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India – Health
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Presentation on MEDI-Classic
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Coverages:- Hospitalization due illness/sickness/disese
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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 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.
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5 Months – 60 Yrs, renewal 80 years
Age Limits 5 Months – 60 Yrs, renewal 80 years Dependent Children can be covered only with any one of their Parents
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For persons with adverse medical history
Medical Examination For persons with adverse medical history and For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.
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Minimum Sum Insured - Rs. 100000/-
Maximum Sum Insured - Rs. 10,00,000/- The following Sum Insured options are available Rs. 1,00,000/- Rs. 1,50,000/- Rs. 2,00,000/- Rs. 2,50,000/- Rs. 3,00,000/- Rs. 3,50,000/- Rs. 4,00,000/- Rs. 5,00,000/- Rs.10,00,000/-
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Allowable expenses Room Rent 2% of S.I. Max.4000/- Per Day
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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/-
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Working for post-hospitalization
Room rent 1200*10 = Nursing *10 = Dr. Con *10 = Medicine = Pathology = Total = =33,000 7% of 33,000= 2310/- or Actuals Max. 5000/
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Day Care Treatment Minimum of 24 hours Hospitalization is not necessary for the following Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy, The above treatment shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.
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Name of the Ailment / Surgery / Procedure
Sub limits Name of the Ailment / Surgery / Procedure Sub Limit Cataract surgery Rs. 20,000/- in respect of one eye and Rs. 30,000/- in the entire policy period Lithotripsy (Kidney stone removal) Rs. 20,000/- Tonsillectomy Rs. 7,500/- Cutting and Draining of Abscess Rs. 1,500/- Liver Aspiration Rs. 2,000/- Pleural Effusion Aspiration Colonoscopy Sclerotheraphy Rs. 5,000/-
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Premium Rating (Excluding.s.t.)(Old Premium)
Age Sum Insured (Rs.) 1 Lakh 1.5 Lacs 2 Lacs 2.5 Lacs 3 Lacs 3.5 Lacs 4 Lacs 5 Lacs 10 Lacs 5 Months to 35 Years 1200 1800 2350 2800 3300 3750 4200 4900 7065 36 Years to 45 Years 1350 2000 2600 3150 3650 4150 4500 5400 7965 46 Years to 55 Years 2447 3400 4583 5548 6170 7408 8700 10700 13265 56 Years to 65 Years 3000 5300 7200 8200 10196 11451 13958 16525 66 Years to 70 Years 4547 6717 8768 10696 12625 14434 16242 19859 NA 71 Years to 75 Years 4872 7284 9574 11744 13914 15964 18015 22113 76 Years to 80 Years 6029 9284 12420 15433 18449 21341 24236 30023
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Premium Rating Revised Premium w.e.f. 1st Sept., 2011(excluding S.T.)
Age Sum Insured (Rs.) 1 Lakh 1.5 Lacs 2 Lacs 2.5 Lacs 3 Lacs 3.5 Lacs 4 Lacs 5 Lacs 10 Lacs 5 Months to 35 Years 1530 2130 2680 2800 3300 3750 4200 4900 7065 36 Years to 45 Years 1680 2330 2930 3150 3650 4150 4500 5400 7965 46 Years to 55 Years 2780 3730 4915 5550 6170 7408 8700 10700 13265 56 Years to 65 Years 3330 4530 5630 7200 8200 10196 11451 13958 16525 66 Years to 70 Years 4880 7050 9100 12625 14434 16242 19859 NA 71 Years to 75 Years 5205 7615 9905 11745 13914 15964 18015 22113 76 Years to 80 Years 6360 9615 12750 15435 18449 21341 24236 30023
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No Claim Discounts (NCD) in case of Renewal
5% Discount on Basic Premium for every Claim Free Year Maximum 25% In the event of a Claim One Step back in NCD for Age Group 5M – 35 Yrs Two Steps back for Age Group 36 – 45 Yrs Above 45 Yrs – No NCD
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NCD 5 % TO 25 % AGE AGE =1140(5%) AGE =1080(10%) AGE =1148(15%) AGE =1080(20%) AGE =1013(25%) AGE =1013(25%) AGE =1013(25%)
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NO TRANSFERS ARE ALLOWED AFTER AGE 45.
Transfer of Policy Transfer from other company is allowed upto age 45 only and there should not be any claim in previous policy. In transfer polices only only 30 day and 1st year excusion will be excluded if the is one year old, if policy has completed 2 years 2nd year exclusion is also waived off. NO TRANSFERS ARE ALLOWED AFTER AGE 45.
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Optional Benefits This insurance provides for Cash benefit of Rs. 500/- for and each and every completed day of Hospitalisation subject to a maximum of Rs. 1,500/- per hospitalisation and Rs. 3,000/- per policy period. Insured persons aged less than 21 years and more than 60 years are not entitled for this benefit. Premium Age Band Premium (Rs.) 0-35 Years 200 36-45 Years 250 46-55 Years 300 56-60 Years 350
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Optional Benefits (contd.)
This insurance is extended to provide for the cost incurred for engaging one attendant at residence after discharge from the hospital of the Insured Person following a covered occurrence under the policy up to Rs. 400 per day for a maximum of 5 days per occurrence. Subject to Time excess of 2 days. Provided engagement of such an attendant is recommended by the attending physician and agreed to by the Company, in writing Premium – Rs.300/- per person
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Exclusions Pre Existing Diseases (covers after 4 yrs of continuous renewal with us without break) 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
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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
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Exclusions (Contd.) Hospital registration charges, record charges, telephone charges and such other similar charges. Non Allopathic shall be restricted to 25% of the sum insured subject to a maximum of Rs. 25,000/- per occurrence for the entire policy period.
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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
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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
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Thank You
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