Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Certificate of Insurance
STAR GROUP HEALTH INSURANCE POLICY FOR BANK CUSTOMERS
Unique id : SHAHLGP21290V022021
Master Policy No P/900000/01/2024/000541
Certificate No. P/171215/01/2024/005540
Account Number 29500100028326
Previous Certificate No. P/171215/01/2023/014023
Name and Address of the Account Holder cum
Insured Person
JITENDRABHAI JOSHI
7 , HAPPY BUNGLOWS , NR. DPS SCHOOL
G.E.B. ROAD , BOPAL-GHUMA , AHMEDABAD
Ahmedabad-380058
Gujarat
Contact No : 9974791265
Email ID : joshiaruna539@[Link]
Fulfiller Code : SO171215
Name and Address of the Proposer M/[Link] OF BARODA
Baroda Corporate Centre, Plot No. C-26,
Block G, Bandra Kurla Complex,
Bandra (East)
Mumbai-400051
Maharashtra
Details of Insured Person(s)
Name of the Insured Gender Date of Birth Relation with
[Link] Sum Insured Premium ID Card No
Person the Member
1 JITENDRABHAI M 08/08/1957 Self 500000 11931 148619480121
JOSHI 86626
Pre- existing disease: Diabetes Mellitus and its complications
Details of Dependent
Relation with ID Card No
[Link] Name of the Insured Person Gender Date of Birth
the Member
1 ARUNABEN JOSHI F 06/10/1960 SPOUSE 14861948012186627
Pre- existing disease: NIL
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Period of Insurance From : 21/02/2024 To : 20/02/2025
Scheme Description : 2A
Total Sum Insured (Rs.) Rs.500000 /-
Premium Rs. 11931 /-
Premium Details GST Rs. 2148 /-
Total Rs. 14079 /-
Nominee Details
Age of the Appointee Appointee Appointee
[Link] Name of the Nominee Nominee Relation with
Gender ( if Minor) Age Relation
the Member
1 ARUNABEN JOSHI F 63 SPOUSE
Coverage Details
Eligible Room Category
Sum Insured Rs Limit Rs
2,00,000/- Up to 2,000/- per day
3,00,000/- & 4,00,000/- Up to 5,000/- per day
5,00,000/ - to 25,00,000/- Single Standard A/C Room
Expenses relating to hospitalization will be considered in proportion to the eligible room category stated in the policy or
actual whichever is less.
b. Cataract: Expenses incurred on treatment of Cataract is subject to the limit as per the following table
Sum Insured Rs Limit per eye Rs. Limit per policy period Rs.
2,00,000/- Up to 12,000/-per eye, per policy period
3,00,000/- Up to 25,000/- Up to 35,000/-
4,00,000/- Up to 30,000/- Up to 45,000/-
5,00,000/- & 7,00,000/- Up to 40,000/- Up to 60,000/-
10,00,000/- to 25,00,000/- Up to 50,000/- Up to 75,000/-
[Link] hospitalization expenses up to 60 days prior to date of admission
[Link] hospitalization expenses up to 90 days after date of discharge
[Link] Ambulance expenses up to Rs.750 per hospitalization & maximum of Rs.1500 during entire period of
insurance
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
[Link] Restoration of Sum Insured: There shall be automatic restoration of the Sum Insured immediately upon
exhaustion of the Sum Insured, which has been defined, during the policy period upto 25% of the Sum Insured.
Restoration will operate only after the exhaustion of the sum insured.
It is made clear that such restored Sum Insured can be utilized only for illness / disease unrelated to the illness / diseases
for which claim/s was / were made. The unutilized restored sum insured cannot be carried forward.
Note: Automatic Restoration of Basic Sum Insured is available only for sum insured options of Rs.3,00,000/- and above.
Not applicable for Sum Insured of Rs.2,00,000/-.
[Link] day care treatment covered
[Link] Donor Expenses for organ transplantation where the insured person is the recipient are payable provided the
claim for transplantation is payable and subject to the availability of the sum insured. Donor screening expenses and
post-donation complications of the donor are not payable. This cover is subject to a limit of 10% of the sum insured or
Rs.1 lakh whichever is less.
