BEST HEALTH INSURANCE PLAN FOR FAMILY

THANKS FOR OPPORTUNITY TO SERVEW E A R E O N E O F T H E L E A D I N G I N S U R A N C E &

I N V E S T M E N T C O N S U L T A N T I N C O I M B A T O R E

S I N C E 2 0 0 0M O B I L E

99949 10202 , 94431 86864 ,83000 20102

EMAIL l icnanda@gmai l .com,s ta rhea l thwi thu@gmai l .com

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Best service is our motto

S.V.NANDAGOPALSALES MANAGER STAR HEALTH & ALLIED INSURANCE CO.LTD

mailto:[email protected],[email protected]

PRESENTATION ON

FAMILY HEALTH OPTIMA

( R E V S E P ’ 1 4 )

S.V.NANDAGOPAL SALES MANAGER STAR HEALTH INSURANCE 9994910202

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STAR FHO – NOW, It gives you more than what you paid for.

FHO-rev2014/cpu/ver1.4/16 Oct 2014

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For Instance, You pay for

5L SI.

You get 5L+ sum insured.

You pay for hospitalization

benefits

You get hospitalization

plus benefits.

Let us have a look at it, to understand how it works……

Basics first…

Umbrella cover for the entire family

Up to 3 children can be covered in a single policy

Entry age raised to 65 years

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SI Insufficient? Feeling helpless?

Recharge is REAL protection. Just at the very moment of your need. No need to wait for future claims! Available for your existing treatments!

At no extra cost to you!!! (only for SI 3/4/5L)

Our industry-first feature…

Pay for your chosen SI, get more than what you opted for!ABSOLUTELY FREE!!!

A reward for running policy without claims: Earn up to 35% of SI free of cost.

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In case you run out of SI…..? *Auto-Restore refills your SI! 100%!!! (*Only for future claims after ‘NIL’ SI and not for same illnesses claimed before. Benefit for SI above 2L)

More benefits…


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Worried about medical expenses of the new arrival?

The policy gives free of cost coverage of the newborn!

Organ Transplant….?Who will pay the Donor expenses….?

The policy pays for expenses (within limits).

And more…

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Pre and post hospitalization expenses covered in full.

Domiciliary hospitalization exceeding 3 days, covered in full(TnC).

Adding to it…

Enjoy quick recovery: 400+ Day-care-procedures covered.

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Six different SI options: 2/3/4/5/10/15 Lacs

The first year, for 5L SI (Zone 2;2A;46-50), see how it works:

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You wanted 5 L sum insured. Paid Rs12,325.

• You GET AN ASSURED SEAMLESS BENEFIT OF 6.50 L, thanks to free cover of RECHARGE (1.50L), a regular annual feature.

• You are entitled to an extra SI of 5 L, after your SI touches zero, for future claims, at no extra cost thanks to Restore.

• Your benefit limit swells to 11.50L

Additional SI benefit is worth more than Rs15,000.

• On top of it, you GET FREE ADDITIONAL COVERS like ‘Extended Pre and post hospitalization with no caps’, ‘New-born cover’, ‘Organ donor cover’, ‘Domiciliary hospitalization benefits’, etc.

You are in the 2nd claim-free year, 5L (Zone 2; 2A; 46-50), see how it works:



• You GET AN ASSURED SEAMLESS BENEFIT of 6.50 L, thanks to free cover of RECHARGE (1.50 L), a regular annual feature.

• You get a BONUS (1.25L) FoC.


• Your benefit limit swells to 12.75 L

Additional SI benefit is worth more than Rs17,000

• On top of it, you GET FREE ADDITIONAL COVERS like ‘Extended Pre and post hospitalization with no caps’, ‘New-born cover’, ‘Organ donor cover’, ‘Domiciliary hospitalization benefits’, etc.

You are in 3rd claim free year with 5L S.I. (Zone 2, 2A, 46-50),

see how it works…



• You GET AN ASSURED SEAMLESS BENEFIT OF 6.50 L, thanks to free cover of RECHARGE (1.50 L), a regular annual feature

• You get a BONUS (1.75L) FoC.


• Your benefit limit swells to 13.25 L

Additional SI benefit is worth more than Rs18,000

• On top of it, you GET FREE ADDITIONAL COVERs like ‘Extended Pre and post hospitalization with no caps’, ‘New-born cover’, ‘Organ donor cover’, ‘Domiciliary hospitalization benefits’, etc.

FHO advantage.


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All members covered up to the highest benefit limit chosen.

Single policy Coverage for the entire family

Considerable saving in premium

Recharge - the STAR Innovation.


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1 • INSTANT RE-CHARGE BENEFIT

1.a

• FREE OF COST extra coverage just when SI becomes insufficient (Claim exceeding SI).

• Need not wait for future claims!!!

1.b• All types of claims – not just fresh and unrelated

ones! Single incident or multiple claims .

1.c• Benefit limit filled only once during policy period. • For every renewal, benefit available afresh.

