STAR HEALTH GAIN INSURANCE

Major Product Features Flat premium of only Rs. 14,725/- Coverage for both inpatient and outpatient treatment Policy can be given for both individual and family floater basis. Any unutilised amount under outpatient benefit can be carried forward to the next one year

Coverages Under section – I Hospitalization Expenses incurred as an inpatient for Sickness/Illness/Diseases Accidental injuries Under section – II Hospitalization Expenses incurred as an outpatient treatment subjects to the limits

Family Means Proposer Spouse Dependent Children

What is a Hospital ? Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner or Should comply with minimum criteria as under It should have at least 15 inpatient beds (10 in Class ‘C’ Towns). Fully equipped operation theatre of its own wherever surgical operation is carried out. Fully qualified nursing staff under its employment round the clock Fully qualified Doctor(s) should be in charge round the clock.

Age Limits 5 Months – 60 Yrs Dependent Children can be covered only with any one of their Parents

Sum Insured Minimum Sum Insured - Rs. 1,00,000/- Maximum Sum Insured - Rs. 5,00,000/- The following Sum Insured options are available Rs. 1,00,000/- Rs. 2,00,000/- Rs. 3,00,000/- Rs. 4,00,000/- Rs. 5,00,000/-

Allowable Expenses Room rent & boarding charges as follows Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 4,000/- per day (Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi & NCR and Secunderabad) Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Indore, Ludhiana, Coimbatore, Cochin and all State Capitals other than those falling under Class A) Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day (Other Cities) Nursing charges Surgeons, Anesthetist, Consultants and Specialists fees

Allowable Expenses (Contd.) Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Emergency Ambulance charges to go to Hospital for Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period Pre-hospitalization expenses incurred 30 days prior to the date of hospitalization Post hospitalization expenses on a lump-sum 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs 5,000/-

Sub limits Name of the Ailment / Surgery / Procedure Sub Limit Cataract surgeryRs. 15,000/- in the entire policy period

Day Care Treatment Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

Limit of Outpatient benefits for individual Sum insured for IP(Rs) m NA NA IP – Inpatient NA – Not Available

Limit of Outpatient benefits for family floater Sum insured for IP(Rs) Age A 5mths-35yr y-45y yNA NA 56-60yNA NA 1A+1C 5mths-35yr y-45y yNA NA 56-60yNA NA 1A+2C 5mths-35yr y-45y yNA NA 56-60yNA NA 1A+3C 5mths-35yr y-45y yNA NA 56-60yNA NA A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)

Limit of Outpatient benefits for family floater (contd.) Sum insured for IP(Rs) Age A+1C 5mths-35yr y-45y yNA NA 56-60yNA NA 2A+2C 5mths-35yr y-45y yNA NA 56-60yNA NA 2A+3C 5mths-35yr y-45y yNA NA 56-60yNA NA A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given

Renewal Discount Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart It is not Cumulative

For IndividualsSum Insured in Rupees Age Months – 35 Years Years – 45 Years Years – 55 Years NA 56 Years – 60 Years NA No Claim Discount for Individual basis

No Claim Discount for family floater basis FAMILY COVER ON Floater Basis (FAMILY SIZE) Sum Insured in Rupees AdultsDiscount in Rupees 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA NA 56 Years – 60 YearsNA NA 1 Adult + 1 Child 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA NA 56 Years – 60 YearsNA612919NA 1 Adult + 2 Child 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA NA 56 Years – 60 YearsNA623973NA

Discount for family floater basis ( Contd. ) FAMILY COVER ON Floater Basis (FAMILY SIZE) Sum Insured in Rupees Adult + 3 ChildDiscount in Rupees 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA572763NA 56 Years – 60 YearsNA NA 2 Adult + 1 Child 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA593787NA 56 Years – 60 YearsNA NA 2 Adult + 2 Child 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA645840NA 56 Years – 60 YearsNA NA 2 Adult + 3 Child 5 Months – 35 Years Years – 45 Years Years – 55 YearsNA680871NA 56 Years – 60 YearsNA NA

Other Benefits Benefits under Section 80-D of the IT Act Cashless Service without intervention of TPA Direct Tie up with hospitals on an All India Basis 24 X 7 In-House Call center Toll Free Telephone line assistance Full knowledge based website to offer medical information, including Health Tips. Health Check-up benefits Frequent health meets to disseminate info on the health related topics

Exclusions (IP Section) Pre Existing Diseases Any Disease contracted during first 30 days First Year Exclusions Benign prostate hypertrophy Hernia, Hydrocele, Fistula in Anus, Piles Sinusitis Renal stone and Gall stone removal First Two Years Exclusions Cataract hysterectomy following menorrhia or fibromyoma Knee Replacement Surgery Joint Replacement Surgery Prolapse of intervertibral Vericose veins/ulcers congenital internal disease/defect

Exclusions (IP Section)(Contd.) Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations Circumcision unless necessary for treatment of a disease Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids Dental treatment or surgery Convalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol Naturopathy Treatment Expenses incurred on Lasik Laser or Refractive Error Correction treatment

Exclusions (IP Section) (Contd.) Hospital registration charges, record charges, telephone charges and such other similar charges. Expenses incurred on Non Allopathic Treatment.

Claim Procedure In case of Network Hospitals Immediate intimation to the Call Centre ( ) The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital Based on the intimation a field visit will be done by the Star Doctor Pre Authorization will be issued to the Hospital Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital

Claim Procedure (Contd.) In case of Non Network Hospitals Immediate intimation to the Call Centre ( ) Claim form will be sent to the Insured. Based on the intimation a field visit will be done by the Star Doctor Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents Original Discharge Summary Main Hospital Bill with Break Up Investigation Reports with X-Ray Film Medical Bills with Prescriptions

How is ‘Star Health Gain’ different from ICICI’s Tax Advantage ICICI’s Tax Advt OP claim cannot be made after 90 days from the date of the policy- No such restriction in Star Health Gain policy ICICI Tax Advt allows only ONE OP claim per year - Any number of OP claims allowed in one year under Star Health Gain policy Residue OP amount can be carried forward to next one year under Star Health Gain policy OP benefit can be taken even for PED, Maternity, dental, diagnostics under Star Health Gain policy

How is different from Mediclassic MediclassicHealth Gain Coverage under one sectionCoverage under 2 sections Covers only Hospitalisation expenses as an Inpatient Covers medical expenses as on outpatient also Premium varies depending on the ageThe premium does not vary depending on the age Individual sum insured has to be chosen for each insured person Sum Insured floats for all the family members Room rent flat 2% of SI maximum of Rs.4000/- Room rent varies depending of the location of the hospital There is a limit for day care proceduresNo limit for day care procedure except Cataract For persons aged between 5mnths to 80 yrs For persons aged between 5months to 60 yrs

How is it different from FHO FHOHealth Gain OP Treatment not coveredOP Treatment Covered Premium varies the size of the family and Sum Insured Premium does not vary depending on the size of the family and Sum Insured Cataract Limit Rs.12000/-Cataract Limit 15000/-

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