{"id":4997,"title":"Annexure to Proposal Form - Star Flexi","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Star_Flexi_Proposal_form_Annexe_V_1_14_05_25_0c5ff42fdd.pdf","sha256":"fbbbcb0f2972b8b378cb03cdeab400a37ded927f118ccf714e8b9ff41b637131","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is an annexure to the proposal form for the Star Flexi insurance product and is filled by the proposer to select add-on coverages and options for insured persons.","notes":["This annexure is to be filled along with the base proposal form.","Coverage options and sums insured vary by insured person and age eligibility.","Select options carefully as per eligibility and requirement."],"title":"Annexure to Proposal Form - Star Flexi","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Proposal Form No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Proposer as per the Proposal Form","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Selection for Insured Persons","fields":[{"help":"Select sum insured amount for each insured person","type":"choice","label":"Durable Medical Equipment Cover","options":["Rs.1,00,000","Rs.2,00,000","Rs.3,00,000"],"required":null,"pdf_field":""},{"help":"Select daily limit for nursing at home for each insured person","type":"choice","label":"Nursing at Home - Limit per day","options":["Rs.1,000","Rs.2,000"],"required":null,"pdf_field":""},{"help":"Select amount for compassionate visit cover for each insured person","type":"choice","label":"Compassionate Visit","options":["Rs.10,000","Rs.20,000"],"required":null,"pdf_field":""},{"help":"Select sum insured for hospice care for eligible insured persons","type":"choice","label":"Hospice Care (for persons aged 56 years and above)","options":["Rs.1,00,000","Rs.2,00,000","Rs.3,00,000","Rs.4,00,000","Rs.5,00,000"],"required":null,"pdf_field":""},{"help":"Select amount for convalescence benefit for each insured person","type":"choice","label":"Convalescence Benefit","options":["Rs.10,000","Rs.20,000"],"required":null,"pdf_field":""},{"help":"Select number of days for daily cash allowance","type":"choice","label":"Hospital Daily Cash Allowance - No. of days in a policy year","options":["5","10","15","30"],"required":null,"pdf_field":""},{"help":"Select or specify accommodation details","type":"text","label":"Accompanying Person Accommodation","options":[],"required":null,"pdf_field":""},{"help":"Coverage is 2X of Base Policy Sum Insured up to Rs. 1 Crore","type":"text","label":"Personal Accident (for Adult Insured aged 18-65 years)","options":[],"required":null,"pdf_field":""},{"help":"Coverage equal to Base Policy Sum Insured up to Rs. 50 Lakhs","type":"text","label":"Critical Illness (for Adult Insured aged 18-65 years)","options":[],"required":null,"pdf_field":""},{"help":"Select one package per insured person","type":"choice","label":"Preventive Health Check-up (for persons aged 18 years and above)","options":["Package A","Package B","Package C","Package D","Package E"],"required":null,"pdf_field":""},{"help":"Select number of fitness sessions per week","type":"choice","label":"Stay Fit (for aged 18 years and above) - Number of fitness sessions per week per insured","options":["1","2","3","4","7"],"required":null,"pdf_field":""},{"help":"Select wellness care plan for female insured","type":"choice","label":"Mamta (Women Wellness Care) (for female insured aged 12 years and above)","options":["Plan A","Plan B","Plan C"],"required":null,"pdf_field":""},{"help":"Select wellness care plan for senior citizen insured","type":"choice","label":"Param seva (Senior Citizen Wellness Care) (for persons aged 56 years and above)","options":["Plan A","Plan B","Plan C"],"required":null,"pdf_field":""},{"help":"Select if opting for unlimited tele-consultation","type":"checkbox","label":"Unlimited Tele - Consultation","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Quick Shield cover","type":"checkbox","label":"Quick Shield (for persons aged 18-65 years)","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Star THRIVE cover","type":"checkbox","label":"Star THRIVE","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Limitless Loyalty Bonus","type":"checkbox","label":"Limitless Loyalty Bonus","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Limitless Loyalty Bonus Plus","type":"checkbox","label":"Limitless Loyalty Bonus Plus","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Limitless Care","type":"checkbox","label":"Limitless Care","options":[],"required":null,"pdf_field":""},{"help":"Specify multiplier if