1.d • Up to 30% of SI [Facility for Rs3 & 4 L (25%) and for 5 L (15% in Z1 & 30% Z2 n Z3)]

Star health Recharge -Superior benefit!


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Get brand new value-additions.


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• Auto cover for New-born baby• 10% of SI (Up to 50K)

• Cover from 16 days till policy expiry (Subject to limit and SI availability)• Coverage within policy sum insured.• Intimation of birth, Name of baby and proof of birth-date necessary• 30 days/ PED waiting, Congenital (Int & Ext) conditions apply.

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• Donor expenses for TRANSPLANT of ORGANS (Organ harvesting)

• 10% of SI (Up to 1L)

• Coverage within policy sum insured.• Transplant surgery must be admissible under policy terms.• Expenses for donor-screening and post-donation complications not covered

Free Value-additions.


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• UNLIMITED Domiciliary Hospitalization Expense

• Exceeding 3days. Does not cover certain minor medical conditions.

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• No-claim-Bonus, every year• Max 35% of SI (25% 1st year + 10% 2nd year)

• Not extended to SI 2L (Existing/accrued bonus will be protected, but no fresh NCB will accrue).

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• Automatic Restoration of SI*• Amount equal to SI.• Claims following SI becoming ‘zero’.• For fresh and unrelated claims only.• Can be availed in a single claim or multiple claims. • Restoration SI filled only once during policy period• *Not for treatments for which claims taken previously; Benefit available above 2L SI)


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• Check-up costs up to Rs5,000 after every 3 years of policy run.

• CLAIMS OR NO-CLAIMS!• 1% of SI. (Not available for Rs 2L SI)

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• Pre & Post Hospitalization benefits extended to 60 & 90 days respectively.

• NO CAPS.

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• Day care procedures expanded to 400 plus• NO CAPS (Cataract excepted).

Free Value-additions.

Who are eligible?


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• Persons aged *18 to 65 can take the cover (*completed year).

• 2 A (or 1A+1C) minimum requirement for cover.

Who can avail?

• Adults: 18 to 65• Dependent children: 16 days old to 25 years

Who can enter?

• Life time renewal.• At least 2 A cover maintained.Continuity

What are the *sum insured options?


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(* `1 lac option available for renewal only)

What is covered?


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Hospitalized medical expenses• Room stay and connected medical expenses• Intensive care unit and related medical expenses

Day care treatment benefits for 405 named procedures.

Pre & Post-hospitalization expenses

• Initial medical expense – 60 days prior.• Recovery and rehabilitation expense after discharge – 90 days after.

Ambulance cost for shifting patient to hospital

Domiciliary hospitalization•Medical expenses whilst confined at home (TnC)•For treatment stretching for more than3 full days

Benefit l..i..m..i..t..s


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Room Rent/ Hospital Stay

(slide 23)

Depends on SI, Zone and Class of City.

All connected treatment expenses

(Slide 24)

Proportionate to entitled room rent in the policy

Day Care Expenses

(Slide 25)

405 Procedures covered. No caps except for

Cataract.

ICU

No caps

Pre & Post Hospitalization expense

60 days prior to admission and 90 days post-discharge.

NO CAPS.

Ambulance charges Rs 750

(Overall limit Rs1500)

Room rent explained


23Room rent provisions - Per day cost limits

Zone differentiator Sum InsuredClass of cities

A B C

For all Zones (Zone 1,

2 & 3)

2L 2% of SI 1% of SI 1% of SI

3 & 4 L (Max 5K) (Max 3K) (Max 2K)

Zone 1 only 5/10/15 L Single Std a/c room (no caps)

Zone 2 and 35L 7.5K

10/15 L 10K *Zone 1 means Delhi (NCR), Mumbai (Thane incldg) and State of Gujarat.

*Zone 2 means Bangalore, Chennai, Coimbatore, Kerala and Pune.

*Zone 3 means all remaining places and locations other than Zone 1& 2.

Delhi is Delhi NCR and Mumbai is Mumbai Metropolitan Region

# Class A: 4 metros plus Ahmedabad, Bangalore, Hyderabad and Pune.

# Class B: Goa, State Capitals not falling in Class A, and 22 named major cities.

# Class C: Rest of India.

NB: No bar on Hospitalization across ZONES. No extra premium or Co-pay. Limits as per Zone from which policy was purchased.

* Connected treatment expenses explained


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Pro

fess

ion

a f

ee

• Surgeon• Consultant• Anesthetist• Specialist• Etc

Med

ica

l S

erv

ices

• Anesthesia• Blood• Oxygen• OT charges• Cost of

special equipments

• Etc

Dru

gs

an

d m

edic

ines • Medicines

• Parenterals• Injectibles• Ointments

and gels• Etc

Cataract limits explained


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CATARACT TREATMENT LIMITS

S I range For a single eye

surgery

For the policy

term

2 Lacs 12,000 12,000

3 to 5 Lacs 20,000 30,000

10 & 15 Lacs 30,000 40,000

Age co-pay and movement across zones for hospitalization.


