Policy 474429332 1907833758525

IMPORTANT
To, 12-JUL-22
Rina Chowdhury
44 - A, Jatin Das Road
Near Sai Baba Temple
Kolkata (M Corp.),Kolkata,West Bengal -700029

Mobile : 9432583877.
Dear Customer,
Re: Health Insurance Policy - P/161130/01/2023/061359
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.
However, the ultimate decision will be that of yours only. CN=R Margabandhu,
R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
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 :Tue Jul 12 19:17:52 IST 2022
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 :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
STAR COMPREHENSIVE INSURANCE POLICY
SCHEDULE (INDIVIDUAL)
UNIQUE ID:SHAHLIP22028V072122
Policy No. : P/161130/01/2023/061359 Previous Policy No. :

Customer Code : AA0026726103 GSTIN : 06AAJCS4517L1Z2
Customer Name : Rina Chowdhury SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 30123959 Issuing Office Code : 161130
Proposer's Name : Rina Chowdhury Issuing Office Name : Branch Office - Gurgaon III
Address : 44 - A, Jatin Das Road Address : 412/2, K - I Tower,
Near Sai Baba Temple M G Road, Sector 14,
Gurgaon, Haryana
Kolkata (M Corp.),Kolkata,West
Bengal -700029
Phone No : /9432583877/ Phone No : 0124-4797452
E-mail Id : gopalch1945@gmail.com E-mail Id : gurgaon3@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 11/07/2022 Fulfiller Code : SO161130
Date of Inception of first policy : 12-JUL-2022

Renewal Year : NEW
Collection Number : 1439069754 Intermediary Code : LC0000000619
Receipt Date : 11/07/2022 Name : M/S.POLICYBAZAAR
Premium :Rs 24,462 /- INSURANCE BROKERS
IGST @18% : 4,403 /- PRIVATE LIMITED
Stamp Duty :Rs 1 /- Total Premium :Rs 28,865 /- Phone No : 1800-258-5970/9971552250
E-mail Id : care@policybazaar.com
Total Premium In Words : Rupees Twenty Eight Thousand Eight Hundred Sixty Five Only Installment Facility Optn :No
Premium Payment Frequency :Annual Installment Amount : Rs. 0

Period of Insurance : FROM 12/07/2022 19:17 TO : Midnight Of 11/07/2023 Policy Term: 1 Year
Details of Insured Persons :
Section 1 Section 10 Pre- Inception

Basic Sum Existing Date
Age in ID Card Co-Pay Cumulative Capital Sum Disease
Sl. Name of the Insured Sex Date of Relationshi Insured Bonus Rs Insured (Rs.)
Yrs p with No (Health) (Rs.)
no. Birth
Proposer
1 Rina Chowdhury F 21/04/1957 65 SELF 30123959-1 10 500000 0 500000 12/07/2022
Pre Existing Disease : Diseases related to Thyroid and its Complications

Diabetes Mellitus and its complications
Buy Back Pre Existing Disease Opted: No
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
For Star Health and Allied Insurance Company Ltd.

Entered by : STAR_PORTAL
Aproved by : PORTAL
IRDAI Regn. No 129

Corporate Identity Number L66010TN2005PLC056649
Email ID : info@starhealth.in
2 of 7
Attached to and forming part of Policy No : P/161130/01/2023/061359
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.
Sector Classification :
Urban
Toll Free No: 1800 425 2255/1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522
AYUSH Hospital means a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are carried out by
AYUSH Medical Practitioner(s) comprising of any of the following:
1. Central or State Government AYUSH Hospital or
2. Teaching hospital attached to AYUSH College recognized by the Central Government / Central Council of Indian
Medicine/Central Council for Homeopathy; or
3. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH
Medical Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where
surgical procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance Company's
authorized representative.
AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary, Clinic,
Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having facilities for carrying out
treatment procedures and medical or surgical/para-surgical interventions or both under the supervision of registered AYUSH Medical
Practitioner (s) on day care basis without in-patient services and must comply with all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures
are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance company's authorized representative.
Nominee Details
Nominee Details for the proposer Appointee Details
S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee
1 Gopal Chowdhury Spouse 76 100

In witness whereof the undersigned being authorised by and on behalf of the company has set his hand at Branch Office - Gurgaon III on 12th
Day of July 2022.

