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Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Presentation on
MICRO HEALTH INSURANCE
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Coverages
Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accident
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
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• 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.
Presentation on Micro Health Insurance
Age Limits
5 Years – 50 Years
Dependent Children can be covered only with any one of their Parents
Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required.
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Sum Insured
Sum Insured :
Rs.30,000, Rs.20,000 and Rs.10,000
Per Hospitalization Maximum - Rs. 15,000/-, Rs.10,000/- & Rs.5000/- for a SI of Rs.30,000/-, Rs.20000/- & Rs.10,000 respectively
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Allowable ExpensesSI – Rs.30,000
Room rent & boarding charges & Nursing expenses @ Rs.150/- per day and Rs. 5,000/- per hospitalisation
Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 4,500/- per hospitalisation
Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 4,500/- per hospitalisation
Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Allowable ExpensesSI – Rs.20,000
Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 3333/- per hospitalisation
Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 3000/- per hospitalisation
Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 3000/- per hospitalisation
Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Allowable ExpensesSI – Rs.10,000
Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 1667/- per hospitalisation
Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 1,500/- per hospitalisation
Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 1,500/- per hospitalisation
Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
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, • Eye surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, taken in the Hospital / Nursing Home and the Insured is discharged
on the same day.
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Rating
Age
Premium
SI Rs.30,000
Premium
SI Rs.20,000
Premium
SI Rs.10,000
5 Years to 25 Years
275 185 95
26 Years to 35 Years
350 230 115
36 Years to 45 Years
425 280 140
46 Years to 50 Years
500 330 165
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
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.
Presentation on Micro Health Insurance
Group policies can be given
Group Discount of 5% of the premium for a Group Exceeding 100 members
Group Policies
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
ExclusionsPre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break)Any Disease contracted during first 30 daysCataractFirst 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• Hysterectomy following Menorrhia or Fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Exclusions (Contd.)Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operationsCircumcision unless necessary for treatment of a diseaseCost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aidsDental treatment or surgeryConvalescence, 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/alcoholNaturopathy Treatment Expenses incurred on Lasik Laser or Refractive Error Correction treatment
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Exclusions (Contd.)
Hospital registration charges, record charges, telephone charges and such other similar charges.
Non Allopathic Treatment
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Claim Procedure
In case of Network HospitalsImmediate 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
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
In case of Non Network HospitalsImmediate 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
Claim Procedure (Contd.)
Star Health and Allied Insurance Co. Ltd.
Presentation on Micro Health Insurance
Thank You