Polsch 11251229961100 V1.0

Star Health And Allied Insurance Company Limited
Date : 30-Oct-2024
To, IMPORTANT
CHETAN CHAUDHARI,
7/349
behind civil court ,backside hp petrol pump, kulkarni plots, bhusawal
Bhusawal Tehsil,Maharashtra-425201
Mobile : 9890973307
Dear Customer,
Re: Health Insurance Policy - 11251229961100
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 30 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
This is an electronically generated document(Policy

Schedule).
Page 1 of
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :support@starhealth.in Website :www.starhealth.in
IRDAI Regn.no: 129
Super Star
Unique Identification No. SHAHLIP25036V012425
POLICY SCHEDULE(Floater)
Policy No. : 11251229961100 Previous Policy No :
Customer Code : PI0006982383 GSTIN : 06AAJCS4517L1Z2
Customer Name : CHETAN CHAUDHARI SAC Code : 997133 / Accident and Health
Cust CKYC No : 40026745819882 Insurance Services
Proposer Code : PI0006982383 Issuing Office Code : 161130

Proposer Name : CHETAN CHAUDHARI Issuing Office Name : Branch Office - Gurgaon III
Proposer Address : 7/349 Issuing Office Address : Plot no 412/2, K - I Tower
behind civil court ,backside hp M G Road, Sector -14,
petrol pump, kulkarni plots, .
bhusawal Gurugram Town Haryana
122001
Bhusawal Tehsil Maharashtra
425201
Phone No : 9890973307 Phone No : 0124-4797452
E-mail Id : chetan_ch@rediffmail.com E-mail Id : gurgaon3@starhealth.in
Proposer GSTIN : NO Place of Supply : Maharashtra
Proposal Date : 29-Oct-2024 Fulfiller Code : SO161130
Date of Inception : 29-Oct-2024
of first policy
Policy Category : New Intermediary : LC0000000619
Collection No : 161130/RV/2025/0171218184
Code
Collection Date : 29-Oct-2024
Base Product Premium : Rs. 22,147/-
Life Style and Habit : Rs. 3,322/-
Name : M/S.POLICYBAZAAR
related & Other discounts INSURANCE
Medical U/W Loading : Rs. 0/- BROKERS PRIVATE
Optional Cover : Rs. 753/-
Loading LIMITED
Optional Cover : Rs. 0/-
Discount
IGST @ 18% : Rs. 3,524/-
Phone No :1800-258-
5970/9971552250
E-mail Id : star@policybazaar.co
m
Total Premium : Rs. 23,102/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Twenty Three thousand one hundred two
only
Period of Insurance : From : 29-Oct-2024 19:19 Hrs To : Midnight of 28-Oct-2025 Policy Term :1 Year
Installment Facility Option:Yes Premium Payment Frequency :Monthly Installment Amount Rs. : 1,916/-
Entered by : CUSTPORTAL This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL Schedule).
IRDAI Regn.No.129
Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of
Email ID: info@starhealth.in
IRDAI Regn.no: 129
Attached to and forming part of Policy No: 11251229961100

Scheme Description (Family Size) :2A+2C Basic Floater Sum Insured : Rs. 25,00,000/-
Total Sum Insured In Words : Rupees Twenty Five lakhs only
Plan Type: FLOATER Bonus : Rs. 0/-
Details of Insured Persons : No. of Persons Insured : 4

Sl. Age in Relationship
Name of the Insured Gender Date of Birth ID Card No Inception date
no. Yrs with Proposer
CHETAN CHAUDHARI
1 Male 23-Nov-1985 38 Self PI0006982383 29-Oct-2024
Pre Existing Disease : No PED Declared

DIMPAL SHASHIKANT NEMADE
2 Female 20-Aug-1989 35 Spouse ME0456922558 29-Oct-2024

VIHAAN CHETAN CHAUDHARI
3 Male 03-Sep-2018 6 Son ME0456922559 29-Oct-2024

RISHABH CHETAN CHAUDHARI
4 Male 12-Aug-2023 1 Son ME0456922560 29-Oct-2024
IRDAI Regn.no: 129
Name of the optional cover-Status
S. CHETAN DINKAR DIMPAL SHASHIKANT VIHAAN CHETAN RISHABH CHETAN