Aproved by : PORTAL
3 of 7
Attached to and forming part of Policy No : P/161130/01/2023/061359
Permanent Exclusion Details
Insured Name ID Card Permanent Exclusion Disease

Aproved by : PORTAL
4 of 7
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. : 30123959-1
This Card is valid until otherwise Cancelled. Name : Rina Chowdhury
This ID Card is invalid, if the insurance cover is not in force Date Of Birth : 21-APR-57 Age : 65 Years
Immediate intimation to 'Star' through above Tel Nos. is a must
Gender : Female Office Code : 161130
in case of Hospitalisation.
At the time of hospitalization, kindly submit any Government Valid From : 12-JUL-22 TA/SSM/SM Code : SO161130
approved photo ID Card. Agent/Broker/TE Code : LC0000000619
Corporate Identity Number: L66010TN2005PLC056649 IRDAI Regn. No:129

Aproved by : PORTAL
5 of 7
TAX Invoice
Invoice No. : 6D439Y23P0006952 Customer ID : AA0026726103

Invoice Date : 12/07/22 Policy No : P/161130/01/2023/061359
Recipient Supplier
GSTIN : - GSTIN : 06AAJCS4517L1Z2

Proposer's : Rina Chowdhury NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Gurgaon III
Address : 44 - A, Jatin Das Road Address : 412/2, K - I Tower,
Near Sai Baba Temple M G Road, Sector 14,
Gurgaon, Haryana
City : City : GURGAON III
State : West Bengal State : Haryana
Pincode : 700029 Pincode : 122001
Client Category : IND Place of Supply : 6 - Haryana
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 25750 1288 24462 4403 Rs. 28865

Services
Total Invoice Value (in Figures) : Rs. 28865
Total Invoice Value (in Words) : Rupees: Twenty-eight thousand
eight hundred sixty-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 L66010TN2005PLC056649 Email ID : stargst@starhealth.in

Aproved by : PORTAL
6 of 7
Name Of the Product Star Comprehensive Insurance Policy
Product UIN No. SHAHLIP22028V072122

Summary of Important Benefits
Refer to Policy clause No.
S.No Particulars of Coverage / Benefits Benefit Limits (in Rs.)
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 Private Single A/c Room

1 II.Section 1(A)
*Hospitalization expenses will be considered in
proportion to the eligible Room Rent
Surgeon, Anesthetist, Medical Practitioner,
2 Consultants, Specialist Fees, Anesthesia, Actual II. Section 1(B & C)
blood, oxygen, operation theatre charges,
Surgical Appliances, Medicines and Drugs
3 Road Ambulance charges(per policy period) Actual II.Section 1(D)

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 Up to Up to Up to Up to Up to 5,000/- Up to 5,000/- Up to
Out Patient Medical Consultation Coverage
7 1,200/- (per 1,500/-(per 2,100/- (per 2,400/-(per 3,000/-(per 3,300/-(per (per (per 5,000/-(per
other than Out Patient Dental/ Ophthal consultation consultation
Consultation consultation consultation consultation consultation consultation consultation II.Section 1(H)
limit limit limit limit limit limit limit limit Rs.300/- limit
Rs.300/-) Rs.300/-) Rs.300/-) Rs.300/-) Rs.300/-) 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/- 25000/- 30000/- 30000/- 30000/- 50000/- 50000/- 50000/-
30000/-
9b. 20000/- 40000/- 50000/- 50000/- 50000/- 100000/- 100000/- II. Section 2.B
Delivery Charges(Caesarean Delivery) 50000/- 100000/-
10 New Born Cover 100000/- 100000/- 100000/- 100000/- 100000/- 100000/- 200000/- 200000/- 200000/-
11 Vaccination Expenses for New Born (Subject 5,000/- 5,000/- 5,000/- 5,000/- 5,000/- 5,000/- 10,000/- 10,000/- 10,000/- II. Section 2.C
to a valid claim under 9a or 9b above)
24 months for first delivery from first inception of the policy Special condition no.1-
12 Waiting Period for Delivery
24 months from claim under 9a or 9b for next delivery Under Section 2
Out-patient Dental and Ophthalmic Treatment Up to Up to Up to Up to Up to Up to Up to Up to Up to
13 Coverage- Once in a block of every 3 years II Section 3
5,000/- 5,000/- 10,000/- 10,000/- 10,000/- 10,000/- 15,000/- 15,000/- 15,000/-
of continuous renewal
14 Organ Donor Expenses Payable up to the Basic Sum Insured II.Section 4
Hospital Cash Benefit upto 7 days per

