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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 Note: Please avoid the acceptance of the following risk Heart Disease Cancer 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 – 65 Yrs Renewal upto 65 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. 2,00,000/-
Maximum Sum Insured - Rs. 10,00,000/- The following Sum Insured options are available Rs. 2,00,000/- Rs. 3,00,000/- Rs. 4,00,000/- Rs. 5,00,000/- Rs. 10,00,000/- 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 Sum Insured subject to a maximum of Rs. 4,000/- per day (Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi and Secunderabad) Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Coimbatore 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 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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Name of the Ailment / Surgery / Procedure
Sub limits Name of the Ailment / Surgery / Procedure Sub Limit Cataract surgery Rs. 12,000/- in the entire policy period 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 (Contd.) Rs. 2,00,000/- S.tax included 3701 6309 7225
Sum Insured Rs. 2,00,000/- Age Band 5 Months – 35 yrs 36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 61 yrs – 65 yrs 2A 3778 4087 6789 7776 NA 1A + 1C 3292 3623 6149 7109 1A + 2C 3452 3701 6309 7225 1A + 3C 4076 6646 7688 2A + 1C 4224 4544 7219 8399 2A + 2C 4401 4677 7798 8835 2A + 3C 4588 5101 8179 9342 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 3,00,000/- S.tax included Sum Insured Age Band
5 Months – 35 yrs 36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 61 yrs – 65 yrs 2A 4395 4809 8388 11063 18450 1A + 1C 4092 4346 7644 10131 NA 1A + 2C 4219 4533 7897 10727 1A + 3C 4550 4897 8416 11135 2A + 1C 4622 5327 8675 11719 2A + 2C 4754 5636 9265 12232 2A + 3C 5090 5868 9607 12966 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 4,00,000/- S.tax included Sum Insured Age Band
5 Months – 35 yrs 36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 61 yrs – 65 yrs 2A 5730 6138 11593 14907 22170 1A + 1C 5239 5592 10655 14041 NA 1A + 2C 5416 5791 11195 14571 1A + 3C 5918 6315 12111 15172 2A + 1C 5840 6370 12431 15762 2A + 2C 6226 6883 13093 16424 2A + 3C 6646 7214 13881 17444 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 5,00,000/- S.tax included Sum Insured Age Band
5 Months – 35 yrs 36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 61 yrs – 65 yrs 2A 6530 7197 13247 17488 25740 1A + 1C 5923 6568 12740 16793 NA 1A + 2C 6210 6932 13087 17256 1A + 3C 6657 7467 13666 17951 2A + 1C 6999 7771 14135 18475 2A + 2C 7583 8466 14571 19247 2A + 3C 8008 9039 15288 19970 A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.
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Rating (Contd.) Rs. 10,00,000/- S.tax included Sum Insured Age Band
5 Months – 35 yrs 36 yrs – 45 yrs 46 yrs – 55 yrs 56 yrs – 60 yrs 61 yrs – 65 yrs 2A 9287 9910 16501 20554 NA 1A + 1C 9061 9668 16098 20053 1A + 2C 9194 9811 16341 20356 1A + 3C 9513 10148 16903 21056 2A + 1C 9966 10633 17709 22060 2A + 2C 10418 11118 18514 23058 2A + 3C 10638 11355 18916 23560 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
10% Co-Pay for each and every claim where the entry age is between 60-65Yrs. 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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