Star Health And Allied Insurance Company Limited

Date : 25-Jan-2023
To, IMPORTANT

JEYAVEL MUNUSAMY ,
NO:9 , OLD HOSPITAL STREET, TIRUTTANI
THIRUVALLUR

Tiruttani Taluka,Tamil Nadu-631209

Mobile : 8884667411

Dear Customer,

Re: Health Insurance Policy - 11220015627602

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 :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 :Fri Nov 03 08:29:47 IST 2023
 Star Health And Allied Insurance Company Limited

Family Health Optima Insurance Plan

Unique Identification No. SHAHLIP22030V062122

In Consideration of payment of Rs. 34,456/- towards renewal premium of policy

number:11220015627601, the policy stands renewed for a further period of 1 Year as per the details
given below

Renewal Endorsement No:11220015627602

Customer Code : 20439625 GSTIN : 33AAJCS4517L1Z5
Customer Name : JEYAVEL MUNUSAMY SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 20439625 Issuing Office Code : 700001
Proposer Name : JEYAVEL MUNUSAMY Issuing Office Name : Chennai - TS
Proposer Address : NO:9 , OLD HOSPITAL STREET, Issuing Office Address : No.289, 2nd & 3rd Floor,
TIRUTTANI West Sivan Koil Street,
THIRUVALLUR Vadapalani
Chennai Tamil Nadu 600026
Tiruttani Taluka Tamil Nadu
631209
Phone No : 8884667411 Phone No : 044-47686041
E-mail Id : vigneshr.voip@gmail.com E-mail Id : telesupport@starhealth.in
Proposer GSTIN : NO Place of Supply : Tamil Nadu
Proposal date : 20-Feb-2021 Fulfiller Code : SO700001
Date of Inception : 20-Feb-2021
of first policy
Renewal Year : Second Year
Collection No : 181137067483,191137006341,19
1137032535,700001/RV/2024/00
79058483
Collection Date : 03-May-2023,03-Nov-2023,21-
Aug-2023,25-Jan-2023

Premium : Rs. 29,200/-

Name : Office Direct

CGST @ 9% : Rs. 2,628/-

Phone No :044-47686041
:
SGST @ 9% Rs. 2,628/-
E-mail Id : telesupport@starhealt
h.in
Total Premium : Rs. 34,456/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Thirty Four thousand four hundred fifty six
only
PERIOD OF INSURANCE : From : 20-Feb-2023 00:00 To : Midnight Of 19-Feb-2024
Installment Facility Option:Yes Premium Payment Frequency :Quarterly Installment Amount Rs. : 8,614/-

Basic Floater Sum Insured : Rs. 5,00,000/- Scheme Description : 2A

In Words : Rupees Five lakhs only
Bonus : Rs. 1,75,000/- Limit of Coverage : Rs. 6,75,000/- Recharge Benefit : Rs. 1,50,000/-

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

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
Email ID: info@starhealth.in

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
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11220015627602

Details of Insured Persons :
Sl. Age in Relationship with Co- Inception
Name of the Insured Gender Date of Birth ID Card No
no. Yrs Proposer Pay date
JEYAVEL MUNUSAMY
1 Male 12-Dec-1957 65 Self 20439625-1 20 20-Feb-2021

Pre Existing Disease : Diabetes Mellitus and its complications

KALA JEYAVEL
2 Female 20-Oct-1962 60 Spouse 20439625-2 NA 20-Feb-2021

Pre Existing Disease : No PED Declared

Installment Schedule :

Installment Cycle No Installment Payment Amount Installment Due Date Installment Status
1 8,614 20-Feb-2023 Paid
2 8,614 20-May-2023 Paid
3 8,614 20-Aug-2023 Paid
4 8,614 20-Nov-2023 Paid

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 KALA JEYAVELU Spouse 60 100

Sector Classification:
Urban

''CONSOLIDATED STAMP DUTY PAID VIDE G.O.(RT) NO.244 DATED.2ND JUNE 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).
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.
It is hereby made clear that all terms, conditions, clauses, warranties, exclusions etc., as already issued, forming
part of the policy of insurance originally issued at the time of inception of this relationship, shall continue to be
operative and unaltered, forming part of this renewal insurance cover also.

Reference may be made to those terms, conditions etc., for identifying the scope/extent of coverage.

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

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 :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Chennai
- TS on 25th Day of January 2023.

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

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 :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : 11220015627602 Type of Policy : Family Health Optima Insurance

Plan - 2021
Issue Office : 700001-Chennai - TS

Address : No.289, 2nd & 3rd Floor,

West Sivan Koil Street,
Vadapalani
Chennai Tamil Nadu 600026

Tel / Fax : 044-47686041

Email : telesupport@starhealth.in

This is to certify that JEYAVEL MUNUSAMY has paid Rs 8,614/- (Total Premium : Indian Rupees Eight
thousand six hundred fourteen only ) towards Premium for Hospitalization Insurance vide Policy No:
11220015627602 for the Period 20-Feb-2023 To 19-Feb-2024 issued on 25-Jan-2023.

Payment received by Payment Gateway vide Receipt No: 700001/RV/2024/0079058483/1 Receipt

Date: 03-Nov-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 : 03-Nov-2023 For and on behalf of

Place : Chennai - TS Star Health and Allied Insurance Company Ltd.

IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

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

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 :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129