STAR HEALTH INSURANCE COIMBATORE

Star Health and Allied Insurance Co. Ltd.

STAR HEALTH

NEW PLAN

Family Health Optima (Revised)

Best policy for family (Floater coverage)

S.V.NANDAGOPAL SALES MANAGER

COIMBATORE 9994910202


Revised Family Health Optima Insurance Plan

Sum Insured Options

Rs.2,00,000/-

Rs.3,00,000/-

Rs.4,00,000/-

Rs.5,00,000/-

Rs.10,00,000/-

Rs.15,00,000/-

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NANDAGOPAL.S.V 9994910202 COIMBATORE



In the case of renewals, where the existing

sum insured is Rs.1,00,000/-, provision to renew

with the same sum insured is also available.

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NANDAGOPAL.S.V 9994910202

COIMBATORE



Premium Rating

Three Tier Rating

Zone 1

Zone 2

Zone 3

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Classification of Zones

Zone 1 : Delhi including National Capital Region, Mumbai

including Thane and the State of Gujarat

Zone 2 : Bangalore, Chennai, Coimbatore, Pune and State

of Kerala

Zone 3 : Rest of India excluding areas falling under Zone 1

and Zone 2

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Classification of Cities (for claims) into three

Class A

Class B

Other locations

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Classification of Cities (contd)

Class A cities : Ahmedabad, Bangalore, Chennai, Hyderabad

including Secunderabad, Kolkata, Mumbai including Thane,

Pune, New Delhi including Noida, Gurgaon, Ghaziabad and

Faridabad (otherwise called as National Capital Region)

……

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Class B cities : Allahabad, Amritsar, Agra, Baroda, Coimbatore,

Cochin, Goa, Indore, Jalandhar, Jodhpur, Kanpur, Kota, Ludhiana,

Mohali, Meerut, Nagpur, Pakhola, Rajkot, Surat, Udaipur,

Varanasi, Vizag, Vijayawada and all State capitals other than

those falling under Class A.

Other locations : Rest of India not falling under Class A & Class B

above ……

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- In the event of claims the limit of liability for room rent will

be as per the Zone for which the premium was paid –

irrespective of place of treatment.

- Expenses relating to hospitalisation will be considered in

proportion to the room rent stated in the policy.

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Benefits

- Hospitalisation Expenses for Accidents / Diseases

/ illnesses

- Pre & Post Hospitalisation

- Domiciliary Hospitalisation (New)

- Cost of Health Check up

- No claim Bonus ….. 10


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Benefits (contd)

- Recharge (New)

- Restore

- Cover for child from day 16 ( New)

- Donor Expenses (New)

- 405 Day Care Procedures

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Hospitalisation Benefits

- Covering Surgeon, Anesthetist, Medical Practitioner,

Consultants, Specialist fees.

- Anesthesia, blood, operation theatre charges, surgical

appliances, medicines and drugs, diagnostic materials and X-ray, diagnostic imaging modalities, dialysis, chemotherapy, radiotherapy, cost of pacemaker, stent, similar expenses, with regard to coronary stenting, the Company will pay such amount up to the extent of bare metal stent / drug eluting cobalt-chromium stent / drug eluting stainless steel stent.

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Pre & Post Hospitalisation

Pre Hospitalisation : 60 days

Post Hospitalisation : 90 days

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Domiciliary Hospitalisation (New)

Medical treatment for a period exceeding three days, for an illness / diseases / injury, which in the normal course, would require care and treatment at a hospital but, on the advice of the attending Medical Practitioner, is taken whilst confined at home under any of the following circumstances : The condition of the patient is such that he / she is not in a condition to be removed to a Hospital, or The patient takes treatment at home on account of non-availability of room in a hospital.

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Cost of Health Check up

- Up to 1% of average basic Sum Insured subject to a

limit of Rs.5,000/-

- Available after every block of 3 continuous renewals,

- Irrespective of whether a claim is made or not.

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NO Claim Bonus

- In respect of a claim free year of Insurance.

- Available for the Sum Insured options Rs.3,00,000/- and above - 25% of the expiring sum insured in the second year and additional 10% of the expiring sum insured during the third year. …….

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NO Claim Bonus (contd)

- The maximum allowable bonus shall not exceed 35% of the expiring sum insured. - The earned bonus for the sum insured option of Rs.2,00,000/- will be protected if the policy is renewed continuously without break. No fresh bonus will accrue.

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Recharge

On exhaustion of Sum Insured, additional Sum Insured up to

the specified limits, available even for the same disease and even during the same hospitalization.

• This benefit is available once during the policy period.

Limits of Recharge For Zone-1:

• 25% for Sum Insured options of Rs.3 lacs & Rs.4 lacs.

• 15% for Sum Insured of Rs.5 lacs.

• No recharge for Sum Insured of Rs.10 Lacs & Rs.15 Lacs.

…….


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Recharge (contd)

Limits of Recharge For Zone 2 & 3:

• 25% for Sum Insured options of Rs.3 lacs & Rs.4 lacs.

