star health and allied insurance co. ltd. presentation on star wedding gift presentation on star...

Star Health and Allied Insurance Co. Ltd.

Presentation on Star Wedding Gift

Presentation on

Star Wedding Gift



Major Features / Coverages

• Child Delivery Expenses• Pre and Post Natal expenses• New Born Baby cover• Post delivery complications• Expenses for detecting abnormality in Foetus

and• Hospitalisation expenses cover on floater basis



Child Delivery Expenses

• Child delivery expenses (Normal and Caesarean)



Pre and Post Natal expenses

• Covered as part of Child Delivery expenses

• Pre-Natal Expenses mean expenses incurred 12 weeks before child delivery and during pregnancy

• Post-Natal Expenses mean expenses incurred 12 weeks post delivery



New Born Baby cover

• Expenses on treatment of the New-born for any disease, illness (including any congenital internal or external disorders) or accidental injuries.

• Where the New-Born is diagnosed with Down’s syndrome or Cerebral Palsy the Company will pay a lump-sum.



Post delivery complications

• Expenses incurred on treatment for complications to the insured mother post delivery.

• However, Claim for Post Partum Haemorrhage admissible only where it is severe & requiring hysterectomy and is payable only if there is an admissible claim



Abnormality in Foetus

• Test for detecting congenital abnormalities in the foetus Rs. 1,000/-.

• Payable only once after 27 months of continuous coverage under this policy with the Company.



Hospitalisation expenses

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accident

For the entire family on floater basis



Medical Examination

No pre acceptance medical examination



Coverage Period

• There is a provision to purchase a long term policy.

• Policy is offered for the following terms1 year2 years or4 years



Free Look In Period

• Free look period of 15 days from the date of receipt of policy is available (under 4 year period policy only)

• During this free look period if the insured person is not satisfied , he / she has option to cancel the policy . On doing so the premium paid will be refunded after deduction of 5% subject to there being no claim.



Age Limits

Entry Age : 18 years to 40 years

Renewals allowed upto 45 Years



Allowable Expenses

Room Rent, Boarding, Nursing Expenses up-to a maximum of Rs. 4,000/- per day

Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees.

Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses.

Expenses for delivery of a baby either normal or by Caesarean up-to the limits mentioned below (including pre-natal and post natal).



Allowable Expenses (Contd.)

Expenses incurred on treatment for complications to the insured mother post delivery.

Expenses up-to the limits mentioned in the Schedule, incurred in a hospital/ nursing home on treatment of the New-born for any disease, illness (including any congenital disorders) or accidental injuries.

Emergency Ambulance charges to go to Hospital for treatment @ Rs 1,000/- per hospitalisation upto a maximum of Rs 1,500/- per policy period



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 basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs. 5,000/-



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

orShould 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.



Day Care TreatmentMinimum of 24 hours Hospitalization is not necessary for the following • Dialysis• Chemotherapy• Radiotherapy• Cataract surgery• Dental Surgery following accident• Lithotripsy• Tonsillectomy• Treatment of Fracture/Dislocation• Incision and Draining of Abscess• Liver Aspiration• Pleural Effusion Aspiration• Sclerotheraphy The above treatment shall be taken in the Hospital / Nursing Home

and the Insured is discharged on the same day.



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.15,000/-

Incision and Draining of Superficial Abscess

Rs. 1,500/-

Incision and Draining of Deep seated Abscess

Rs. 4,000/-

Liver Aspiration Rs. 2,000/-

Pleural Effusion Aspiration Rs. 2,000/-



Sub Limits (Contd.)

Name of the Ailment / Surgery / Procedure

Sub Limit

Sclerotheraphy Rs. 5,000/-

Treatment of Fracture/Dislocation Rs. 2,000/-

Chalazion Rs. 3,000/-

Tympnoplasty Rs. 20,000/-

Dialysis Rs. 1,200/-

Test for detecting congenital abnormalities in the foetus Rs. 1,000/- (payable only once after 27 months of continuous coverage with the Company)



Sum InsuredOptions Option 1 Option 2

(a) Hospitalisation Expenses Rs. 3,00,000/- Rs. 5,00,000/-

(b) Child Delivery Expenses Rs. 15,000/- for normal and Rs. 20,000/- for ceasarean

Rs. 20,000/- for normal and Rs. 25,000/- for ceasarean

(c) Pre and Post Natal Expenses (as part of Child Delivery Expenses)

Pre Natal : Rs. 1,500/-

Post Natal : Rs. 2,000/-

Pre Natal : Rs. 2,000/-

Post Natal : Rs. 4,000/-

(d) New Born Baby Cover : Hospitalisation expenses for treatment including congenital diseases

Rs. 30,000/- Rs. 50,000/-

(e) New Born Baby Cover :

Lump sum payment for Down’s Syndrome and Cerebral Palsy

Rs. 60,000/- Rs. 1,00,000/-

(f) Post Delivery Complications Actuals within Hospitalisation Limits

Actuals within Hospitalisation Limits

(g) Test for detecting congenital abnormality in foetus

Rs. 1,000/- Rs. 1,000/-

Note : The coverage limits mentioned in (b) to (f) above, are part of the overall Sum Insured mentioned under (a) above.