applicable","type":"text","label":"Sum Insured Multiplier (Applicable only for long term policies)","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for premium return","type":"checkbox","label":"Premium Return","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for health booster","type":"checkbox","label":"Health Booster","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for inflation protector","type":"checkbox","label":"Inflation Protector","options":[],"required":null,"pdf_field":""},{"help":"Select sum insured option for global cover","type":"choice","label":"Global Cover (Equal to Base Policy Sum Insured Maximum upto Rs. 1 Crore; Applicable for Policies with Sum Insured >= Rs. 25 Lakhs)","options":["Sum Insured option - Rs.25 lakh","Rs.50 lakh","Rs.75 lakh","Rs.100 lakh"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Cover Options","fields":[{"help":"Select if opting for E-Connect cover","type":"checkbox","label":"E - Connect","options":[],"required":null,"pdf_field":""},{"help":"Select sum insured for Star OPD Essential","type":"choice","label":"Star OPD – Essential","options":["Rs.2,500","Rs.5,000","Rs.7,500","Rs.10,000","Rs.15,000","Rs.20,000","Rs.25,000","Rs.50,000"],"required":null,"pdf_field":""},{"help":"Enter wallet limit amount; select PED Waiting Period: 0 months or 12 months","type":"number","label":"Star OPD – Smart - Wallet limit (SI) Rs.","options":[],"required":null,"pdf_field":""},{"help":"Enter wallet limit amount; select PED Waiting Period: 0 months or 12 months","type":"number","label":"Star OPD – Premier - Wallet limit (SI) Rs.","options":[],"required":null,"pdf_field":""},{"help":"Select sum insured for dental and vision care","type":"choice","label":"Dental and Vision Care","options":["Rs.5,000","Rs.10,000","Rs.20,000"],"required":null,"pdf_field":""},{"help":"Select number of consultations per year","type":"choice","label":"In-Clinic Consultation - No. of Consultations in a policy year","options":["4","6","8","10"],"required":null,"pdf_field":""},{"help":"Select sum insured for diagnostics","type":"choice","label":"Diagnostics","options":["Rs.1,000","Rs.2,000","Rs.3,000","Rs.4,000","Rs.5,000","Rs.6,000","Rs.7,000","Rs.8,000","Rs.9,000","Rs.10,000","Rs.15,000","Rs.20,000"],"required":null,"pdf_field":""},{"help":"Select sum insured for pharmacy","type":"choice","label":"Pharmacy","options":["Rs.1,000","Rs.2,000","Rs.3,000","Rs.4,000","Rs.5,000","Rs.6,000","Rs.7,000","Rs.8,000","Rs.9,000","Rs.10,000"],"required":null,"pdf_field":""},{"help":"Select if opting for consumables cover","type":"checkbox","label":"Consumables Cover","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for comprehensive consumables cover","type":"checkbox","label":"Consumables Cover – Comprehensive","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for grace period cover","type":"checkbox","label":"Grace Period Cover","options":[],"required":null,"pdf_field":""},{"help":"Select pre and post hospitalization coverage period","type":"choice","label":"Pre & Post Hospitalization Modification","options":["30-60 days","60-90 days","60-180 days","No Limit of days"],"required":null,"pdf_field":""},{"help":"Select room rent modification option","type":"choice","label":"Room Rent Modification","options":["Single Private AC room","1% of Sum Insured max up to Rs. 5,000 Per day","1% of Sum Insured max upto Rs. 7,500 Per day","1% of Sum Insured max up to Rs. 10,000 Per day","1% of Sum Insured max up to Rs. 15,000 Per day","1% of Sum Insured max up to Rs. 20,000 Per day","1% of Sum Insured max up to Rs. 25,000 Per day","Twin Sharing Room","Multi-Bed Sharing Room (with 3 or more bed) OR General Ward","Multi-Bed Sharing Room (with 3 or more bed) OR General Ward max. up to Rs 3,000 per day"],"required":null,"pdf_field":""},{"help":"Select if opting for value network","type":"checkbox","label":"Value Network","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for future shield","type":"checkbox","label":"Future Shield (Applicable only for individual policies)","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Extra Protect A","type":"checkbox","label":"Extra Protect A","options":[],"required":null,"pdf_field":""},{"help":"Select if opting for Extra Protect B","type":"checkbox","label":"Extra Protect B","options":[],"required":null,"pdf_field":""},{"help":"Select voluntary deductible amount","type":"choice","label":"Voluntary Deductible","options":["Rs.10,000","Rs.25,000","Rs.50,000","Rs.75,000","Rs.1,00,000","Rs.2,00,000","Rs.3,00,000","Rs.4,00,000","Rs.5,00,000"],"required":null,"pdf_field":""},{"help":"Select