Star Health and Allied Insurance Company Limited: R Margabandhu

Star Health And Allied Insurance Company Limited
Date : 09-Aug-2023
To, IMPORTANT
SUNIL TIKARAM BAVISKAR ,

A/103 GAJANAN MAHARAJ NAGAR AGRA ROAD NEAR GAJANAN MAHARAJ
TEMPLE
KALYAN WEST
Kalyan Tehsil,Maharashtra-421301
Mobile : 9619708827
Dear Customer,
Re: Health Insurance Policy - 11240353692605
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 :Wed Aug 09 21:47:15 IST 2023
Family Health Optima Insurance Plan

Unique Identification No. SHAHLIP23164V072223
POLICY SCHEDULE
Policy No. : 11240353692605 Previous Policy No : P/171117/01/2023/011221
Customer Code : 9640301 GSTIN : 27AAJCS4517L1ZY
Customer Name : SUNIL TIKARAM BAVISKAR SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 9640301 Issuing Office Code : 171117
Proposer Name : SUNIL TIKARAM BAVISKAR Issuing Office Name : Branch Office - Dombivali
Proposer Address : A/103 GAJANAN MAHARAJ NAGAR Issuing Office Address : 1st Floor, Ketkar Residency,
AGRA ROAD NEAR GAJANAN Off Phadke Road,Dombivali
MAHARAJ TEMPLE East.Landmark - Karur Vyasa
KALYAN WEST Bank and Municipal Library
Dombivali
Kalyan Tehsil Maharashtra 421301 Kalyan Tehsil Maharashtra
421201
Phone No : 9619708827 Phone No :
E-mail Id : baviskarsunil22@gmail.com E-mail Id : dombivali.mumbai@starhealt
h.in
Proposer GSTIN : NO Place of Supply : Maharashtra
Proposal date : 06-Aug-2018 Fulfiller Code : SH20807
Date of Inception : 07-Aug-2018
of first policy
Policy Category : Fifth Year Intermediary : BA0000158141
Collection No : 191191014236
Code
Collection Date : 09-Aug-2023
Base Product Premium : Rs. 29,915/- Name : Mr.ASHOK B SHISVE
No Claim Discount : Rs. 1,496/-
Premium : Rs. 28,419/-
CGST @ 9% : Rs. 2,558/-

Phone No :9920619395
:
SGST @ 9% Rs. 2,558/-
E-mail Id : ashokshisve@gmail.co
m
Total Premium : Rs. 33,535/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Thirty Three thousand five hundred thirty
five only
PERIOD OF INSURANCE : From : 13-Aug-2023 00:00 To : Midnight Of 12-Aug-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
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: 11240353692605

Scheme Description (Family Size) :2A+2C Basic Floater Sum Insured :Rs. 5,00,000/-
Bonus : Rs. 3,25,000/- Limit of Coverage : Rs. 8,25,000/- Recharge Benefit : Rs. 1,50,000/-
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
SUNIL TIKARAM BAVISKAR
1 Male 23-Mar-1974 49 Self 9640301-1 07-Aug-2018
Pre Existing Disease : No PED Declared

VAISHALI SUNIL BAVISKAR
2 Female 12-Oct-1984 38 Spouse 9640301-2 07-Aug-2018

JATASYA SUNIL BAVISKAR
3 Male 02-Aug-2012 11 Son 9640301-3 07-Aug-2018

KSHITIJ SUNIL BAVISKAR
4 Male 11-Nov-2014 8 Son 9640301-4 07-Aug-2018
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 VAISHALI SUNIL Spouse 39 100

BAVISKAR
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: 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 - Dombivali on 09th Day of August 2023.
Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Policy No : 11240353692605 Type of Policy : Family Health Optima Insurance

- 2022
Issue Office : 171117-Branch Office - Dombivali
Address : 1st Floor, Ketkar Residency,

Off Phadke Road,Dombivali East.Landmark - Karur Vyasa Bank and Municipal Library
Dombivali
Kalyan Tehsil Maharashtra 421201
Tel / Fax :
Email : dombivali.mumbai@starhealth.in
This is to certify that SUNIL TIKARAM BAVISKAR has paid Rs 33,535/- (Total Premium : Indian
Rupees Thirty Three thousand five hundred thirty five only ) towards Premium for Hospitalization Insurance
vide Policy No: 11240353692605 for the Period 13-Aug-2023 To 12-Aug-2024 issued on 09-Aug-2023.
Payment received by Payment Gateway vide Receipt No: 191191014236/1 Receipt Date: 09-Aug-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 : 09-Aug-2023 For and on behalf of
Place : Branch Office - Dombivali 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. : 272308I000747095 Customer ID : 9640301
Invoice Date : 09-Aug-2023 Policy No. : 11240353692605
Recipient Supplier
GSTIN : GSTIN : 27AAJCS4517L1ZY
Name : SUNIL TIKARAM BAVISKAR Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Dombivali
Address : A/103 GAJANAN MAHARAJ NAGAR Address : 1st Floor, Ketkar Residency,
AGRA ROAD NEAR GAJANAN MAHARAJ
TEMPLE
KALYAN WEST Off Phadke Road,Dombivali East.Landmark -
Karur Vyasa Bank and Municipal Library
Dombivali
City : Kalyan Tehsil Pin Code : 421301 City : Kalyan Tehsil Pin Code : 421201
State : Maharashtra Client : IND State : Maharashtra Place of : Maharashtra

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 28,419.00 0 28,419.00 0 2,558.00 2,558.00 0 33,535.00
Services
Total Invoice Value (in Figures) : Rs. 33,535/-

Total Invoice Value (in Words) : Rupees Thirty Three thousand five hundred thirty 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
"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
Annexure 1A
Forming part of Policy Number : 11240353692605
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

SUNIL TIKARAM BAVISKAR ,

Re: Health Insurance Policy - 11240353692605

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

Premium : Rs. 28,419/-

CGST @ 9% : Rs. 2,558/-

Corporate Identity Number L66010TN2005PLC056649

Attached to and forming part of Policy No: 11240353692605

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

1 VAISHALI SUNIL Spouse 39 100

Authorised Signatory Page 3 of 6

Hospitalisation Benefit Policy

Policy No : 11240353692605 Type of Policy : Family Health Optima Insurance

Address : 1st Floor, Ketkar Residency,

Date : 09-Aug-2023 For and on behalf of

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

Authorised Signatory Page 4 of 6

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

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Invoice Value (in Figures) : Rs. 33,535/-

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

Authorised Signatory Page 5 of 6

List of Conditions covered under Home care treatment

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

Authorised Signatory Page 6 of 6

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