Premium Rating for One Year cover

Option Family Size

Premium Rs.

5mths-35 yrs 36yrs-45yrs

Option 1 – Rs. 3,00,000/-2A 10305 10740

2A+1C 10535 11305

Option 2 – Rs. 5,00,000/-2A 13960 14680

2A+1C 14470 15310

Note : Premium figures are excluding Service Tax.



Premium Rating for Two Years cover

Option Family Size

Premium Rs.


Option 1 – Rs. 3,00,000/-2A 18550 19335

2A+1C 18965 20350

Option 2 – Rs. 5,00,000/-2A 25130 26425

2A+1C 26050 27560




Premium Rating for Four Years cover

Option Family Size

Premium Rs.


Option 1 – Rs. 3,00,000/-2A 43285 45110

2A+1C 44250 47485

Option 2 – Rs. 5,00,000/-2A 58635 61660

2A+1C 60775 65145




No Claim Discounts

Nil


Presentation on Star Wedding GiftExclusions

Pre Existing DiseasesAny Disease contracted during first 30 days

First Year Exclusions• Deviated Nasal Septum• Benign Prostate Hypertrophy• Hernia • Hydrocele• Congenital Internal disease/defect• Fistula in anus, Piles, Fissure in anus, Sinusitis, and related

disorders• Nasal Polyps• Gall Bladder Calculi And Renal Calculi



Exclusions (Contd.)First Two Years Exclusions

• Cataract, • Hysterectomy• Dysfunctional Uterine Bleeding (DUB)• Fibroid Uterus• Prolapsed Uterus• Treatment of Internal Derangement of Knee (other than caused by

an accident)• Treatment for Joints (other than caused by an accident)• Inter-vertebral Disc Prolapse (other than caused by accident)• Degenerative Vertebral and Disc diseases• Varicose veins and Varicose ulcers



Exclusions (Contd.)Expenses for delivery of a child within 36 months in case of premium paid for 1 or 2 year and 24 months in case of premium paid for 4 years of continuous renewal from the date of commencement of this policy with the company.

The amount of claim indicated in the schedule to be borne by the Insured Person.

Injury/ Disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operations (whether war be declared or not)

Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.



Exclusions (Contd.)Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids.

Dental treatment or surgery of any kind unless necessitated due to accidental injuries and requiring hospitalization.

Convalescence, general debility, Run-down condition or rest cure, Psychosomatic disorders, Congenital external disease or defects or anomalies, infertility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol.

All expenses arising out of any condition directly or indirectly caused due to or associated with human T-cell Lymph tropic Virus type III (HTLV-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.



Exclusions (contd.)

Charges incurred at Hospital or Nursing Home primarily for Diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at hospital / nursing home.

Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician.

Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons / materials.

Treatment arising from or traceable to pregnancy, miscarriage, abortion or complications of any of these other than what is stated to be covered under this policy.



Exclusions (Contd.)

Naturopathy Treatment.

Hospital registration charges, record charges, telephone charges and such other similar charges.

Expenses incurred on Lasik Laser or Refractive Error Correction treatment

Expenses incurred on weight control services including surgical procedures for treatment of obesity, medical treatment for weight control/loss programs

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.



In case of Non Network HospitalsImmediate intimation to the Call Centre

(1800 425 2255 /044-28263300)Claim form will be sent to the Insured.Based on the intimation a field visit will be done by the Star DoctorBills 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.)



Other BenefitsBenefits under Section 80-D of the IT Act

Cashless Service without involvement of TPA

Direct Tie up with hospitals on an All India Basis

24 X 7 In-House Call center (044-2826 3300)

Toll Free Telephone line assistance

(1800 425 2255)

Full knowledge based website to offer medical information, including Health Tips.

Information on health through free health magazine



Target Group

Newly married couples

Couples with one child



Transfer from any other policy of Star to Wedding Gift

Continuity benefits with regard to the following will be provided

• 30 days waiting period• First year exclusions• First two years exclusions• Pre Existing Diseases

However, child delivery expenses will be covered only after 36 months of continuous coverage under this policy.



Transfer from other Insurers to Wedding gift

Continuity benefits with regard to the following will be provided

• 30 days waiting period

However, for other exclusions are concerned, it will treated as a fresh policy only.



How it is wider than FHO ?

Increased Day Care limits

Eg : Cataract 20,000/- & 30,000/- as against 12,000/- under FHO

Coverage for New Born against any congenital disease (both Internal & External)



Thank You

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