[Link] Treatment: In-patient hospitalization expenses incurred on treatment under Ayurveda, Unani, Sidha and
Homeopathy systems of medicines in a Government Hospital or in any institute recognized by the government and / or
accredited by the Quality Council of India / National Accreditation Board on Health is payable up to the limits given below:
Note: Payment under this benefit forms part of the sum insured.
Sum Insured Rs Limit per policy period Rs.
Up to 4,00,000/- Up to 10,000/-
5,00,000/- to 15,00,000/- Up to 15,000/-
20,00,000/- and 25,00,000/ Up to 20,000/-
Cost of Health Checkup: Expenses incurred towards cost of health check-up up to the limits mentioned in the table given
below for every claim free year provided the health checkup is done at network hospitals and the policy is in force. Payment
under this benefit does not form part of the sum insured. If a claim is made by any of the insured persons, the health check
up benefits will not be available under the policy for the other covered members of the family of that insured person who
has made a claim.
Note : Payment of expenses towards cost of health check up will not prejudice the company's right to deal with a claim in
case of non disclosure of material fact and / or Pre-Existing Diseases in terms of the policy.
Sum Insured (Rs.) Limit Per Policy Period (Rs.)
2,00,000/- Not Available
3,00,000/- Up to 750/-
4,00,000/- Up to 1,000/-
5,00,000/- Up to 1,500/-
7,00,000/- Up to 1,750/-
10,00,000/- Up to 2,000/-
15,00,000/- Up to 2,500/-
20,00,000/- Up to 3,000/-
25,00,000/- Up to 3,500/-
Air Ambulance charges up to 10% of the sum insured, provided that
1. It is for life threatening emergency health condition/s of the insured person which requires immediate and rapid ambulance
transportation to the hospital/medical centre that ground transportation cannot provide.
2. Necessary medical treatment not being available at the location where the Insured Person is situated at the time of
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Emergency
3. It is prescribed by a Medical Practitioner and is Medically Necessary;
4. The insured person is in India and the treatment is in India only
5. Such Air ambulance should have been duly licensed to operate as such by Competent Authorities of the Government/s.
Note: This benefit is available for sum insured options of Rs.5,00,000/- and above only.
All other terms and conditions as per Star Group Health Insurance Policy For Bank Customers Policy Clause.
Exclusions: The Company shall not be liable to make any payments under this policy in respect of any expenses what
so ever incurred by the insured person in connection with or in respect of:
[Link] disease contracted by the insured person during the first 30 days from the commencement date of the policy.
[Link] the first year of continuous operation of Insurance Policy, any expenses on
a)During the first year of operation of the Insurance cover, the expenses on treatments (conservative, interventional,
laparoscopic and open) related to Hepato-pancreato-biliary diseases including Gall bladder and Pancreatic calculi, all
types of management for kidney and genitourinary tract calculi., all Diseases of Prostate, all types of Hernia,,
Hydrocele, Congenital Internal disease/defect anomalies (Except to the extent covered under Newborn Baby Cover if
specifically opted) Pilonidal sinus and Fistula / Fissure in ano, Piles, Sinusitis and related disorders, If these are Pre-
Existing at the time of proposal they will be covered subject to exclusion number 4 mentioned below.
b)Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to
Thyroid, Prolapse of intervertebral disc (other than caused by accident), Varicose veins and Varicose ulcers, all
Stricture Urethra, all Obstructive Uropathies, Epididymal Cyst, Benign Tumours of Epididymis, Spermatocele,
Varicocele, Hemorrhoids, Rectal Prolapse, Stress Incontinence.
c)Desmoid tumour of anterior abdominal wall.
d)All treatments (conservative, interventional, laparoscopic and open) related to all Diseases of Uterus, Fallopian tubes,
Cervix and Ovaries, Uterine bleeding, Pelvic Inflammatory Diseases, Benign breast diseases, Umbilical sinus, Umbilical
fistula.
