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Presentation on FAMILY HEALTH OPTIMA
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Hospitalization Expenses incurred as an inpatient for
Coverages Hospitalization Expenses incurred as an inpatient for Sickness/Illness/Diseases Accident For the entire family on floater basis Star Health and Allied Insurance Co. Ltd.
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Family Means Proposer Spouse Dependent Children
Star Health and Allied Insurance Co. Ltd.
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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. Star Health and Allied Insurance Co. Ltd.
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Age Limits 5 Months – 60 Yrs Dependent Children can be covered only with any one of their Parents Star Health and Allied Insurance Co. Ltd.
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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/- Star Health and Allied Insurance Co. Ltd.
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Allowable Expenses Room rent & boarding charges as follows
Class A Cities – 2% of the SI or Rs.4000/- per day (Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, New Delhi and Secunderabad) Nursing charges Surgeons, Anesthetist, Consultants and Specialists fees Star Health and Allied Insurance Co. Ltd.
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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/- Star Health and Allied Insurance Co. Ltd.
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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. Star Health and Allied Insurance Co. Ltd.
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Rating Rs. 1,00,000/- Sum Insured Age Band 5 Months – 45 yrs
46 yrs – 55 yrs 56 yrs – 60 yrs 2A 1765 NA 1A + 1C 1515 1A + 2C 1640 1A + 3C 1785 2A + 1C 1890 2A + 2C 2025 2A + 3C 2165 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 2,00,000/- Sum Insured Age Band 5 Months – 35 yrs
36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 2A 2890 3140 5535 6400 1A + 1C 2715 3005 5265 6120 1A + 2C 2835 3075 5410 6225 1A + 3C 3085 3415 5715 6645 2A + 1C 3295 3555 5925 6965 2A + 2C 3455 3675 6450 7360 2A + 3C 3625 4060 6795 7820 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 3,00,000/- Sum Insured Age Band 5 Months – 35 yrs
36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 2A 3985 4360 7605 10030 1A + 1C 3710 3940 6930 9185 1A + 2C 3825 4110 7160 9725 1A + 3C 4125 4440 7630 10095 2A + 1C 4190 4830 7865 10625 2A + 2C 4310 5110 8400 11090 2A + 3C 4615 5320 8710 11755 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 4,00,000/- Sum Insured Age Band 5 Months – 35 yrs
36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 2A 5195 5565 10510 13515 1A + 1C 4750 5070 9660 12730 1A + 2C 4910 5250 10150 13210 1A + 3C 5365 5725 10980 13755 2A + 1C 5295 5775 11270 14290 2A + 2C 5645 6240 11870 14890 2A + 3C 6025 6540 12585 15815 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 5,00,000/- Sum Insured Age Band 5 Months – 35 yrs
36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 2A 5920 6525 12010 15855 1A + 1C 5370 5955 11550 15225 1A + 2C 5630 6285 11865 15645 1A + 3C 6035 6770 12390 16275 2A + 1C 6345 7045 12815 16750 2A + 2C 6875 7675 13210 17450 2A + 3C 7260 8195 13860 18105 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Renewal Discount 10% Discount on Basic Premium is allowed on renewal for every Claim Free Year It is not Cumulative Star Health and Allied Insurance Co. Ltd.
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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 Star Health and Allied Insurance Co. Ltd.
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Exclusions Pre Existing Diseases
Any Disease contracted during first 30 days First Year Exclusions Benign prostate hypertrophy Hernia, Hydrocele, Fistula in Anus, Piles Sinusitis congenital internal disease/defect 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 Star Health and Allied Insurance Co. Ltd.
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Exclusions (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 Star Health and Allied Insurance Co. Ltd.
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Exclusions (Contd.) Hospital registration charges, record charges, telephone charges and such other similar charges. Expenses incurred on Non Allopathic Treatment. Star Health and Allied Insurance Co. Ltd.
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In case of Network Hospitals
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 Star Health and Allied Insurance Co. Ltd.
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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 Star Health and Allied Insurance Co. Ltd.
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Thank You Star Health and Allied Insurance Co. Ltd.
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