It is a fully loaded Top end Floater Policy for the entire family with High Sum Insured Extended...

It is a fully loaded Top end Floater Policy for the entire family with

High Sum InsuredExtended BenefitsNo Sub LimitsNo Capping on Room RentRestoration of Sum Insured

Unique Features

Star Comprehensive Insurance Policy


Sum Insured Options

Sum Insured

5 Lakhs

7.5 Lakhs

10 Lakhs

15 Lakhs

20 Lakhs

25 Lakhs

18 years – 65 Years.

Children of 5 months can be Covered if Parent is

Covered.

Beyond the age of 65 years only renewals are accepted. But

sum insured options will be limited to a max of Rs7.5 lacs.

Guaranteed renewal.


Age Eligibility

Cover can be given to HIV + persons whose CD 4 count is not less than 350 at entry point

No claim payable for Opportunistic infections

No claim on treatment for HIV / AIDS


Eligibility

Section CoverageSection - I

In-patient Hospitalization

Section - II

Delivery Charges, New Born Baby coverage and Vaccination benefits

Section - III

Out-Patient Dental / Ophthalmic coverage

Section - IV

Hospital Cash

Section - V

Cost of Health Check-upStar Comprehensive Insurance Policy

Coverage

Section I - HOSPITALISATION

Room Rent ,Boarding and Nursing Expenses - No Cap

ICU and Operation Theatre Expenses - No Cap

Surgeon, Anaesthetist, Medical Practitioner, Consultants,

Specialist Fees - No Cap

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 -

No Cap



Sum Insured (Rs.) Ambulance Charges Per Policy Period (Rs.)

5 Lakhs 2000

7.5 Lakhs 3000

10 Lakhs 3500

15 Lakhs 4000

20 Lakhs 4500

25 Lakhs 5000

Pre Hospitalization Expenses - 30 Days

Post Hospitalization Expenses - 60 days

For both these benefits prescriptions, bills / receipts /

copy of reports to be submitted.

Section II

Delivery and New Born Baby CoverWaiting period 36monthsMaximum 2 deliveries. Waiting period between

the first delivery claim and the second one is 24 months.

Delivery Benefit Limits

No Pre and Post Hospitalisation benefits for this Section Both Insured and Spouse should be covered in the same

policy for identical sum insured throughout.


Sum Insured(Rs.)

Normal Delivery(Rs.)

Caesarean Section Delivery

(Rs.)

5 Lakhs 10,000 15,000

7.5 Lakhs 20,000 40,000

10 Lakhs -25 Lakhs

25,000 40,000

New Born Baby Coverage for the remaining policy period

Vaccination expenses up to Rs 1000/- incurred on the new born baby

Subject to Valid claim for DeliveryCovers congenital defects alsoClaim Made under this Section will not reduce

the policy Sum Insured, adversely affect Health Check-up benefit or add on for Claims loading


Section IIDelivery and New Born Baby Cover

For Sum Insured (Rs.) Limit of Coverage (Rs.)

5,00,000/- 50,000/-

7,50,000/- & above 1,00,000/-

Section - III

OP Dental and Ophthalmic Treatment • Dental & Ophthalmology Treatment is covered after a waiting

period 36 Months• Can be taken as an Out-patient• Payable even if there is claim in the three year period• Can be claimed for Root Canal Treatment also• Purchase of spectacles

Limits

• The claimant must have been insured continuously.

Claim Made under this Section will not reduce the policy Sum Insured, adversely affect Health Check-up benefit or add on for Claims loading


Sum Insured (Rs)Amount payable subject to production of

Prescription and supporting Bills (Rs.)

5,00,000/- & 7,50,000/- Upto 5000

10,00,000/- & above Upto 10000

Section - III

OP Dental and Ophthalmic Treatment

For example : A family of three persons 2A + 1C covered

for a Sum Insured of Rs. 5 lakhs for 2 years - 2010-11 and 2011-12.