e)Conservative, operative treatment and all types of intervention for Diseases related to Tendon, Ligament, Fascia,
Bones and Joint Including Arthroscopy and Arthroplasty [other than caused by accident]
f)Degenerative disc and Vertebral diseases including Replacement of bones and joints and Degenerative diseases of
the Musculo-skeletal system
g)Subcutaneous Benign lumps, Sebaceous cyst, Dermoid cyst, Mucous cyst lip / cheek, Carpal tunnel syndrome,
Trigger finger, Lipoma , Neurofibroma, Fibroadenoma, Ganglion and similar pathology
h)Any transplant and related surgery
Note : If these are pre-existing at the time of proposal, they will be covered subject to exclusion number 3 mentioned
below
[Link] Existing Diseases as defined in the policy until 36 consecutive months of continuous coverage have elapsed
under this Star Group Health Insurance Policy For Bank Customers since inception of the first policy with the Company.
[Link] : In the event of this Star Group Health Insurance Policy For Bank Customers not being renewed or when the
Individual member of the group leaves the group on account of resignation / retirement / termination or otherwise, such
individual member has the option to migrate to any individual health insurance policy on indemnity basis offered by the
Company. In such an event the continuity of benefits with respect to waiting periods under exclusions 1, 2, and 3 will be
given in the individual health insurance policy according to the number of years covered continuously under this Star
Group Health Insurance Policy For Bank Customers Circumcision, Preputioplasty, Frenuloplasty, Preputial Dilatation
and Removal of SMEGMA, Inoculation or Vaccination (except for post-bite treatment and for medical treatment other
than for prevention of diseases)
[Link] External diseases/condition defects or anomalies
[Link] treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization. (Dental
implants are not payable)
[Link], general debility, run-down condition or rest cure, Nutritional deficiency states, Psychiatric, mental and
behavioral disorders, Venereal disease and Sexually transmitted diseases, intentional self injury and use of intoxicating
drugs / alcohol, smoking and tobacco chewing
[Link]/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy,
warlike operations (whether war be declared or not)
[Link] or disease directly or indirectly caused by or contributed to by nuclear weapons/materials
[Link] arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these
(other than ectopic pregnancy), family planning treatment and all types of treatment for infertility and its complications
thereof.
[Link] incurred on weight control services including surgical procedures for treatment of obesity, medical
treatment for weight control, treatment for endocrine disorders, treatment for sleep apnea
[Link] incurred on High Intensity Focused Ultra Sound, Uterine fibroid embolisation, Balloon Sinoplasty,
Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain Stimulation,
Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low level laser therapy,
Photodynamic therapy and such other therapies similar to those mentioned herein under exclusion no12
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
[Link] incurred on Lasik Laser or Refractive Error Correction and its complications all treatment for disorders of
eye requiring intra-vitreal injections and related procedures.
[Link] incurred at Hospital or Nursing Home primarily for diagnostic, Radiology or laboratory Tests not consistent
with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury,
for which confinement is required at hospital/nursing home.
[Link] on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending
Physician.
[Link] Treatment, unconventional, untested, unproven, experimental therapies.
[Link] cell Therapy, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection
therapy. Immunotherapy without proper indication.
[Link] Chemotherapy, Immuno therapy and Biologicals, except when administered as an in-patient, when clinically
indicated and hospitalization warranted.
[Link] registration charges, admission charges, record charges, telephone charges and such other charges
[Link] of sex or cosmetic or aesthetic treatment of any description, plastic surgery (other than as necessitated due
to an accident or as a part of any illness), all treatment for Priapism and erectile dysfunctions.
[Link] of spectacles and contact lens, hearing aids, Cochlear implants and procedures, walkers and crutches, wheel
chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar aids.
[Link] expenses as detailed in the website " [Link]"
IMPORTANT: The insurance coverage is subject to terms, conditions, exclusions stated in the master policy
<<P/900000/01/2024/000541>> available with the group administrator / proposer.
Claim Procedure
In the event of any claim, intimation should be given to Star Health immediately, through toll free no: 1800 425 2255 or
1800 102 4477, or email: support@[Link] or fax - 1800 425 5522.
For Cashless Treatment:
[Link] the 24 hour toll free no. for assistance - 1800 425 2255 / 1800 102 4477
[Link] the ID number for easy reference
[Link] admission in the hospital, produce the ID Card issued by Star Health at the Hospital Helpdesk
[Link] the Pre-authorisation Form from the Hospital Help Desk, complete the Patient Information and resubmit to the
Hospital Help Desk.
