1. Presentation on Star Unique Health Insurance Policy

2. Why Unique??
This policy is Unique because it covers
Certain Pre-Existing diseases as well as any future ailments –
all under one policy

3. 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

4. Coverages Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accidental injuries

5. 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

6. 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

7. 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

8. 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.

9. What is a Hospital?
Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which
Either
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.

10. 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

11. Sum Insured Options (Rs) Sub-limit for PED Cover (Rs)
The following Sum Insured options are available
Sum Insured Options (Rs)
Sub-limit for PED Cover (Rs)
100000
50000
200000
300000
150000
Note : The sum insured is for each year of insurance and
cannot be cumulated or carried forward

12. Allowable Expenses
Room rent, nursing & boarding 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 Rs 750/- per hospitalisation up to a maximum of Rs 1,500/- per policy period

13. Allowable Expenses (Contd.)
Pre-hospitalization expenses incurred for a period of 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/-

14. 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

15. Day-Care………
The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

16. Name of the Ailment / Surgery / Procedure
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
Sclerotheraphy
Rs. 5,000/- per policy year
Treatment of Fracture / Dislocation
Chalazion
Rs. 3,000/- per policy year
Tympanoplasty
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.

17. 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

18. 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)
Age
18yrs-25yrs
26yrs-40yrs
41yrs-55yrs
56yrs-60yrs
61yrs-65yrs
66yrs-70yrs
100000
50000
5880
6720
10080
11760
14170
16100
200000
7585
9840
14760
17220
20745
23575
300000
150000
10625
13800
20010
22770
23805
26450
Note : Premium figures are excluding Service Tax.

19. Annual Installment Premium
Applicable for rest of India
Sum Insured Options (Rs)
Sub-limit for PED Cover (Rs)
Age
18yrs-25yrs
26yrs-40yrs
41yrs-55yrs
56yrs-60yrs
61yrs-65yrs
66yrs-70yrs
100000
50000
4900
5600
8400
9800
12320
14000
200000
6320
8200
12300
14350
18040
20500
300000
150000
8855
11500
16675
18975
20700
23000
Note : Premium figures are excluding Service Tax.

20. Exclusions
Pre-Existing Disease/ Condition within 11 months of commencement of this insurance
Any Disease contracted during first 30 days

21. Exclusions (Contd.) 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 Pre-Existing at the time of proposal they are payable after 24 months of continuous coverage with the Company.

22. 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

23. Exclusions (Contd.) First Two Years Exclusions (Contd.)
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.

24. 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

25. Exclusions (Contd.)
30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims
War and allied perils including nuclear risks
Circumcision unless necessary for treatment of a disease not excluded hereunder
or as may be necessitated due to an accident,
vaccination or inoculation (except as a post-bite treatment)
change of life or cosmetic or aesthetic treatment of any description,
plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids.

26. Exclusions (Contd.)
Dental treatment or surgery of any kind unless necessitated due to accidental injuries and requiring hospitalization.
Convalescence, general debility, Run-down condition or rest cure, Psychosomatic disorders, Congenital external disease or defects or anomalies, infertility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol.
Treatment for HIV / AIDS and opportunistic infections.

27. Exclusions (Contd.) Purely diagnostic expenses
Expenses on vitamins and tonics not forming part of treatment
Maternity expenses (other than ectopic pregnancy)
Naturopathy Treatment
Hospital registration charges, admission charges, record charges, telephone charges and such other charges

28. Exclusions (Contd.)
Lasik Laser or Refractive Error Correction treatment
weight control or treatment for obesity 
Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs /- for each year of insurance.

29. 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

30. 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

31. 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
24 X 7 In-House Call center ( )
Toll Free Telephone line assistance
( )
Full knowledge based website to offer medical information, including Health Tips.
Information on health through free health magazine

32. Value added services
Consult our Expert Doctor for Free Medical Advice on Toll
Free Number /
Quarterly Health Magazine to all policy holders providing an
insight into health related issues.

33. Target segment
Who can be the target segment for selling this insurance?
Persons who are hypertensive
Diabetics with no complications set in as yet
Persons who have undergone CABG

34. Who should be avoided? Proposals from Cancer patients
Persons with Chronic kidney failure
Persons suffering from Alzhemiers
Persons with Psycho somatic disorders
Stroke affected persons
Paralytic patients

35. 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.

36. 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.

37. Thank You