DS Policy Schedule 11240321201204 V1.0

Star Health And Allied Insurance Company Limited
Date : 10-Jul-2023
To, IMPORTANT
MR.VANGALA ESHWARA REDDY ,

#126 MARUTHI MANOR FLAT NO 202,NRI LAYOUT-2 MR RICHES GARDEN
RAMAMURTHY NAGAR,
BANGALORE.
Bengaluru Taluk,Karnataka-560043
Mobile : 9916219616
Dear Customer,
Re: Health Insurance Policy - 11240321201204
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 6
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@starhealth.in
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 :Mon Jul 10 02:51:36 IST 2023
Family Health Optima Insurance Plan

Unique Identification No. SHAHLIP23164V072223
POLICY SCHEDULE
Policy No. : 11240321201204 Previous Policy No : P/141115/01/2023/004211
Customer Code : 11725105 GSTIN : 29AAJCS4517L1ZU
Customer Name : MR.VANGALA ESHWARA REDDY SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 11725105 Issuing Office Code : 141115
Proposer Name : MR.VANGALA ESHWARA REDDY Issuing Office Name : Branch Office - Malleswaram
Proposer Address : #126 MARUTHI MANOR FLAT NO Issuing Office Address : No.48/2,1st floor, 8th Main
202,NRI LAYOUT-2 MR RICHES 13th Cross,Diagonal Opp to
GARDEN Canara Union
RAMAMURTHY NAGAR, Malleswaram
BANGALORE. Bengaluru City Karnataka
Bengaluru Taluk Karnataka 560043 560003
Phone No : 9916219616 Phone No : 080-48534002/3/9
E-mail Id : eswarvreddy@gmail.com E-mail Id : malleswaram.bangalore@star
health.in
Proposer GSTIN : NO Place of Supply : Karnataka
Proposal date : 13-Jul-2019 Fulfiller Code : SO141115
Date of Inception : 13-Jul-2019
of first policy
Policy Category : Fourth Year Intermediary : BA0000040354
Collection No : 191032004398
Code
Collection Date : 10-Jul-2023
Base Product Premium : Rs. 20,588/- Name : D R JAVARE GOWDA
No Claim Discount : Rs. 1,029/-
Loading (Star Extra : Rs. 3,088/-

Protect)
Discount (Star Extra : Rs. 4,735/-
Protect)
Premium : Rs. 17,912/-
CGST @ 9% : Rs. 1,612/-

Phone No :9845558287
:
SGST @ 9% Rs. 1,612/-
E-mail Id : javaregowda64@gmail.
com
Total Premium : Rs. 21,136/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Twenty One thousand one hundred thirty
six only
PERIOD OF INSURANCE : From : 13-Jul-2023 00:00 To : Midnight Of 12-Jul-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Scheme Description (Family Size) :2A+1C Basic Floater Sum Insured :Rs. 10,00,000/-
Bonus : Rs. 5,50,000/- Limit of Coverage : Rs. 15,50,000/- Recharge Benefit : Rs. 1,50,000/-
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 6
Email ID: info@starhealth.in
Attached to and forming part of Policy No: 11240321201204

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
MR.VANGALA ESWARA REDDY
1 Male 03-Jul-1978 45 Self 11725105-1 13-Jul-2019
Pre Existing Disease : No PED Declared

MRS.B.ANNAPURNAMMA
2 Female 20-Jun-1987 36 Spouse 11725105-2 13-Jul-2019

MR. VANGALA DARAHAS REDDY
3 Male 14-Jan-2010 13 Son 11725105-3 13-Jul-2019
Star Extra Protect - Add on Cover (UIN NO.: SHAHLIA23061V012223 )

Section(s) Opted : Section-I : Yes Section-II : Yes
For Section II (Aggregate Deductible Limit Opted) : Rs.50,000/-
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 MRS. Spouse 36 100

ANNAPURNAMMA
Sector Classification:
Urban
''CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE ORDER NO. NO IG0223003027565328 DT
14.02.2023''
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: support@starhealth.in, 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 - Malleswaram on 10th Day of July 2023.
Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Policy No : 11240321201204 Type of Policy : Family Health Optima Insurance

- 2022
Issue Office : 141115-Branch Office - Malleswaram
Address : No.48/2,1st floor, 8th Main

