STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Why Unique? •
This policy is Unique because it covers Certain Pre-Existing diseases as well as any future ailments – ------- all under one policy
Major Features.. Pre Existing Diseases (other than those for which specific time periods have been mentioned separately) covered after complete of 11 months The policy provides coverage to HIV positive persons. Premium payable in installments No pre acceptance medical examination
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Coverages.. Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases Accidental injuries
Pre Existing Disease.. Pre-Existing Disease/ Condition will be covered after 11 months of continuous coverage Does this mean that any PED is covered after 11 months? No – only certain diseases that are Pre-Existing
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Coverage for HIV positive persons The policy extends coverage to HIV positive persons. Minimum CD 4 count at entry level should be 350 Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not covered Expenses for treatment of HIV / AIDS not covered
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Period of Insurance.. The policy is for a two year period. Even renewal will be for a two year period Advantages are : Customer retention Claims loading, if applicable will happen only once in two years However, Sum insured will be available afresh for each year. For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for first yr and 2 lacs for the second yr. However sum insured cannot be cumulated or carried forward
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Installment Premium.. •
The premium can be paid in 2 annual installments.
•
The grace period of 15 days for benefit of continuity will be available for instalment premium also. However, the expiry date of the policy will not change.
•
Where a claim is made in the first year itself the premium towards the next installment would be deducted from the claim amount.
•
The policy would lapse if the installment is not paid on or before the due date.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Age Limits.. Entry age 18 Years to 65 Years Policies can be renewed up to 70 years Beyond 70 yrs the insured person would be eligible to move to any other health insurance policy that the Company offers
Sum Insured The following Sum Insured options are available
Sum Insured Options (Rs)
Sub-limit for PED Cover (Rs)
100000
50000
200000
100000
300000
150000
Note : The sum insured is for each year of insurance and cannot be cumulated or carried forward STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Allowable Expenses.. Room rent, nursing & boarding charges @ 1% of the sum insured subject to a maximum of Rs. 3000/- per day.
Surgeons, Anesthetist, Consultants and Specialists fees Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/per hospitalisation up to a maximum of Rs 1,500/- per policy period Pre-hospitalization expenses incurred for a period of 30 days prior to the date of hospitalization Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs. 5,000/STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Day Care Treatment.. Minimum of 24 hours Hospitalization is not necessary for the following • Dialysis • Chemotherapy • Radiotherapy • Cataract surgery • Dental Surgery following accident • Lithotripsy • Tonsillectomy • Treatment of Fracture/Dislocation • Incision and Draining of Abscess • Liver Aspiration • Pleural Effusion Aspiration • Colonoscopy • Sclerotheraphy • Tympanoplasty • Chalazion STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Day-Care.. • The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Sub Limits.. Name of the Ailment / Surgery / Procedure
Sub Limit
Cataract surgery
Rs. 12,000/- in respect of one eye and Rs. 24,000/- in the entire policy period
Lithotripsy (Kidney stone removal)
Rs. 20,000/- per policy year
Tonsillectomy
Rs. 15,000/- per policy year
Incision and Draining of Superficial Abscess
Rs. 1,500/- per policy year
Incision and Draining of Deep seated Abscess
Rs. 4,000/- per policy year
Liver Aspiration
Rs. 2,000/- per policy year
Pleural Effusion Aspiration
Rs. 2,000/- per policy year
Sclerotheraphy
Rs. 5,000/- per policy year
Treatment of Fracture / Dislocation
Rs. 2,000/- per policy year
Chalazion
Rs. 3,000/- per policy year
Tympanoplasty
Rs. 20,000/- per policy year
Dialysis
Rs. 1,200/- per sitting
Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Premium ….. approach
• We have introduced a dual pricing concept Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Ahmedabad will have a slightly higher premium • Rest of India will have comparatively lower premium
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Annual Installment Premium Applicable for offices in Ahmedabad, Bangalore, Mumbai (including Thane) and New Delhi (including Faridabad, Gurgaon & Noida) Sum Insured Options (Rs)
Sub-limit for PED Cover(Rs)
100000
50000
5880
6720 10080 11760 14170 16100
200000
100000
7585
9840 14760 17220 20745 23575
300000
150000
Age 18yrs- 26yrs- 41yrs- 56yrs- 61yrs- 66yrs25yrs 40yrs 55yrs 60yrs 65yrs 70yrs
10625 13800 20010 22770 23805 26450
Note : Premium figures are excluding Service Tax.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Annual Installment Premium Applicable for rest of India
Sum Insured Options (Rs)
Sub-limit for PED Cover (Rs)
100000
50000
4900
5600
8400
200000
100000
6320
8200
12300 14350 18040 20500
300000
150000
8855
11500 16675 18975 20700 23000
Age 18yrs- 26yrs- 41yrs- 56yrs- 61yrs- 66yrs25yrs 40yrs 55yrs 60yrs 65yrs 70yrs 9800
12320 14000
Note : Premium figures are excluding Service Tax.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Exclusions Pre-Existing Disease/ Condition within 11 months of commencement of this insurance Any Disease contracted during first 30 days First Year Exclusions – Deviated Nasal Septum – Benign Prostate Hypertrophy – Nasal Polyps – Hernia – Hydrocele – Congenital Internal diseases/defects – Fistula in anus, Piles, Sinusitis, and related disorders – Post trauma non union / mal union – Cholecystectomy and Renal Calculi /Gall bladder calculi are not payable. If these diseases (other than congenital internal disease /defects) are PreExisting at the time of proposal they are payable after 24 months of continuous coverage with the Company. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Exclusions (Contd.) First Two Years Exclusions – Cataract, – Hysterectomy (abdominal and Vaginal), – Dysfunctional Uterine Bleeding (DUB) – Fibroid Uterus – Prolapsed Uterus – Myomectomy – Cystectomy – Treatment of Internal Derangement of Knee (other than caused by an accident) – Treatment for Joints (other than caused by an accident) – other Arthroscopic Surgeries
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Exclusions (Contd.)
First Two Years Exclusions (Contd.) 1. 2. 3. 4. 5. 6. 7.
Inter-Vertebral Disc Prolapse (other than caused by accident) Degenerative Vertebral and Disc diseases Varicose veins and Varicose ulcers Thyroiditis Treatment of Goitre Tympnoplasty Mastoidectomy Glaucoma
are not payable irrespective of whether they are Pre-Existing or not.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Exclusions (Contd.) First Four Years Exclusions – – – – – – – – – –
Stapedectomy Bone marrow transplant Cirrhosis of liver with or without portal Hypertension Hepatitis Loss of vision partial / total including Retinopathy Retinal Detachment Macular degeneration and Papill Oedema all types of Cancer Nephropathy and Chronic Kidney diseases Implant Removal
The above shall not be payable during the first four years only if these are Pre Existing at the commencement of this insurance
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Exclusions (Contd.) 30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs. 25000/- for each year of insurance
Other Benefits Benefits under Section 80-D of the IT Act Cashless Service without involvement of TPA Direct Tie up with hospitals on an All India Basis STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
Transfer of Policy from Star Health to this policy Only waiver of 30 days waiting period is allowed. For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.
Transfer of Policy from other Insurers Only waiver of 30 days waiting period is allowed. This waiver will not be provided even if there is one day gap. For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING
