Cashless - Final Approval

Date : 21-Mar-25
Dear Sir/Madam, Time : 04:33 PM

Greetings from STAR Health Insurance!

We are writing with regard to your claim request for the below-mentioned insured patient, for the
treatment of CATARACT:

Claim Intimation Number : CIR/2025/700004/1921734

Name of the Insured : SATISH KUMAR SHARMA
Age / Gender : 54 years / Male
Product Name : Family Health Optima Insurance Plan
Policy Number : P/700004/01/2025/008165
Policy Period : 17-Aug-24 to 16-Aug-25
Date of Admission : 21-Mar-25
Date of Discharge : 21-Mar-25
Name of the Hospital and Location : Mahajan Eye Centre A Unit of MECPL - NEW
DELHI - 110034

We acknowledge receipt of the final bill amount - Rs.55000/- for cashless treatment availed
for the insured patient. Based on your latest request and the documents submitted, we have
approved Rs. 40000/- on 21-Mar-25.
Please find below a summary with details:

Initial (Pre-Authorisation) Approved Rs. 33000

Final Hospital Bill Rs. 55000
Admissible Hospital Bill Rs. 40000
Bill items not covered as per Policy Conditions (Refer Working Sheet) Rs. 15000

Amount Payable by STAR Health to Hospital (Refer Section F for details) Rs. 40000

Amount to be Paid by Insured to Hospital (Refer Section D for details)

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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 Detailed Breakdown

Section Description Amount

A. Final Hospital Bill Rs. 55000
B. Bill items not covered by Policy Conditions Rs. 15000
C. Admissible Hospital Bill Rs. 40000
D. Amount to be Paid by Insured to Hospital
1. Non-payables as shown in the statement
2. Co-Pay as per policy conditions
3. Deductibles/Defined Limit
4. Sum Insured/ Sub-limit 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
2. Deviation from agreed package/SOC
3. Others
E. Total
F. Amount Payable by STAR Health to Hospital (C-D-E) Rs. 40000

Amount Payable by STAR Health to Hospital: Rs. 40000 (Indian Rupees Forty Thousand Only)

Remarks: MAXIMUM PAID

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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 Detailed Working Sheet for Expenses not covered as per policy Terms and Conditions

Expenses not covered as

Claimed per policy Terms and Proportionate
S.No Description Remarks
Amount Conditions against deductions
Hospital Bill
Refer
1 b) Composite Package 55000 15000
Note #1
Total 55000 15000

Note Remarks
as per sublimit
#1

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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 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.

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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 Important points to be followed
1. Please note that this approval for cashless facility is subject to the terms and conditions of the
network partnership with you, including pricing agreements. Any deviations from the agreed
pricing will be reviewed at the time of final settlement.
2. After patient’s discharge, please submit all documents (except which you have already uploaded
for Pre-Authorisation) through our STAR Provider Portal or Vitraya Portal.
3. All the investigation/diagnosis reports/documents pertaining to the present hospitalisation should
also be submitted.
4. If any issue or discrepancy in the bill/claim documents is noted, our Claims team will intimate you
over a call/email/WhatsApp/SMS and finalise the bill amount before the actual payment to your
hospital.
5. Please release the deposit amount (if any) to the patient after collecting or adjusting what we have
specifically mentioned to be collected from patient. Please do not recover any further amount.
6. GST on room rent of above Rs. 5,000 per day will be payable subject to overall limit for room rent
under this policy. In that case, kindly mention our GST Number 09AAJCS4517L1ZW and yours in
the final invoice.
7. Expenses not payable by STAR Health:
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, support accessories such as crutches, spectacles, etc.
f. Attendant pass
g. Cosmetic treatment for eye/teeth including their accessories
h. Water purifiers and energy drinks like glucose c/d and glycerin
i. Nutritional supplements like vitamins, pro-biotic, hepatic tonic (Udiliv, Liv52, Heparmerz, etc.) &
digestive (Aristozyme, etc.)

Warm Regards,

(Team STAR Health)

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.

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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 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 No. : 1800 425 2255 / 1800 102 4477
WhatsApp : +91 95976 52225
E-mail : [email protected]

If you are not satisfied with our Customer Care’s response and have further queries, you may
contact our Grievance Redressal Officer.

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

Warm Regards,
Team STAR Health

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: [email protected]
Website: www.starhealth.in | Toll Free Number: 1800-425-2255/1800-102-4477
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