13th Cross,Diagonal Opp to Canara Union
Malleswaram
Bengaluru City Karnataka 560003
Tel / Fax : 080-48534002/3/9
Email : malleswaram.bangalore@starhealth.in
This is to certify that MR.VANGALA ESHWARA REDDY has paid Rs 21,135/- (Total Premium : Indian
Rupees Twenty One thousand one hundred thirty five only ) towards Premium for Hospitalization Insurance
vide Policy No: 11240321201204 for the Period 13-Jul-2023 To 12-Jul-2024 issued on 10-Jul-2023.
Payment received by Payment Gateway vide Receipt No: 191032004398/1 Receipt Date: 10-Jul-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 : 10-Jul-2023 For and on behalf of
Place : Branch Office - Malleswaram Star Health and Allied Insurance Company Ltd.
IRDA Regn.No.129
Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory
Email ID: info@starhealth.in
Tax Invoice
Invoice No. : 292307I000770493 Customer ID : 11725105
Invoice Date : 10-Jul-2023 Policy No. : 11240321201204
Recipient Supplier
GSTIN : GSTIN : 29AAJCS4517L1ZU
Name : MR.VANGALA ESHWARA REDDY Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Malleswaram
Address : #126 MARUTHI MANOR FLAT NO Address : No.48/2,1st floor, 8th Main
202,NRI LAYOUT-2 MR RICHES
RAMAMURTHY NAGAR, 13th Cross,Diagonal Opp to Canara Union
BANGALORE. Malleswaram
City : Bengaluru Pin Code : 560043 City : Bengaluru City Pin Code : 560003
Taluk
State : Karnataka Client : IND State : Karnataka Place of : Karnataka

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 17,912.00 0 17,912.00 0 1,612.00 1,612.00 0 21,136.00
Services
Total Invoice Value (in Figures) : Rs. 21,136/-

Total Invoice Value (in Words) : Rupees Twenty One thousand one hundred thirty six 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: stargst@starhealth.in
Name Of the Product Star Extra Protect – Add on Cover

Product UIN No. SHAHLIA23061V012223
Summary of Important Benefits
Refer to
S.No Particulars of Coverage / Benefits Benefit Limits (in Rs.)
Policy clause No.
10 to 20 Lakh Above 20 Lakh
(as per base policy) (as per base policy)
1 Enhanced Room Rent Any Room (Except for C Section – I (1)

suite room and above
Any Room
the category of suite
room)
If there is an admissible claim under In-

CLAIM GUARD (Coverage for Non- patient/Day Care Treatment, under the base
2 C Section – I (2)
medical Items (Consumables)) policy, then the expenses of the items as per
List I will become payable.
The procedures covered under the Base policy
Enhanced Limit for Modern with sub-limits are covered up to sum insured
3 C Section – I (3)
treatments of the base policy.
Medical expenses for In-patient Hospitalization
incurred on treatment under Ayurveda, Unani,
4 Enhanced Limit for Ayush treatment Siddha and Homeopathy systems of medicines C Section – I (4)
in a AYUSH Hospital is payable up to sum
insured of the Base Policy.
Payable up to 10% of sum insured of the base

policy, subject to maximum of Rs.5 lakh in a
5 Home care treatment policy year, for treatment availed by the C Section – I (5)
insured person at home, only for the specified
conditions.
Cumulative bonus available under base policy
6 Bonus Guard will not be reduced at renewals unless the C Section – I (6)
bonus is utilized.
If the insured chooses any of the deductibles,
Option to choose aggregate the Company will provide discount on
7 C Section – II (1)
deductible premium.
Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings
attached.

DS Policy Schedule 11240321201204 V1.0

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Star Health And Allied Insurance Company Limited

MR.VANGALA ESHWARA REDDY ,

Re: Health Insurance Policy - 11240321201204

With kind regards,

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

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

Family Health Optima Insurance Plan

Loading (Star Extra : Rs. 3,088/-

CGST @ 9% : Rs. 1,612/-

Corporate Identity Number L66010TN2005PLC056649

Attached to and forming part of Policy No: 11240321201204

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Star Extra Protect - Add on Cover (UIN NO.: SHAHLIA23061V012223 )

1 MRS. Spouse 36 100

Authorised Signatory Page 3 of 6

Hospitalisation Benefit Policy

Policy No : 11240321201204 Type of Policy : Family Health Optima Insurance

Address : No.48/2,1st floor, 8th Main

Tel / Fax : 080-48534002/3/9

Date : 10-Jul-2023 For and on behalf of

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

Authorised Signatory Page 4 of 6

State : Karnataka Client : IND State : Karnataka Place of : Karnataka

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Invoice Value (in Figures) : Rs. 21,136/-

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

Authorised Signatory Page 5 of 6

Name Of the Product Star Extra Protect – Add on Cover

1 Enhanced Room Rent Any Room (Except for C Section – I (1)

If there is an admissible claim under In-

Payable up to 10% of sum insured of the base

Authorised Signatory Page 6 of 6

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