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1. For those who enter the insurance cover at 61 or above:

• Co-pay of 20% (including future renewals).

2. For persons availing hospitalization benefits in higher zones:

• NO BAR on moving from lower ZONE to higher ZONE for hospitalization of insured’s choice!

• Eligible ROOM-RENT and BENEFITS will be as per Class of city within the ZONE mentioned in the policy (For 2/3/4L SI).

Understand the POLICY ‘Exclusions’


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Certain diseases/conditions/treatments are not paid for:

New policy holders have to wait some time for getting full benefits under the policy.

i. For the first 30 days of cover, no treatment benefits for any diseases/surgeries (Accidents coverd in day one)

ii. For the first 24 months of cover, certain identified surgeries/ medical conditions/diseases not paid for

iii. There are some permanent exclusions also.

FIRST-2-YEAR exclusions*


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•1. Cat aract , diseases of t he vit reous and ret ina

•2. Diseases of t he ENT, m ast o id ect om y/ t ym p anop last y/ st ap ed ect om y

•3. Diseases of t he t hyroid gland

•4. Var icose veins and var icose ulcers.

•5. Diseases of t he prost at e

•6. Uret hral st r ict ure/obst ruct ive uropat hies

•7. All t ypes of Hernia

•8. Var icocele/ Hydrocele,

•9. Fist ula/ f issure in Ano, hem orrhoids/ Pilonidal sinus and f ist ula

•10. Congenit al int ernal def ect /disease

•11. Gall bladder diseases and St ones (Calculii) in any in t ernal o rgan and it s m anagem ent /t reat m en t

•12. Any t reat m ent relat ed t o f em ale reproduct ive syst em /benign breast diseases

•13. Any t reat m ent relat ed t o t endon/ ligam ent / f ascia/bone and joint s

•14. Diseases of disc and ver t ebra including IVDP (PIVD)

•15. Lum ps/cyst s of any t ype on any par t of t he body

•16. Transplant of organs and surgery

Moving into Revised FHO with FIRST-12 months exclusions completed?


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For the benefit of old FHO policy-holders renewing their policies for the

second year, the following exclusions will not apply:

Some *PERMANENT exclusions


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All

• Circumcision/inoculation/vaccination• Non-allopathic treatment including naturopathy/unconventional/experimental • Dental treatments (Accidents excepted)• Prostheses/walking aids/lens/specs etc

through

• Weight control/reduction treatments• Non-medical expenses (Registration, Medical Record charges, Telephone/TV etc)• STD (Sexually Transmitted Diseases including HIV)• Psychiatric/ mental disorders

Policy term

• Treatment arising from alcohol/drug use or abuse • Congenital external defects/anomalies• Convalescence/General debility/Run-down condition etc• Intentional self injury/suicide attempts

* For full list, pls refer to the policy.


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Instant comparison – Existing FHO vs Revised FHO!

Details Existing FHO Revised FHO

Age of Entry

Children Age 05 months – 25 yrs 16 days – 25 yrs

Adult Age 18 yrs – 65 yrs

Recharge Benefit not available in old FHO

25% additional amount for SI 3/4L which can be

used for any type of claims.

5L: 15% for Z1 & 30% for Z2&3

Pre / Post Hospitalization

30 / 60 days

With post-hospitalization sub-limit of

Rs.5,000/-60 / 90 days without any sub-limits

Day care procedures 101 (Cataract has a Sub-limit) 405 (Cataract has a Sub-limit)

Auto Cover for New Born Baby Not Available

Free-of-cost value addition. Baby aged 16 days

can be covered.

(Max Benefit limit Rs.50,000)

Package Charges Limit 80% is Payable on Package ChargesNO “20% CO-PAY”.

100% is Payable on Package Charges


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To cap it, some extra-benefits to the policyholders!


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Star Health WEBSITE has “Exclusive Services” for policyholders’ BENEFITS

• Personal Health Record: Create and store your digital health record for use anytime, anywhere.

• Star Health Magazine – An electronic digital magazine with useful information on health and medical matters

NO TPA-Direct claim settlement for efficient service

• Largest Hospital Network – more than 6500 hospitals tied up.

• Toll Free Telephone line assistance: (1800 425 2255) – from BSNL and MTNL

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


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Improving products and service, hand-in-hand!

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARINGFHO-rev2014/cpu/ver1.4/16 Oct 2014 36

• ALSO WE PROVIDE

• LIFE INSURANCE

• HEALTH INSURANCE

• CHIL FUTURE

• TAX SAVING & PLANNING

• PAN CARD & PASSPORT

• MOTOR VEHICLE INSURANCE

• IMPORT & EXPORT INSURANCE

• INDIVIDUAL,FAMILY,GROUP &

CORPORATE INSURANCE NEEDS

BEST HEALTH INSURANCE PLAN FOR FAMILY

Healthcare

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