Name of the optional cover NA NA
No CHAUDHARI NEMADE CHAUDHARI CHAUDHARI
1 Quick Shield Not Opted Not Opted Not Opted Not Opted NA NA
2 Personal Accident Cover Not Opted Not Opted Not Opted Not Opted NA NA
Reduction of PED Waiting Period

3 (from 36 months)
Not Opted Not Opted Not Opted Not Opted NA NA
S.
Name of the optional cover Status
No
1 Smart Network Not Opted
Coverage for Non-Medical Items (Consumables cover Table I (68

2 Not Opted
items))
3 Future Shield Not Opted
Delivery Expenses Not Opted

4 Maternity Expenses
Assisted Reproduction Treatment Not Opted
5 Women Care Not Opted
6 High-end Diagnostics Not Opted
7 Annual Health Check-up Not Opted
Voluntary Co-payment
8 10% /20% /30% /40% /50% Not Opted
9 Voluntary Deductible 10k/ 25k/ 50k/ 1L/ 2L/ 3L /4L /5L/ 7.5L/ 10L Not Opted
10 Room Rent Modification Not Opted
11 Sub-limits for Modern Treatments Not Opted
12 E- International Second Opinion Not Opted
13 Durable Medical Equipment Cover Not Opted
14 Compassionate Visit Not Opted
15 Hospital Cash(1 day deductible) Not Opted
Reduction of Specific Diseases Waiting

16 Not Opted
Period
17 Limitless Care Not Opted
IRDAI Regn.no: 129
18 Super Star Bonus (Guaranteed Bonus) Not Opted
19 NRI Advantage Not Opted
Installment Premium Table

Total Installment Premium
S.No. Installment Due Dt. Premium Amount (Rs) GST Amount (Rs)
Amount (Rs)
1 29-Oct-2024 1,626 290 1,916
2 29-Nov-2024 1,632 294 1,926
3 29-Dec-2024 1,632 294 1,926
4 29-Jan-2025 1,632 294 1,926
5 28-Feb-2025 1,632 294 1,926
6 29-Mar-2025 1,632 294 1,926
7 29-Apr-2025 1,632 294 1,926
8 29-May-2025 1,632 294 1,926
9 29-Jun-2025 1,632 294 1,926
10 29-Jul-2025 1,632 294 1,926
11 29-Aug-2025 1,632 294 1,926
12 29-Sep-2025 1,632 294 1,926
The following Conditions shall apply.
i.Grace Period of 15 days for monthly instalment and 30 days iv. ln case of instalment premiumdue not
for quarterly and half yearly instalment would be given to receivedwithinthe grace period, the policy will get
pay the instalment premium due for the policy. cancelled.
ii. The insured person will get the accrued continuity v. ln the event of a claim, all subsequent
benefit in respect of the "Waiting Periods", "Specific premiuminstalments shall immediately
Waiting Periods" in the event of payment of premium becomedueandpayable.
within the stipulated grace Period.
vi. The company has the right to recover
anddeductallthe pending installments fromthe
iii.No interest will be charged lf the instalment premium is claimamountdueunder the policy.
not paid on due date.
vii.For premium paid in instalments
duringthepolicyperiod, coverage is available during
thegraceperiodalso
IRDAI Regn.no: 129
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 Dimpal Spouse 35 100

Shashikant
Nemade
Sector Classification:
Urban
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@starhealth.in
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Gurgaon III on 30th Day of October 2024.
As per Section 34 of CGST Act of 2017, Policy Issued in one Financial Year and Cancelled in another Financial Year
on or after 01st of December, then Only Premium Amount will be Refunded to the Customer and GST Amount will
Not be Refunded. Customer has to Claim the Refund of GST Amount from the GST Portal.
IRDAI Regn.no: 129
Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
Policy No : 11251229961100 Type of Policy : Super Star
Issue Office : 161130-Branch Office - Gurgaon III
Address : Plot no 412/2, K - I Tower

