FAMILY HEALTH OPTIMA INSURANCE POLICY - SCHEDULE
Policy No.
Proposer's Code
Proposer's Name
Address
Phone No
E-mail id
Previous Policy No.
: 3629867
Issuing Office Code
700002
: ASHWANI KUMAR RAI
: E-48 A KUNWAR SINGH NAGAR
NANGLOI
NEAR NILOTHI MOR
Issuing Office Name
Address
Online Business
No:111-112,Gokul Arcade-A 1st Floor
Sahar Road Vile Parle(East)
Mumbai - 400057
ONLINE BUSINESS
:
:
P/700002/01/2015/007530
New Delhi,West,Delhi-110041
9013246272/
ashwanirai85@gmail.com
Toll Free No
Proposal date
: 02/07/2014
Date of Inception of first policy : 03/07/2014
Renewal Year
Receipt No
:
:
NEW
1272007864
Receipt Date
02/07/2014
Fulfiller Code
OL0000000004
Delhi Telesales
Phone No
E-mail id
NIL
Name
Stamp Duty : Re 1.00 /- Total Premium
Total Premium In Words
Intermediary Code
: Rs 5,400.00 /- Service Tax : Rs 667.00 /-
Premium
: 1800-425-2255
: online@starhealth.in
Sector
: SO700002
E-mail id
: Rs 6,067.00 /-
: Urban
: Rupees Six Thousand Sixty-Seven Only
FROM
PERIOD OF INSURANCE
: 03/07/2014 00:00:00
TO
Midnight Of 02/07/2015
SCHEME - DESCRIPTION
: 2 ADULTS + 1 CHILD
BASIC FLOATER SUM INSURED :
LIMIT OF COVERAGE
: Rs.300000 /-
Bonus
Rs 300000 /- ( Three Lakhs Only)
.
: Rs
.
/-
Details of Insured Persons :
Sl.
No.
Name of the Insured
Sex
Date of Birth
Age-Yrs/Mths
Relationship with
Proposer
Pre Existing Disease/s
ID Card No
ASHWANI KUMAR RAI
MALE
10-07-1985
28 Yrs 11 Mths
SELF
NONE
3629867-1
SUSHAMA RAI
FEMALE
01-07-1987
27 Yrs 0 Mths
SPOUSE
NONE
3629867-2
ASHUTOSH RAI
MALE
08-11-2012
1 Yrs 7 Mths
DEPENDANT
CHILD
NONE
3629867-3
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).
Expenses relating to the hospitalisation will be in proportion to the room rent stated in the policy.
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In the event of the policy being withdrawn in future, intimation about the withdrawal will be sent 3 months prior to the date when renewal falls
due.The insured will have the option of migrating to any other similar health insurance policy offered by the Company at the relevant time.
Continuity of benefits for waiting period and bonus, if any and if applicable, will be given provided the insured had been renewing the policy
without any break (or renewing within the grace period offered)
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Online Business
on 02nd Day of July 2014.
Entered By
: STAR_PORTAL
This is an electronically
generated document(Policy
IRDA Regn. No 129
Schedule). "Consolidated stamp
paid vide certificate
Corporate Identity Number U66010TN2005PLC056649
No.CSD/33/2014/2177
Email ID : info@starhealth.in
Dt.17/05/2014"
Kannan S
CN=Kannan S,
SERIALNUMBER=f29a5b3b9c6f48e2841a06abb56c43b5ab5
647325765c9667cc1b11bd05622a2, ST=Tamil Nadu, OID.
2.5.4.17=600034, OU=Star Health And Allied Insurance
Company Limited, O=Star Health And Allied Insurance
Company Limited, C=IN Date: 2014.07.02 11:33:55 IST
For Star Health and Allied Insurance Company Ltd.
Authorised Signatory
Attached to and forming part of Policy No.
P/700002/01/2015/007530
Revision in sum insured:In case of an upward revision in sum insured on renewal, in respect of disease, sickness, illness
the sum insured will be restricted to that policy sum insured when the signs or symptoms was diagnosed or received medical advice or
treatment.
Entered By
: STAR_PORTAL
This is an electronically
generated document(Policy
Schedule). "Consolidated stamp
paid vide certificate
No.CSD/33/2014/2177
Dt.17/05/2014"
For Star Health and Allied Insurance Company Ltd.
Authorised Signatory
Hospitalisation Benefit Policy
Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Issue Office
: P/700002/01/2015/007530
: 700002 - Online Business
Address
: No:111-112,Gokul Arcade-A 1st Floor
Policy No
Type Of Policy : FHO-Policy
Sahar Road Vile Parle(East)
Mumbai - 400057
Toll Free No
: 1800-425-2255
Email
: online@starhealth.in
This is to certify that ASHWANI KUMAR RAI has paid Rs 6067 (Total Premium In Words
: Indian Rupees Six Thousand
Sixty-Seven Only ) towards Premium for Hospitalization Insurance vide Policy No: P/700002/01/2015/007530 for the Period
03-JUL-14 To 02-JUL-15 issued on 02-JUL-14 .
