Star Health and Allied Insurance Co - LTD

Cashless - Final Approval
Date: 26-Apr-24
Dear Sir/Madam,
Greetings from STAR Health!
We are writing with regard to your claim request for the below-mentioned insured patient, for the
treatment of ACUTE GASTROENTERITIS WITH SEVERE DEHYDRATION:
Claim Intimation Number : CIR/2025/231123/0108415
Name of the Insured Patient : SAKSHI GARG
Age / Gender : 1 years 4 months / Female
Product Name : Family Health Optima Insurance Plan
Policy Number : 11240311344600
Policy Period : 26-Jun-23 to 25-Jun-24
Diagnosis : ACUTE GASTROENTERITIS WITH SEVERE
Date of Admission : 23-Apr-24
Name of the Hospital and Location : AMAR HEALTHCARE - MATHURA - 281004
We acknowledge receipt of the final bill amount - Rs.31571/- for cashless treatment availed
for the insured patient. Based on your latest request and the documents submitted, we have
approved Rs. 26676/- on 26-Apr-24.
Please find below a summary of the requested amount, deductions and payables:
Initial (Pre-Authorisation) Approved Rs. 6000

Final Hospital Bill Rs. 31571
Admissible Hospital Bill Rs. 30313
Inadmissible Hospital Bill (Refer Detailed Working Sheet for details) Rs. 1258
Amount Payable by STAR Health to Hospital from Admissible Hospital Bill(
Rs. 26676
Refer Section F for details)
Amount Payable by Insured to Hospital from Admissible Hospital Bill (Refer
Section D for details)
Detailed Breakdown
Section Description Amount
A. Final Hospital Bill Rs. 31571
Star Health and Allied Insurance Co.Ltd.

Balaji Complex, No. 15, Whites Lane, Whites Road, Royapettah, Chennai - 600014
Customer Care Number - 044 6900 6900 | Corporate Customers - 044 43664666 | Chat - +91 9597652225
IRDAI Registration No: 129 | CIN: L66010TN2005PLC056649 | Ph: 044-28288800 | Email: info@starhealth.in
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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B. Deductions against Hospital Bill (Refer Detailed Working Sheet) Rs. 1258
C. Admissible Hospital Bill Rs. 30313
D. Amount Payable by Insured to Hospital from Admissible Hospital Bill
1. Non-payables as shown in the statement
2. Co-Pay as per policy conditions
3. Deductibles/Defined Limit
4. Sum Insured/ Sublimit Exceeded
5. Recovery of Discount(s) applied on Renewal
Balance premium installments to be paid by patient (wherever
6.
Insured has opted for installments
D. Total
E. Miscellaneous
1. Network Hospital discount Rs. 3637
2. Deviation from agreed package/SOC
E. Total Rs. 3637
F. Amount Payable by STAR Health to Hospital (C-D-E) Rs. 26676
Amount Payable by STAR Health to Hospital: Rs. 26676 (Indian Rupees Twenty Six Thousand Six
Hundred and Seventy Six Only)
Detailed Working Sheet for Deductions
Deductions
S.No Description against Deduction Reason
Hospital Bill
Room Rent(Inclusive of GST)

1
& Nursing charges
Professional Fees (Surgeon,

2 Anastheist, Consultation
charges etc)

2
Deductions
S.No Description against Deduction Reason
Hospital Bill
3 Investigation & Diagnostics
4 Medicines and Consumables 558 thermometer,uro bag,cotton not payable
5 Others 700 file,op not payable
Total 1258

3
We are at your service 24/7, including Sundays and Holidays. For assistance, please call:
044 6900 6900 / 1800 425 2255 / 1800 102 4477 (or) WhatsApp +91 95976 52225
If hospital insurance services are not available on Sundays/Holidays, the discharge request may be
sent a day in advance.

4
Important points to be followed
1.
2.
3.
4.
5.
6.
7.
a. Registration charges/documentation/maintenance/service
b. Telephone/fax/barber/toiletries/TV/laundry
c. Food and beverages for the relatives/attendants
d. Dental treatment if not due to accident/requiring hospitalisation
e. External implants, supports accessories such as crutches, spectacles, etc.
f. Shaving blade/razor sets
g. Attendant pass
h. Antiseptic creams
i. Cosmetic treatment for eye/teeth including their accessories
j. Water purifiers and energy drinks like glucose c/d and glycerin
k. Nutritional supplements like vitamins, pro-biotic, hepatic tonic (Udiliv, Liv52, Heparmerz) &
digestive (Aristozyme)
Regards,
Team STAR Health
(This is a computer-generated letter, hence does not require a signature.)
Please hand over a copy of this letter to the Insured/Patient/Patient’s family members or Attendant.
This letter is also being sent via email to the Insured.

5
Customer Support
Dear Customer,
If you have any queries or need further assistance regarding our decision relating to your claim,
please contact our Customer Support via:
Landline : 044 6900 6900

Toll-Free. : 1800 425 2255 / 1800 102 4477
WhatsApp : +91 95976 52225
E-mail. : support@starhealth.in
If you are not satisfied with our Customer Care’s response and have further queries, you may
contact our Grievance Redressal Officer.
In case you are still not satisfied with the Grievance Redressal Officer’s response, you may reach
out to the office of the Insurance Ombudsman.
The contact details of our Grievance Redressal Officer and the Insurance Ombudsman of your
city/town are provided on our website - https://www.starhealth.in/grievance-redressal
Regards,
Team STAR Health

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Cashless - Final Approval

Greetings from STAR Health!

Initial (Pre-Authorisation) Approved Rs. 6000

Star Health and Allied Insurance Co.Ltd.

Detailed Working Sheet for Deductions

Room Rent(Inclusive of GST)

Professional Fees (Surgeon,

Star Health and Allied Insurance Co.Ltd.

3 Investigation & Diagnostics

4 Medicines and Consumables 558 thermometer,uro bag,cotton not payable

5 Others 700 file,op not payable

Star Health and Allied Insurance Co.Ltd.

Star Health and Allied Insurance Co.Ltd.

Star Health and Allied Insurance Co.Ltd.

Landline : 044 6900 6900

Star Health and Allied Insurance Co.Ltd.

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