long term deductible amount","type":"choice","label":"Long Term Deductible (Applicable only for long term policies)","options":["Rs.10,000","Rs.25,000","Rs.50,000","Rs.75,000","Rs.1,00,000","Rs.2,00,000","Rs.3,00,000","Rs.4,00,000","Rs.5,00,000"],"required":null,"pdf_field":""},{"help":"Select voluntary co-pay percentage","type":"choice","label":"Voluntary Co-Pay","options":["10%","20%","30%","40%","50%"],"required":null,"pdf_field":""},{"help":"Specify sub limits for categories","type":"text","label":"Sub Limits - Category A, B, C","options":["Category A","Category B","Category C"],"required":null,"pdf_field":""},{"help":"Select plus benefit percentage of base sum insured","type":"choice","label":"Plus Benefit","options":["50%","100%","150%"],"required":null,"pdf_field":""},{"help":"Select modification period for specific illness waiting","type":"choice","label":"Modification of Specific Illness Waiting Period","options":["24 months to 36 months","24 months to 12 months","24 months to 0 months"],"required":null,"pdf_field":""},{"help":"Select modification period for pre-existing disease waiting","type":"choice","label":"Modification of Pre Existing Disease Waiting Period","options":["36 months to 24 months","36 months to 12 months","36 months to 0 months"],"required":null,"pdf_field":""},{"help":"Select sum insured for maternity expenses","type":"choice","label":"Maternity Expenses - Sum Insured","options":["Rs.50,000","Rs.1,00,000","Rs.2,00,000"],"required":null,"pdf_field":""},{"help":"Select if opting for time travel cover","type":"checkbox","label":"Time Travel","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Signature","fields":[{"help":"Sign or provide thumb impression","type":"signature","label":"Signature/Thumb Impression of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter name of proposer","type":"text","label":"Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Star Flexi health insurance proposal","attachments":[],"declarations":["The applicable add-on covers will be offered as per the underlying base product."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"044-69006900","label":"24 hours help-line","level":null,"hours":"24 hours","applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 425 2255","label":"Toll Free No.","level":null,"hours":"24 hours","applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be submitted while filing a reimbu","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"4th Floor, Balaji Complex, No.15, Whites Lane, Whites Road, Royapettah, Chennai-600014","label":"Grievance Redressal Officer postal address","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"tarhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, Balaji Complex, No.15, Whites Lane, Whites Road, Royapettah, Chennai-600014 lnsured person may also approach the grievance cell at any of the Company’s branches with the details of grievance. If","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"gro@starhealth.in","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"e: In case of any grievance the Insured Person may contact the Company through\nWebsite | : www.starhealth.in\nE-mail | : gro@starhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, B","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievances@starhealth.in","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"rievance the Insured Person may contact the Company through\nWebsite | : www.starhealth.in\nE-mail | : gro@starhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, Balaji Complex, No.15, Whit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"044-69006900","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"044-43664600","label":"Grievance Officer","level":2,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"d with the redressal of grievance through one of the above methods, Insured Person may contact the grievance officer at 044-43664600.","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.starhealth.in/grievance-redressal","label":"Updated details of grievance officer","level":null,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Policy_Star_Health_Assure_Insurance_Policy_V_9_c53663e68a.pdf","quote":"rson may contact the grievance officer at 044-43664600. For updated details of grievance officer, kindly refer the link https://www.starhealth.in/grievance-redressal If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also a","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/star-health-and-allied-insurance/4997-annexure-to-proposal-form-star-flexi"}