Star Group COVID Insurance Policy

Unique id: SHAHLGP21115V012021

Indemnity Plan
Policy Schedule
Policy No: C/KOL/191117/01/2020-21/000166 Previous Policy No: Nil
Issuing Office Code: 191117
Proposer’s Code: -
Proposer’s Name: M/S.MAXFLOW FANS
MANUFACTURING Issuing office Name: Branch Office - Behala
PRIVATE LIMITED
Address: 2nd Floor, 738/2, Diamond Harbour Road,
Address: 12ESI, 12th Floor, East Block, Mani Kolkata-700008.
Casadona , Plot No-11, f/04, New Town
Action Area, Ii-f, Kolkata, West Bengal
- 700156

Phone No: 8335074995 Phone. No: 033 - 24475051/ 24475052

Email ID: mkd@maxflowfans.com
Email ID: behala@starhealth.in
Proposer GSTIN:19AAFCM0997E1Z8
Receipt No: 1188007441 Fulfiller Code: SH8566
Receipt Date: 29/08/2020
Premium: Rs. 374000/- Intermediary Code : BA0000045626
CGST@9%: 33660/- & SGST/UTGST@9%: 33660/- Name : BISWANATH DAS
Stamp Duty Re. 1/- Phone : 9804707800
Total Premium: Rs. 441320/- Email id : biswanathlic2009@gmail.com

Total Premium in words : Four Lakh Forty One Thousand Three Hundred And Twenty Only
Period Of Insurance : From 28/08/2020 00:00 Hrs To Midnight Of 08/06/2021 23:59 Hrs
Co-insurance -

Risk Coverage Details

No. of Employees / Members Covered 78
No. of Dependents Covered 124
Total No. of Persons covered 202
Sum Insured Slabs Rs. 5,00,000/-
Total Sum Insured Rs. 101000000/-
Total Sum Insured (in words) Ten Crores And Ten Lakhs only.
Special Conditions

Family Definition Individual Basis - Employee, Spouse and Children Only.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Behala
Date : 31/08/2020 Authorised Signatory
Waiting Period Initial Waiting period of 15 days
Room Rent means the amount charged by a hospital towards
Room and Boarding expenses and shall include the associated
medical expenses.

Intensive Care Unit (ICU) I Intensive Cardiac Care Unit

(lCCU) expenses.

Surgeon, Anesthetist, Medical Practitioner, Consultants,

Specialist Fees whether paid directly to the treating doctor I
surgeon or to the hospital

Anesthesia, blood, oxygen, operation theatre charges, surgical

Room Rent limits including Boarding, Nursing appliances, ventilator charges, medicines and drugs, costs
Charges, etc, towards diagnostics, diagnostic imaging modalities, PPE Kit,
gloves, mask and such similar other expenses.

Road Ambulance subject to a maximum of Rs.2000/- per

hospitalization for the Ambulance services offered by a
Hospital or by an Ambulance service provider, provided that
the Ambulance is availed only in relation to Covid
Hospitalization for which the Company has accepted a claim
under section This also includes the cost of the transportation
of the Insured Person from a Hospital to the another Hospital
as prescribed by a Medical Practitioner.

Treatment in our network hospitals only, However in the case

of Medical Emergencies & Accidents treatment can be taken
in other Hospitals. In all cases immediate intimation shall be
given to our Call Center within 24 hours of Hospitalisation.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Behala
Date : 31/08/2020 Authorised Signatory
 Home Care Treatment means Treatment availed by the Insured
Person at home for Covid on positive diagnosis of Covid in a
Government authorized diagnostic Centre, which in normal
course would require care and treatment at a hospital but is
actually taken at home maximum up to 14 days per incident
provided that:
a) The Medical practitioner advices 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
Home care Treatment Expenses 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 shall be permitted to avail the

services as prescribed by the medical practitioner.
Cashless or reimbursement facility shall be offered
under home care expenses subject to claim settlement
policy disclosed in the website.

e) In case the insured intends to avail the

services of non-network provider claim shall be
subject to reimbursement, a prior approval from the
Insurer needs to be taken before
availing such services.

ln this benefit, the following shall be covered if prescribed by

the treating medical practitioner and is related to treatment of
COVID,
a. Diagnostic tests undergone at home or at
diagnostics centre

b. Medicines prescribed in writing

c. Consultation charges of the medical

practitioner

d. Nursing charges related to medical staff

e. Medical procedures limited to parenteral

administration of medicines

f. Cost of Pulse oximeter, Oxygen cylinder and

Nebulizer.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Behala
Date : 31/08/2020 Authorised Signatory
 Maximum of Rs. 2000/-per hospitalization (Transportation
Ambulance Expenses limits:
from a Hospital to the another Hospital)

Relevant Pre-Hospitalization medical expenses incurred for a

period not exceeding 15 days prior to the date of
hospitalization, for the disease/illness, injury sustained
Pre & Post Hospitalisation limits:
following an admissible claim under the policy.

Post –Hospitalization expenses incurred up to 30 days after

discharge from the hospital.

Hospitalization Expenses incured on treatment of COVID-19

(including the treatment for Co-Morbid conditions) comprising
of room , boarding , nursing expenses , consultant, specialist
Coverage : fees , anesthesia , blood , oxygen , PPE kit , Gloves , mask and
such similar other expenses on Indemnity basis.

Expenses of Hospitalization for a minimum period of 24

consecutive hours only shall be admissible.

After the inception of the Policy , NO midterm inclusion of

any employee unless he/her is a new joinee and dependents
of the already insured employee unless they are newly married
spouse and new born child and such inclusion is also subject to
payment of additional premium on pro rata basis as follows,

- If such addition is happened within 3 months from the date of

Addition / Deletion of Employees
commencement of policy : 9 1/2months premium will be
charged.
- If such addition is happened after 3 months but before 6
months from the date of commencement of policy : 6 1/2
months premium will be charged.
- If such addition is happened after 6 months from the date of
commencement of policy : 3 1/2 months premium will be

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Behala
Date : 31/08/2020 Authorised Signatory
 charged

- Deletion of Employees and Dependants : No refund will be

allowed.

AYUSH Treatment Covered upto the limit of SI

Other Conditions: Claims will be settled by in-house claims team.

All other terms and conditions as per Star Group COVID

Insurance Policy Clause.

Sector Classification

Urban

The cover for the persons covered earlier under the group policy will be granted only as per standard
retail policies. However, in respect of persons who have been covered continuously for a period of
one year under the group policy with our Company, we shall waive the 30 days waiting period and
First year exclusions. In respect of persons who have been covered continuously for a period of two
years under the group policy with our Company, we shall waive the 30 days waiting period, First year
exclusions and First two year exclusions.

In respect of persons who have been continuously covered for a period a four years under the group
policy with our Company, we shall grant cover for Pre Existing diseases also.

Condition precedent: In the event of any claim under the policy or intimation should be given to the
company immediately, through toll free no: 1800 425 2255 or 1800 102 4477, 044 2826 3300 (chargeable),
or email: support@starhealth.in or fax - 1800 425 5522.

STAR value added unique services:
Web enabled service for Policy details and health tips
Inhouse Cashless facility for treatment at network hospitals across
india.
24*7 customer care center
Free General Physician advice

Warranted that in case of dishonour 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, endorsements as per forms
attached.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Behala
Date : 31/08/2020 Authorised Signatory