[Link] Treating Doctor will complete the hospitalisation/ treatment information and the hospital will fill up expected cost of
treatment.
[Link] form should be submitted to Star Health
[Link] Health will process the request and call for additional documents/ clarifications if the information furnished is
inadequate.
[Link] all the details are furnished, Star Health will process the request as per the terms and conditions as well as the
exclusions therein and either approve or reject the request based on the merits.
[Link] case of emergency hospitalization information to be given within 24 hours after hospitalization
[Link] facility can be availed only in Networked Hospitals. Please visit [Link] for information on Networked
Hospitals.
[Link] non-network hospitals payment must be made up-front and then reimbursement will be effected on submission of
documents
Please note that denial of cashless is in no way to be construed as denial of treatment or denial of coverage. The Insured
Person can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
Documents to be submitted for Reimbursement claims:
[Link] completed claim form, and
[Link] Admission investigations and treatment papers.
[Link] Summary from the hospital in original
[Link] receipts from hospital, chemists
[Link] receipts and reports for tests done
[Link] from doctors, surgeons, anesthetist
[Link] from the attending doctor regarding the diagnosis.
[Link] of PAN Card
Note: Star Health reserves the right to call for additional documents wherever required.
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Permanent Exclusion Details Of Insured Person
Insured Name ID Card Permanent Exclusion Disease
Permanent Exclusion Details Of Dependent
Insured Name ID Card Permanent Exclusion Disease
Star Health and Allied Insurance
Company Limited
Customer Identity Card
Policy No. : P/900000/01/2024/000541 Valid From: 21/02/2024
Certificate No: P/171215/01/2024/005540
[Link]. Name Age(Yrs) Relationship Sum Insured ID Card No
1 JITENDRABHAI 66 Self 500000 14861948012186626
JOSHI
IRDAI Regn. No:129
Emergency Help Line No. 1800 425 2255 or 1800 102 4477
e-mail : support@[Link] Website : [Link]
Please quote the Customer Id No. for assistance
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 hospitalization, kindly submit any Government
approved photo ID Card.
Personal and Caring
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Star Health and Allied Insurance
Company Limited
Dependent Identity Card
Policy No. : P/900000/01/2024/000541 Valid From: 21/02/2024
Certificate No: P/171215/01/2024/005540
[Link]. Name Age(Yrs) Relationship ID Card No
1 ARUNABEN JOSHI 63 SPOUSE 14861948012186627
IRDAI Regn. No:129
Emergency Help Line No. 1800 425 2255 or 1800 102 4477
e-mail : support@[Link] Website : [Link]
Please quote the Customer Id No. for assistance
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 hospitalization, kindly submit any Government
approved photo ID Card.
Personal and Caring
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai - 600034.
Phone : 044 - 28288800 Telefax : 044 - 28260062 Website :
IRDA Registration No : 129 ; Corporate Identity Number : L66010TN2005PLC056649
[Link]
Hospitalisation Benefit Policy
Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Policy No : P/171215/01/2024/005540 Type of Policy : Star Group Health Insurance
Issue Office : Branch Office - Navrangpura Policy For Bank Customers -
Certificate
Address : 4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Tel / Fax : 079 - 40049240/41 / 079-40049243
Email : [Link]@[Link]
This is to certify that JITENDRABHAI JOSHI has paid Rs.14079 /-( Rupees: Fourteen Thousand Seventy-Nine Only ) towards
Premium for Hospitalization Insurance vide Policy No: P/171215/01/2024/005540 for the Period 21/02/2024 To 20/02/2025
issued on 21-FEB-24
Payment received by Cheque/Credit/Debit Card vide Receipt No: 1198013261 Receipt Date: 21/02/2024
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.
Issue Office Address: For Star Health and Allied Insurance Co., Ltd.,
4th Floor, 45,Viva-III, Shrimali Society,
Near Navrangpura Police Station, Mithakhali Six
Road
Navrangpura, Ahmedabad, Ahmedabad-380009
Ahmedabad Authorised Signatory.
Date: 21/02/2024
