Star Health And Allied Insurance Company Limited

Date : 26-Sep-2023
To, IMPORTANT

MARUPALLI RAVI .,
Hno-2-48,vi-Mothey, mo-Akbarpet bumpally
Dist-siddipet

Dubbak,Telangana-502108
Mobile : 9618193140

Dear Customer,

Re: Health Insurance Policy - 11240425664100

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 abinitio.

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,

Authorized 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 [Link] 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 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Star Health Assure Insurance Policy

Unique Identification No. SHAHLIP23131V022223
POLICY SCHEDULE
Policy No. : 11240425664100 Previous Policy No :
Customer Code : PI0004196189 GSTIN : 36AAJCS4517L1ZZ
Customer Name : MARUPALLI RAVI . SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : PI0004196189 Issuing Office Code : 131139
Proposer Name : MARUPALLI RAVI . Issuing Office Name : Branch Office - Siddipet
Proposer Address : Hno-2-48,vi-Mothey, mo-Akbarpet Issuing Office Address : H NO. 11-1-153
bumpally 2nd flr
Dist-siddipet Main Road, Near Andhra
Bank
Dubbak Telangana 502108 Siddipet Town Telangana
502103
Phone No : 9618193140 Phone No : 08457-222144
E-mail Id : ravimarupalli1@[Link] E-mail Id : [Link]@[Link]
Proposer GSTIN : NO Place of Supply : Telangana
Proposal date : 26-Sep-2023 Fulfiller Code : SH58935
Date of Inception : 27-Sep-2023
of first policy
Policy Category : New Intermediary : BA0000300610
Collection No : 191530004173
Code
Collection Date : 26-Sep-2023

Premium : Rs. 16,674/-

Name : KARAMPURI SAI RAM

CGST @ 9% : Rs. 1,501/-

Phone No :9177460461/917746046
1
:
SGST @ 9% Rs. 1,501/-
E-mail Id : sairamkarampuri@gm
[Link]
Total Premium : Rs. 19,676/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Nineteen thousand six hundred seventy

six only
PERIOD OF INSURANCE : From : 27-Sep-2023 00:00 To : Midnight Of 26-Sep-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Policy Type : FLOATER Scheme Description : 2A+2C
Basic Floater Sum Insured : Rs. 5,00,000/- Bonus : Rs. 0/-
Sum Insured In Words : Rupees Five lakhs only
Optional Cover (Deductible) : No Deductible : Rs. 0/-

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : CUSTPORTAL
IRDA [Link].129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 9
Email ID: info@[Link]

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11240425664100

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
MARUPALLI RAVI .
1 Male 05-Jul-1982 41 Self PI0004196189 27-Sep-2023

Pre Existing Disease : No PED Declared

MARUPALLI SANDHYA .
2 Female 20-May-1995 28 Spouse ME0436855981 27-Sep-2023

Pre Existing Disease : No PED Declared

MARUPALLI HANVIKA .
3 Female 09-Jun-2019 4 Daughter ME0436855982 27-Sep-2023

Pre Existing Disease : No PED Declared

Baby of SANDHYA .
4 Female 11-Sep-2023 0 Daughter ME0436855983 27-Sep-2023

Pre Existing Disease : No PED Declared

Nominee Details:
Nominee Details for the Proposer Appointee Details
[Link] Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 MARUPALLI Spouse 28 100

SANDHYA
Sector Classification:
Urban

''CONSOLIDATED STAMP DUTY PAID VIDE PROCEEDING NO : GSO5/8221/P/2023 DT:01/08/2023''

Please check whether the details given by you about the insured person(s) 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 Email: support@[Link], 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 - Siddipet on 26th Day of September 2023.

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

Authorised Signatory Page 3 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 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 : 11240425664100 Type of Policy : Assure Insurance-2021

Issue Office : 131139-Branch Office - Siddipet

Address : H NO. 11-1-153

2nd flr
Main Road, Near Andhra Bank
Siddipet Town Telangana 502103

Tel / Fax : 08457-222144

Email : [Link]@[Link]

This is to certify that MARUPALLI RAVI . has paid Rs 19,676/- (Total Premium : Indian Rupees Nineteen
thousand six hundred seventy six only ) towards Premium for Hospitalization Insurance vide Policy No:
11240425664100 for the Period 27-Sep-2023 To 26-Sep-2024 issued on 26-Sep-2023.

