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Published byJesse Curtis Modified over 9 years ago
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STAR HEALTH GAIN INSURANCE
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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
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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
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Family Means Proposer Spouse Dependent Children
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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.
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Age Limits 5 Months – 60 Yrs Dependent Children can be covered only with any one of their Parents
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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/-
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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 & 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
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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 treatment @ 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 basis @ 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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Sub limits Name of the Ailment / Surgery / Procedure Sub Limit Cataract surgeryRs. 15,000/- in the entire policy period
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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.
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Limit of Outpatient benefits for individual Sum insured for IP(Rs) 100000200000300000400000500000 5m-4587007750700062505750 46-557900635052003000NA 56-60750058003700NA IP – Inpatient NA – Not Available
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Limit of Outpatient benefits for family floater Sum insured for IP(Rs) Age100000200000300000400000500000 2A 5mths-35yr84007400675059005250 36y-45y84007400650055004900 46-55yNA565040002000NA 56-60yNA50002250NA 1A+1C 5mths-35yr85007700695057505500 36y-45y85007500675057505250 46-55yNA585045002400NA 56-60yNA52002250NA 1A+2C 5mths-35yr84507500690060005500 36y-45y84507250665057505000 46-55yNA575044502250NA 56-60yNA51502250NA 1A+3C 5mths-35yr83507400665057505250 36y-45y83507200645055004750 46-55yNA55004000NA 56-60yNA47502250NA A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)
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Limit of Outpatient benefits for family floater (contd.) Sum insured for IP(Rs) Age100000200000300000400000500000 2A+1C 5mths-35yr82507250660057505000 36y-45y82507000615054504500 46-55yNA52503750NA 56-60yNA45001500NA 2A+2C 5mths-35yr82507000650055004650 36y-45y82507000595050003750 46-55yNA50003500NA 56-60yNA42501500NA 2A+3C 5mths-35yr82507000625052504250 36y-45y82506700575049003700 46-55yNA47503250NA 56-60yNA40001150NA A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given
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Renewal Discount Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart It is not Cumulative
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For IndividualsSum Insured in Rupees Age100000200000300000400000500000 5 Months – 35 Years120235330420490 36 Years – 45 Years135260365450540 46 Years – 55 Years245458617870NA 56 Years – 60 Years300530820NA No Claim Discount for Individual basis
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No Claim Discount for family floater basis FAMILY COVER ON Floater Basis (FAMILY SIZE) Sum Insured in Rupees 100000200000300000400000500000 2 AdultsDiscount in Rupees 5 Months – 35 Years177289399520592 36 Years – 45 Years177314436557653 46 Years – 55 YearsNA5547611051NA 56 Years – 60 YearsNA6401003NA 1 Adult + 1 Child 5 Months – 35 Years152272371475537 36 Years – 45 Years152301394507596 46 Years – 55 YearsNA527693966NA 56 Years – 60 YearsNA612919NA 1 Adult + 2 Child 5 Months – 35 Years164284383491563 36 Years – 45 Years164308411525629 46 Years – 55 YearsNA5417161015NA 56 Years – 60 YearsNA623973NA
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Discount for family floater basis ( Contd. ) FAMILY COVER ON Floater Basis (FAMILY SIZE) Sum Insured in Rupees 100000200000300000400000500000 1 Adult + 3 ChildDiscount in Rupees 5 Months – 35 Years179309413537604 36 Years – 45 Years179342444573677 46 Years – 55 YearsNA572763NA 56 Years – 60 YearsNA6651010NA 2 Adult + 1 Child 5 Months – 35 Years189330419530635 36 Years – 45 Years189356483578705 46 Years – 55 YearsNA593787NA 56 Years – 60 YearsNA6971063NA 2 Adult + 2 Child 5 Months – 35 Years203346431565688 36 Years – 45 Years203368511624768 46 Years – 55 YearsNA645840NA 56 Years – 60 YearsNA7361109NA 2 Adult + 3 Child 5 Months – 35 Years217363462603726 36 Years – 45 Years217406532654820 46 Years – 55 YearsNA680871NA 56 Years – 60 YearsNA7821176NA
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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
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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
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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
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Exclusions (IP Section) (Contd.) Hospital registration charges, record charges, telephone charges and such other similar charges. Expenses incurred on Non Allopathic Treatment.
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Claim Procedure In case of Network Hospitals Immediate intimation to the Call Centre (1800 425 2255) 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 (1800 425 2255) 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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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
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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
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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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