• 30% for Sum Insured of Rs.5 lacs.

• No recharge for Sum Insured of Rs.10 Lacs & Rs.15 Lacs.

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Automatic Restoration of Sum Insured

- Operates immediately on exhaustion of the limit

of coverage.

- Available for sum insured options of

Rs.3,00,000/- and above only.

- Up to 100% of basic Sum Insured

…….

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Automatic Restoration of Sum Insured (contd)

- can be utilized only for illness / disease unrelated

to the illness / diseases for which claim/s was /

were made

- The unutilized restored sum insured cannot be

carried forward

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Free cover for child from day 16

-Free cover for new born baby delivered during the

policy period after 16 days from the date of birth till the

expiry of the policy period subject to a limit of 10% of Sum

Insured or Rs.50,000/- whichever is less (subject to other

terms and conditions of the policy).

- Intimation about the New Born to be given and policy to

be endorsed to include the baby (Nil Endt.)

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Donor Expenses

Organ removal expenses as in-patient only. Over all

limit is 10% of Sum Insured or Rs.1 lakh, whichever

is less. Pre & Post hospitalization expenses for the

Donor are excluded.

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Age Limits

Entry Age : 18 to 65 years

Dependant Children from day 16 (even when

delivery has happened prior to the commencement

of the policy period) up to the age of 25 can be

covered when one of the parents are covered.

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Room Rent Limits

Sum Insured Class A Cities Class B Cities Other Locations

Up to Rs.4,00,000/- (Irrespective of Zones)

2% of the sum insured subject to a maximum of Rs.5000/- per day



Rs.5,00,000/- Single Standard A/c room for Zone-1 & Rs.7,500/- for Zone-2 & 3

Rs.10,00,000/- & Rs.15,00,000/-

Single Standard A/c room for Zone-1 & Rs.10,000/- for Zone 2 & 3.

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Sublimits for Cataract

Amount in Rs.

Sum Insured For Single Eye Surgery For the policy term

Up to 2 Lacs 12,000 12,000

3 to 5 Lacs 20,000 30,000

10 & 15 Lacs 30,000 40,000

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Important Exclusions

- 30 days waiting period

- First Two Year Exclusions

Cataract, Diseases of the Vitreous and Retina,

Glaucoma, diseases of ENT, Mastoidectomy,

Tympanoplasty, Stapedectomy, diseases related to

Thyroid, Prolapse of intervertebral disc (other than

caused by accident), varicose veins and ……

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First Two Year Exclusions (contd …)

Varicose ulcers, all diseases of prostate, Stricture Urethra, all obstructive-uropathies,all types of hernia, varicocele, hydrocele, fistula / fissure in ano,

Hemorrhoids, Pilonidal sinus and fistula, Rectal

Prolapse, stress incontinence and Congenital

Internal disease / defect

b) Gall bladder and ancreatic diseases and all treatments (conservative, interventional, laparoscopic and open) related to ……

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Hepato-pancreatobiliary including gall bladder and pancreatic calculi. All types of management for kidney and genitourinary tract calculi.

c) All treatments (conservative, interventional, laparoscopic and open) related to all diseases of uterus, fallopian tubes, cervix and ovaries, dysfunctional uterine bleeding, pelvic inflammatory diseases, benign breast diseases.

…… 29




d) Conservative, operative treatment and all types

of intervention for diseases related to tendon,

ligament, fascia, bones and joint other than

caused by accident

e) Degenerative disc and vertebral diseases

including replacement of bones and joints and degenerative diseases of the musculo-skeletal system

…… 30




f) Subcutaneous benign lumps, sebaceous cyst,

dermoid cyst, lipoma, neurofibroma, fibroadenoma, ganlion and similary pathology.

g) Any transplant and related surgery

This waiting period shall not however apply in the case of the Insured person/s having been covered under any Individual health insurance scheme with any of the Indian Insurer for a continuous period of preceding 24 months without any break ….. 31




The claim for such illnesses/diseases/disabilities contracted/suffered if admitted will be processed as per the sum insured of the immediately preceding 24 months policy only. Where there is a change in the sum insured in the second continuous policy year the lower of the sum insured will apply.

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Please Note

In respect of renewals, the list of diseases which are

under First Year Exclusion under the expiring policy

- which have become part of first two year

exclusions now, will, however, we covered in the

first renewal / second year of the policy from the

first inception.

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Other Important Features

- Life long renewals.

- Ambulance charges Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policy period.

- Co-Payment : The policy is subject to co-payment

of 20% of each and every claim amount for

fresh as well as renewal policies for insured

persons whose age at the time of entry is

above 60 years.

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FOR ALL KIND OF INSURANCE NEEDS CALL US THANKS WITH REGARDS

NANDAGOPAL.S.V WELLWISHER

PROFESSSIONAL INSURANCE AND INVESTMENT CONSULTANAT

STAR HEALTH INSURANCE COIMBATORE

Healthcare

allied insurance

dayspost hospitalisation

new donor expenses new

new delhi

alimit of rs

similar expenses

existingsum insured

place of treatment