M G Road, Sector -14,
.
Gurugram Town Haryana 122001
Tel / Fax : 0124-4797452
Email : gurgaon3@starhealth.in
This is to certify that CHETAN CHAUDHARI has paid Rs 1,916/- (Total Premium : Indian Rupees One
thousand nine hundred sixteen only ) towards Premium for Hospitalization Insurance vide Policy No:
11251229961100 for the Period 29-Oct-2024 To 28-Oct-2025 issued on 29-Oct-2024.
Payment received by Payment Gateway vide Receipt No: 161130/RV/2025/0171218184/1 Receipt

Date: 30-Oct-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.
Date : 30-Oct-2024 For and on behalf of
Place : Branch Office - Gurgaon III Star Health and Allied Insurance Company Ltd.
IRDAI Regn.No.129
Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory
Email ID: info@starhealth.in
IRDAI Regn.no: 129
Star Health and Allied Insurance

Company Limited
Customer Identity Card
Policy No : 11251229961100
Name DOB Gender Customer id

CHETAN CHAUDHARI
23-Nov-1985 Male PI0006982383
DIMPAL SHASHIKANT
NEMADE 20-Aug-1989 Female ME0456922558
VIHAAN CHETAN CHAUDHARI

03-Sep-2018 Male ME0456922559
RISHABH CHETAN
CHAUDHARI 12-Aug-2023 Male ME0456922560
Valid From : 29-Oct-2024 Valid Till : 28-Oct-2025
Office Code : 161130 Agent/Broker/TE Code : LC0000000619
TA/SSM/SM Code : SO161130
IRDAI Regn.No:129
Emergency Help Line No.1800 425 2255/1800 102 4477
e-mail : support@starhealth.in Website : www.starhealth.in
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 hospitalisation,kindly submit any Government approved photo ID

Card.
Corporate Identity Number : L66010TN2005PLC056649
IRDAI Regn.no: 129
Tax Invoice
Invoice No. : 062410I002213867 Customer ID : PI0006982383
Invoice Date : 29-Oct-2024 Policy No. : 11251229961100
Recipient Supplier
GSTIN : GSTIN : 06AAJCS4517L1Z2
Name : CHETAN CHAUDHARI Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Gurgaon III
Address : 7/349 Address : Plot no 412/2, K - I Tower
behind civil court ,backside hp petrol M G Road, Sector -14,
pump, kulkarni plots, bhusawal
.
City : Bhusawal Pin Code : 425201 City : Gurugram Town Pin Code : 122001
Tehsil
State : Maharashtra Client : IND State : Haryana 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 19,578.00 0 19,578.00 3,524.00 0 0 0 23,102.00
Services
Total Invoice Value (in Figures) : Rs. 23,102/-

Total Invoice Value (in Words) : Rupees Twenty Three thousand one hundred two 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
IRDAI Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: stargst@starhealth.in
IRDAI Regn.no: 129
Name Of the Product Super Star

Product UIN No. SHAHLIP25036V012425
Summary of Important Benefits-Basic Cover
Refer to
S.No Particulars of Coverage / Benefits Benefit Limits (in Rs.) Policy
clause No.
Unlimited
Sum Insured (in Rs.) 5 Lakh 7.5 Lakh 10 Lakhs 15 Lakhs 20 Lakhs 25 Lakhs 50 Lakhs 1Crore
SI
Room Category Any Room
Surgeon, Anesthetist, Medical Practitioner,