Payment received by Payment Gateway vide Receipt No: 191530004173/1 Receipt Date: 26-Sep-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 : 26-Sep-2023 For and on behalf of

Place : Branch Office - Siddipet Star Health and Allied Insurance Company Ltd.

IRDA [Link].129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@[Link]

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

Authorised Signatory Page 4 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Star Health and Allied Insurance

Company Limited
Customer Identity Card
Policy No : 11240425664100

Name DOB Gender Customer id

MARUPALLI RAVI .
05-Jul-1982 Male PI0004196189

MARUPALLI SANDHYA .
20-May-1995 Female ME0436855981

MARUPALLI HANVIKA .
09-Jun-2019 Female ME0436855982

Baby of SANDHYA .
11-Sep-2023 Female ME0436855983

Valid From : 27-Sep-2023 Agent/Broker/TE Code : BA0000300610

Office Code : 131139 TA/SSM/SM Code : SH58935

IRDAI [Link]

Emergency Help Line No.1800 425 2255/1800 102 4477

e-mail : support@[Link] Website : [Link]

Please quote the Customer Id No. for assistance

This Card is valid until otherwise Cancelled.

This ID Card is invalid,if the insurance cover is not in force.
Immediate Intimation to 'Star' through above Tel Nos. is a must in case of
Hospitalisation.

At the time of hospitalisation,kindly submit any Government approved photo ID

Card.

Corporate Identity Number : L66010TN2005PLC056649

*This is a temporary ID card issued along with the policy. Original ID card will be dispatched shortly.

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

Authorised Signatory Page 5 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 362309I000345433 Customer ID : PI0004196189
Invoice Date : 26-Sep-2023 Policy No. : 11240425664100
Recipient Supplier
GSTIN : GSTIN : 36AAJCS4517L1ZZ
Name : MARUPALLI RAVI . Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Siddipet
Address : Hno-2-48,vi-Mothey, mo-Akbarpet Address : H NO. 11-1-153
bumpally
Dist-siddipet 2nd flr
Main Road, Near Andhra Bank
City : Dubbak Pin Code : 502108 City : Siddipet Town Pin Code : 502103

State : Telangana Client : IND State : Telangana Place of : Telangana

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 16,674.00 0 16,674.00 0 1,501.00 1,501.00 0 19,676.00
Services

Total Invoice Value (in Figures) : Rs. 19,676/-

Total Invoice Value (in Words) : Rupees Nineteen thousand six hundred seventy 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 [Link].129 Corporate Identity Number L66010TN2005PLC056649 Email ID: stargst@[Link]

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

Authorised Signatory Page 6 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Name Of the Product Star Health Assure Insurance Policy

Product UIN No. SHAHLIP23131V022223
Summary of Important Benefits
Refer to
[Link] Particulars of Coverage / Benefits Benefit Limits (in Rs.) Policy
clause No.

Sum Insured (in Rs.) 5,00,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 75,00,000 1,00,00,000 2,00,00,000

Room Category
*Associated Medical expenses which vary based on
the room occupied by the insured person will be Up to
considered in proportion to the room rent stated in 1% of
Any room
1 the policy schedule or actuals whichever is less. Sum Any room B. 1
(Except suite or above category)
Proportionate deductions are not applied in respect Insured
of the hospitals which do not follow differential billing per day
or for those expenses in respect of which differential
billing is not adopted based on the room rent.

Surgeon, Anesthetist, Medical Practitioner,

2 Actual B. 2
Consultants, Specialist Fees

Anesthesia, blood, oxygen, operation theatre

3 charges, ICU Charges, Surgical Appliances, Actual B. 3
Medicines and Drugs

4 Day care procedures All Day Care Procedures are Covered B. 4

5 Coverage for Non-medical Items (Consumables) Actual B. 5

6 Emergency Road Ambulance Actual B. 6

7 Air Ambulance Expenses incurred towards the cost of air ambulance service up to 10% of sum insured per policy year B. 7