15 occurrence & upto 120 days per policy 500/- 750/- 750/- 1000/- 1000/- 1500/- 2500/- 2500/- 2500/-
II.Section 5
period. (1 day time excess) per day per day per day per day per day per day per day per day per day
Health Check Up for every claim free Up to Up to Up to Up to Up to Up to Up to Up to

16 Up to II.Section 6
years of continuous renewal 2,000/- 2,500/- 3,000/- 4,000/- 4,500/- 4,500/ 5,000/- 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
18 Second Medical Opinion The Insured Person is given the facility of obtaining a medical Second Opinion from a Doctor in the Company's network of
Medical Practitioners.
II. Section 8
Up to Up to Up to Up to Up to Up to Up to Up to Up to II.Section 9
19 AYUSH Treatment(Per Policy Period)
15,000/- 15,000/- 15,000/- 15,000/- 20,000/- 20,000/- 30,000/- 30,000/- 30,000/-
20 Under Important Note. Point
Day Care Treatments / Procedures All Day Care Procedures No.1
Accidental Death and Permanent Total 1,00,00,000/- II. Section 10
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/-
Disablement
22 Star Wellness Program Discount in the Renewal premium for healthy life style through wellness activities. II. Section 11
23 Buy Back Pre Existing Disease(Optional Waiting Period of Pre Existing Disease reduces from 36 months to 12 months
II.Section 12
Cover)
24 Automatic Restoration of Sum Insured 100% (once during policy period) IV.30a
(Applicable for Section 1 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.

Aproved by : PORTAL
7 of 7

Policy 474429332 1907833758525

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IMPORTANT

Kolkata (M Corp.),Kolkata,West Bengal -700029

Re: Health Insurance Policy - P/161130/01/2023/061359

With kind regards,

Policy No. : P/161130/01/2023/061359 Previous Policy No. :

Date of Inception of first policy : 12-JUL-2022

Premium Payment Frequency :Annual Installment Amount : Rs. 0

Section 1 Section 10 Pre- Inception

Pre Existing Disease : Diseases related to Thyroid and its Complications

For Star Health and Allied Insurance Company Ltd.

IRDAI Regn. No 129

S.No. Name Relationship Age % Appointee Relationship

1 Gopal Chowdhury Spouse 76 100

For Star Health and Allied Insurance Company Ltd.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

For Star Health and Allied Insurance Company Ltd.

For Star Health and Allied Insurance Company Ltd.

Invoice No. : 6D439Y23P0006952 Customer ID : AA0026726103

GSTIN : - GSTIN : 06AAJCS4517L1Z2

997133 Insurance 25750 1288 24462 4403 Rs. 28865

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

IRDAI Regn. No 129 Corporate Identity Number L66010TN2005PLC056649 Email ID : stargst@starhealth.in

For Star Health and Allied Insurance Company Ltd.

Product UIN No. SHAHLIP22028V072122

Room Rent (Per Day) - Up to Private Single A/c Room

3 Road Ambulance charges(per policy period) Actual II.Section 1(D)

14 Organ Donor Expenses Payable up to the Basic Sum Insured II.Section 4

Hospital Cash Benefit upto 7 days per

Health Check Up for every claim free Up to Up to Up to Up to Up to Up to Up to Up to

26 Instalment Facility (If Opted) Available IV.13

For Star Health and Allied Insurance Company Ltd.

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