Actual
1 Consultants, Specialist Fees II. 1
Anesthesia, blood, oxygen, operation theatre

charges, ICU Charges, Surgical Actual
Appliances, Medicines and Drugs
2 Day care Treatment All Day Care treatments are Covered II. 2
3 Pre-Hospitalization Expenses Up to 90 days prior to the date of hospitalization II. 3
4 Post-Hospitalization Expenses Up to 180 days from the date of discharge from the hospital II. 4
5 Coverage for Modern Treatments Actual II. 5
6 AYUSH Treatment Actual II. 6
7 Road Ambulance Expenses Actual II. 7
8 Air Ambulance Covered up to Rs.5,00,000/- in a policy year II. 8
9 Organ Donor Expenses Actual II. 9
10 Home care treatment Actual II. 10
11 Domiciliary Hospitalization Actual II. 11
12 E-Domestic Second Medical Opinion Available II. 12
For one policy year incase of first diagnosis of critical illness/ incase of death of proposer who is also
13 Premium Waiver II. 13
insured
14 Cumulative Bonus 50% of sum insured for each claim free year subject to a maximum of 100% of the sum insured II. 14
15 Automatic Restoration of Sum Insured Sum Insured will be restored unlimited number of times and maximum up to 100% each time II. 15
Tele-Consultation Available unlimited times on star health mobile app

16 II. 16
AI Driven Face Scan Available up to 2 times per month per insured in a policy year on star health mobile app
17 Dental Check-up & Cleaning For one Insured Person under each policy in a policy year, available in 2nd & 3rd policy year II. 17
18 Value Added Services Discounts available on pharmacy, diagnostics and consultation on star health mobile app II. 18
Insured age is locked at entry when they buy the policy, till a claim is paid under In-patient Treatment /
19 Freeze Your Age II. 19
Day care treatment /Ayush Treatment under Basic Cover.
This program intends to promote, incentivize and to reward the Insured Persons' healthy life style
20 Star Wellness Program II. 20
through various wellness activities
Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.
IRDAI Regn.no: 129

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Star Health And Allied Insurance Company Limited

Re: Health Insurance Policy - 11251229961100

With kind regards,

This is an electronically generated document(Policy

Proposer Code : PI0006982383 Issuing Office Code : 161130

Corporate Identity Number L66010TN2005PLC056649

Attached to and forming part of Policy No: 11251229961100

Details of Insured Persons : No. of Persons Insured : 4

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Pre Existing Disease : No PED Declared

Authorised Signatory Page 3 of

Name of the optional cover-Status

S. CHETAN DINKAR DIMPAL SHASHIKANT VIHAAN CHETAN RISHABH CHETAN

Reduction of PED Waiting Period

1 Smart Network Not Opted

Coverage for Non-Medical Items (Consumables cover Table I (68

3 Future Shield Not Opted

Delivery Expenses Not Opted

Assisted Reproduction Treatment Not Opted

5 Women Care Not Opted

6 High-end Diagnostics Not Opted

7 Annual Health Check-up Not Opted

10 Room Rent Modification Not Opted

11 Sub-limits for Modern Treatments Not Opted

12 E- International Second Opinion Not Opted

13 Durable Medical Equipment Cover Not Opted

14 Compassionate Visit Not Opted

15 Hospital Cash(1 day deductible) Not Opted

Reduction of Specific Diseases Waiting

17 Limitless Care Not Opted

Authorised Signatory Page 4 of

18 Super Star Bonus (Guaranteed Bonus) Not Opted

19 NRI Advantage Not Opted

Installment Premium Table

The following Conditions shall apply.

Authorised Signatory Page 5 of

1 Dimpal Spouse 35 100

Toll Free No : 1800 425 2255 Email: support@starhealth.in

Authorised Signatory Page 6 of

Hospitalisation Benefit Policy

Policy No : 11251229961100 Type of Policy : Super Star

Issue Office : 161130-Branch Office - Gurgaon III

Address : Plot no 412/2, K - I Tower

Tel / Fax : 0124-4797452

Payment received by Payment Gateway vide Receipt No: 161130/RV/2025/0171218184/1 Receipt

Date : 30-Oct-2024 For and on behalf of

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

Authorised Signatory Page 7 of

Star Health and Allied Insurance

Name DOB Gender Customer id

VIHAAN CHETAN CHAUDHARI

Valid From : 29-Oct-2024 Valid Till : 28-Oct-2025

Office Code : 161130 Agent/Broker/TE Code : LC0000000619

TA/SSM/SM Code : SO161130

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

e-mail : support@starhealth.in Website : www.starhealth.in