out Patient Medical Consultation Up to 2,100/- Up to 2,400/- Up to 3,000/- Up to 3,300/- Up to 5,000/- Up to 5,000/-
1,200/- (per 1,500/-(per Up to 5,000/-(per
(per (per (per (per (per (per
7. Coverage other than Out Patient Consultation consultation
consultation consultation consultation consultation consultation consultation
consultation limit II.Section 1(H)
Dental/ Ophthal limit limit Rs.300/-)
limit Rs.300/-) limit Rs.300/-) limit Rs.300/-) limit Rs.300/-) limit Rs.300/-) limit Rs.300/-)
Rs.300/-) Rs.300/-)
8. Domiciliary hospitalization Coverage for medical treatment for a period exceeding three days II.Section 1(I)
9a. Delivery Charges(Normal Delivery) 15,000/- 25,000/- 30,000/- 30,000/- 30,000/- 30,000/- 50,000/- 50,000/- 50,000/-
Delivery Charges(Caesarean
9b. 20,000/- 40,000/- 50,000/- 50,000/- 50,000/- 50,000/- 1,00,000/- 1,00,000/- 1,00,000/- II. Section 2.B
Delivery)
10. New Born Cover 1,00,000/-1,00,000/- 1,00,000/- 1,00,000/- 1,00,000/- 1,00,000/- 2,00,000/- 2,00,000/- 2,00,000/-
Vaccination Expenses for New Born

11. (Subject to a valid claim under 9a 5,000/- 5,000/- 5,000/- 5,000/- 5,000/- 5,000/- 10,000/- 10,000/- 10,000/- II. Section 2.C
or 9b above)
24 months for first delivery from first inception of the policy Special condition
12. Waiting Period for Delivery no.1- Under
24 months from claim under 9a or 9b for next delivery Section 2
Out-patient Dental and Ophthalmic
Treatment Coverage- Once in a Up to Up to Up to Up to Up to Up to Up to Up to
13. Up to 15,000/- II Section 3
block of every 3 years of 5,000/- 5,000/- 10,000/- 10,000/- 10,000/- 10,000/- 15,000/- 15,000/-
continuous renewal
14. Organ Donor Expenses Payable up to the Basic Sum Insured II.Section 4
Hospital Cash Benefit upto 7 days
500/- 750/- 750/- 1,000/- 1,000/- 1,500/- 2,500/- 2,500/- 2,500/-
per occurrence & upto 120 days
15. per day per day per day per day per day per day per day per day per day II.Section 5
per policy period. (1 day time
excess)
Health Check Up for every claim Up to Up to Up to Up to Up to Up to Up to Up to Up to 5,000/-
16. II.Section 6
free years of continuous renewal 2,000/- 2,500/- 3,000/- 4,000/- 4,500/- 4,500/- 5,000/- 5,000/-
17. Bariatric Surgery(per policy period) 2,50,000/- 2,50,000/- 2,50,000/- 2,50,000/- 5,00,000/- 5,00,000/- 5,00,000/- 5,00,000/- 5,00,000/- II.Section 7
The Insured Person is given the facility of obtaining a medical Second Opinion from a Doctor in the Company’s II. Section 8
18. Second Medical Opinion
network of Medical Practitioners.
AYUSH Treatment(Per Policy Up to Up to Up to Up to Up to Up to Up to Up to
19. Up to 30,000/- II.Section 9
Period) 15,000/- 15,000/- 15,000/- 15,000/- 20,000/- 20,000/- 30,000/- 30,000/-
Under Important
20. Day Care Treatments / Procedures All Day Care Procedures Note. Point No.1
Accidental Death and Permanent

21. 5,00,000/- 7,50,000/- 10,00,000/- 15,00,000/- 20,00,000/- 25,00,000/- 50,00,000/- 75,00,000/- 1,00,00,000/- II. Section 10
Total Disablement
22. Star Wellness Program Discount in the Renewal premium for healthy life style through wellness activities. II. Section 11
Buy Back Pre Existing II.Section 12

23. Waiting Period of Pre Existing Disease reduces from 36 months to 12 months
Disease(Optional Cover)
Automatic Restoration of Sum
24. Insured (Applicable for Section 1 100% (once during policy period) IV.30a
only)
25. Coverage for Modern Treatment Covered up to limits mentioned in the policy clause II.Section 13
26. Instalment Facility (If Opted) Available IV.13
Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.
Annexure 1A
Forming part of Policy Number : 11240390362000
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

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Star Health And Allied Insurance Company Limited

VASANT RAGHO KHILARE,

Re: Health Insurance Policy - 11240390362000

With kind regards,

Star Comprehensive Insurance Policy

Premium : Rs. 28,560/-

CGST @ 9% : Rs. 2,570/-

Sl. Age in Relationship Buy Back PED

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Corporate Identity Number L66010TN2005PLC056649

Attached to and forming part of Policy No: 11240390362000

1 RAHUL KHILARE Son 27 100

Authorised Signatory Page 3 of 8

Hospitalisation Benefit Policy

Policy No : 11240390362000 Type of Policy : Star Comprehensive Revised -

Address : T-761, 6th Floor,Tower no 3,

Tel / Fax : 022-41121411/12/44

Date : 01-Sep-2023 For and on behalf of

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: [email protected]

Authorised Signatory Page 4 of 8

Star Health and Allied Insurance

Name DOB Gender Customer id

Valid From : 01-Sep-2023 Agent/Broker/TE Code : BA0000723248

Office Code : 171112 TA/SSM/SM Code : SO171112

Emergency Help Line No.1800 425 2255/1800 102 4477

e-mail : [email protected] Website : www.starhealth.in

Please quote the Customer Id No. for assistance

This Card is valid until otherwise Cancelled.

At the time of hospitalisation,kindly submit any Government approved photo ID

Corporate Identity Number : L66010TN2005PLC056649

Authorised Signatory Page 5 of 8

State : Maharashtra Client : IND State : Maharashtra Place of :

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Invoice Value (in Figures) : Rs. 33,700/-

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

Authorised Signatory Page 6 of 8

Name Of the Product Star Comprehensive Insurance Policy

Room Rent (Per Day) - Up to

5. Pre-Hospitalization Expenses Up to 60 days prior to admission II.Section 1(F)

6. Post-Hospitalization Expenses Up to 90 days from the date of discharge II.Section 1(G)

Vaccination Expenses for New Born

Accidental Death and Permanent

Buy Back Pre Existing II.Section 12

26. Instalment Facility (If Opted) Available IV.13

Authorised Signatory Page 7 of 8

List of Conditions covered under Home care treatment

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

Authorised Signatory Page 8 of 8

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