Payment received by Cheque/Credit/Debit Card vide collection No:
Note :- This Certificate must be surrendred 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.
For Star Health and Allied Insurance Company
Ltd.
Authorised Signatory
Family Health Optima
Following values are the details entered to obtain your Family Health Optima policy
Proposer Details
This section contains proposer details
Name
Address:
ASHWANI KUMAR RAI
Mobile:
9013246272
E-48 A KUNWAR SINGH NAGAR NANGLOI
Email:
ashwanirai85@gmail.com
NEAR NILOTHI MOR
New Delhi,West,Delhi-110041
PAN:
Plan Details
This section contains the Plan and Policy Details
Policy End Date:
Policy Start Date:
02-07-2015
03-07-2014
Policy Period: From 03/07/2014 00:00:00 to Midnight Of 02/07/2015
Insured Details
The Section contains the details of all Nominated Members to be covered in the policy
Insured 1
Insured Name
ASHWANI KUMAR RAI
Gender
MALE
Date of Birth
Relationship to the Proposer
:
:
:
10-07-1985
SELF
NONE
Insured Name
SUSHAMA RAI
Gender
FEMALE
Date of Birth
Relationship to the Proposer
:
:
:
01-07-1987
SPOUSE
NONE
Insured Name
ASHUTOSH RAI
Gender
MALE
Date of Birth
Relationship to the Proposer
:
:
Pre Exisiting Disease
08-11-2012
DEPENDANT CHILD
NONE
Pre Exisiting Disease
Insured 2
Pre Exisiting Disease
Insured 3
Whether any of the Insured Members covered in the policy has suffered/advised treatment for any
of the following diseases:
a. Cancer
- No
b. Chronic Kidney Disease
- No
c. Brain Stroke\CVA
- No
d. Parksinsons Disease
- No
e. Alzehimers's Disease
- No
f. Renal Complications
- No
g. Heart Diseases
- No
Social Status :
Premium Calculation
Cover Description
Base Cover
TOTAL PREMIUM
No
Sum Insured
300000
Premium
5400
5400
1
STAMP DUTY
ADD :SERVICE TAX
TOTAL AMOUNT
667
6067
Declaration
I hereby confirm that all the above information is true and correct according to my belief.I also agree that my policy
is for cancellation in case any of the above entered information is found to be false/intentionally misrepresented.
Note: Acceptance of Risk in case of persons suffering from any disease/ailments is subject to evaluation by our
Medical Team
Star Health and Allied Insurance Company Limited
Customer Identity Card
Customer ID No. : 3629867-1
Name
: ASHWANI KUMAR RAI
Date of Birth
: 10/07/1985
Gender
: M
Valid From
: 03/07/2014
Office Code
: 700002
Age
: 28 Years
Personal and Caring
Emergency Help Line No. 1800 425 2255 / 044 2826 3300
E-mail: support@starhealth.in Website: www.starhealth.in
Please quote the Customer ID No. for assistance
Immediate intimation to Star through above Telephone number is a must
in the case of Hospitalisation.
This card to be produced at the time of Hospitalization along with the valid
photo identity proof.
This ID card is invalid, if the insurance cover is not in force.
This card is valid until otherwise cancelled.
Star Health and Allied Insurance Company Limited
Customer Identity Card
Customer ID No. : 3629867-2
Name
: SUSHAMA RAI
Date of Birth
: 01/07/1987
Gender
: F
Valid From
: 03/07/2014
Office Code
: 700002
Age
: 27 Years
Personal and Caring
Emergency Help Line No. 1800 425 2255 / 044 2826 3300
E-mail: support@starhealth.in Website: www.starhealth.in
Please quote the Customer ID No. for assistance
Immediate intimation to Star through above Telephone number is a must
in the case of Hospitalisation.
This card to be produced at the time of Hospitalization along with the valid
photo identity proof.
This ID card is invalid, if the insurance cover is not in force.
This card is valid until otherwise cancelled.
Star Health and Allied Insurance Company Limited
Customer Identity Card
Customer ID No. : 3629867-3
Name
: ASHUTOSH RAI
Date of Birth
: 08/11/2012
Gender
: M
Valid From
: 03/07/2014
Office Code
: 700002
Age
: 1 Year
Personal and Caring
Emergency Help Line No. 1800 425 2255 / 044 2826 3300
E-mail: support@starhealth.in Website: www.starhealth.in
Please quote the Customer ID No. for assistance
Immediate intimation to Star through above Telephone number is a must
in the case of Hospitalisation.
This card to be produced at the time of Hospitalization along with the valid
photo identity proof.
This ID card is invalid, if the insurance cover is not in force.
This card is valid until otherwise cancelled.