8 Pre-Hospitalization Expenses Up to 60 days prior to the date of hospitalization B. 8

9 Post-Hospitalization Expenses Up to 180 days from the date of discharge from the hospital B. 9

10 Domiciliary Hospitalization Coverage for medical treatment (Including AYUSH) for a period exceeding three days B. 10

11 Organ Donor Expenses Up to the Sum Insured B. 11

Individual SI 1,500 2,000 4,000 5,000 5,000 5,000 8,000 8,000 8,000
12 Health Checkup Assure B. 12
Floater SI 2,500 5,000 8,000 10,000 10,000 10,000 15,000 15,000 15,000

13 Home Care Treatment Payable up to 10% of the sum insured subject to maximum of Rs.5 lakhs in a policy year B. 13

Expenses for a Delivery including Delivery by Caesarean section (including pre-natal and post natal
14 Delivery Expenses B. 14
expenses) up-to 10% of the Sum Insured is payable

Expenses incurred for list of In Utero Fetal Surgeries and Procedures after the waiting period of 24
15 In Utero Fetal Surgery/Intervention B. 15
months from the date of inception of this policy

Assisted Reproduction Treatment- Limit of Liability

16 1,00,000 2,00,000 2,00,000 2,00,000 2,00,000 4,00,000 4,00,000 4,00,000 4,00,000 B. 16
in a policy year (Rs.)

Hospitalization expenses for treatment of New Born

17 2,00,000 2,00,000 2,00,000 2,00,000 2,00,000 4,00,000 4,00,000 4,00,000 4,00,000 B. 17
Baby- Limit Per Policy Period (Rs.)

18 Treatment for Chronic Severe Refractory Asthma Payable up to 10% of sum insured not exceeding Rs.5 lakhs per policy period B. 18

Expenses by air incurred upto Rs.10,000/- for one immediate family member(other than the travel
19 Compassionate travel B. 19
companion) for travel towards the place where hospital is located

Payable up to Rs.15,000/- in a policy year towards the cost of repatriation of mortal remains of the
20 Repatriation of Mortal Remains insured person (including the cost of embalming and coffin charges) to the residence of the Insured as B. 20
recorded in the policy.

21 Treatment in Valuable service providers network 1% of Sum Insured subject to a maximum of Rs.5,000/- per policy period is payable as lump sum B. 21

Rs.1,000/- per day will be payable for each continuous and completed period of 24 hours of stay in
22 Shared accommodation B. 22
shared accommodation.

23 AYUSH Treatment Payable up to the sum insured. B. 23

24 Second Medical Opinion e_medicalopinion@[Link]. B. 24

25 Coverage for Modern Treatment Upto sum insured B. 25

The insured person will be eligible for Cumulative bonus calculated at 25% of sum insured for each claim
26 Cumulative Bonus B. 26
free year and maximum upto 100% of the sum insured

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

Authorised Signatory Page 7 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

The policy provides automatic restoration of sum insured for unlimited number of times and maximum
27 Automatic Restoration of Sum Insured B. 27
upto 100% each time.

28 Rehabilitation and Pain Management Up to the sub-limit (or) maximum up to 20% of the sum insured whichever is less, per policy year. B. 28

This program intends to promote, incentivize and to reward the Insured Persons' healthy life style
29 Star Wellness Program B. 29
through various wellness activities.

10% of each and every claim amount for fresh as well as renewal policies for insured person whose age
30 Co-payment B. 30
at the time of entry is 61 years and above

Sum Insured Aggregate Deductible Option Discount offered

Rs. 50,000/- 45%

Up to Rs. 20 lakhs
31 Optional Cover to choose deductible Rs. 1,00,000/- 55% B. 31

Rs. 50,000/- 35%

Above Rs. 20 lakhs
Rs. 1,00,000/- 50%

Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.

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

Authorised Signatory Page 8 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129
 Star Health And Allied Insurance Company Limited

Annexure 3A
Forming part of Policy Number : 11240425664100

Covering Flu Vaccination Approved by ICMR under Health Check Up benefit

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 cover without charging additional premium till 31.03.2024:

Cover for Flu Vaccine Approved by ICMR under Health check up benefit as per relevant clause with the same limits
and conditions provided therein.

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

Authorised Signatory Page 9 of 9

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@[Link]
Website :[Link] IRDAI [Link]: 129