In 2012-13 another Child is added. In 2013-14 a claim is made for Ophthalmic

Section for the Child added in 2011-12. Not admissible because the waiting period

has not been completed by the child.


Section – IV Hospital CashCash Benefit -maximum of 7 days per

hospitalisation, provided there is an admissible claim under Section I.

Maximum during one policy period – 120 daysFirst one day will not be paid

Claim for Hospital cash will not affect the policy sum insured


Sum Insured (Rs.) Limits per day (Rs.)

5 Lakhs 500

7.5 Lakhs – 10 Lakhs

750

15 Lakhs – 20 Lakhs

1000

25 Lakhs 1500

Section – IV Cost of Health Check-up

Cost of Health Check-up Once in a block of every 3 claim- free Continuous renewals

Benefit payable for insured persons who have been

continuously insured under the policy .


Sum Insured (Rs.) Limits per day (Rs.) on submission of prescriptions bills / receipts / report copies

5 Lakhs 5000

7.5 Lakhs – 10 Lakhs

7500

15 Lakhs – 25 Lakhs

12000

Automatic Restoration of Sum Insured

Restoration facility in-built up to 100% for ALL sum insured options.

Restored Sum Insured can be utilized only for illness /disease unrelated to the illness /diseases for which claim/s was /was made.

Restoration will be available for section 1 only.


Exclusions Some important exclusions:First 30-days exclusion (other than for

accidents)No First year exclusions- Only two year

Exclusion.PED – waiting period 48monthsNon-allopathic treatments not coveredEnhanced External Counter Pulsation

therapy and related therapies and Rotational Field Quantum Magnetic Resonance Therapy excluded.


Claims Loading

Where the claim ratio for the preceding 2 consecutive years exceeds 100%, premium loading as per the table given below would be applicable.Average claims ratio of

preceding 2 consecutive years (%)

Loading on Premium

>100 - 125 20%

126-150 30%

> 150 50%


Co-payment

10% co-payment for persons entering between 61 yrs and 65 yrs and continues thereafter

Co-payment applicable only for Section I claims


PortabilityThis policy is portable.Inward portability can be accepted for

policies of other Insurance CompaniesPortability procedure to be followedContinuity will be given ONLY for Section

I benefit and NOT for any other Section


Migration allowed from any other health policy of Star except

Senior Citizens Red Carpet Unique policy Diabetes Safe and Super Surplus - Individual & Floater

Continuity of benefits will be given for Section I only

Persons insured under this policy can migrate to any other policy of Star with continuity of benefits again for in-patient hospitalization only.

Migration permitted upto the age of 60 yrs only.Migration permissible only on Renewal for

Policies with 2 continuous Claims free years. Where claims have been made in the past case to be referred to Corporate office


Migration from Star Policies

Migration guidelines….

AGE NO CLAIMWITH

CLAIM REMARKS

≤ 50yrsPre acceptance

Medical Examination NOT required

Refer to Head Office

51 yrs – 60 yrs

Pre acceptance Medical Examination as per Package 1.4

Refer to Head Office

No migration if MER reveals

declined risks*

> 60 yrs No MigrationNo

migration


Migration not permitted for persons suffering from the following declined risks : * Cancer

* Stroke* Heart Diseases* Chronic Renal Diseases

Declined Risks*

Underwriting

Acceptance limits (FRESH PROPOSALS )

Branch < 50years and Sum Insured of Rs 15Lakhs.

Branch > 50 Years Sum Insured upto 5 Lakhs.

Beyond 5 lacs and > 50 yrs refer to Corporate office


Star Comprehensive Apollo’s Easy Health

Automatic Restoration of 100% of Sum Insured

Premium less by 1% to 9%

No Restoration facility

More expensive than Star

Star and Apollo comparison


Star Comprehensive v/s Apollo’s Easy Health

Both Price and benefit comparison given separately

Benefit Illustration 1 Claim under Delivery and New Born Baby Cover:Sum Insured for 1st Year 5 LakhsSum Insured for 2nd Year 7.50 LakhsSum Insured For 3rd Year 7.50 LakhsSum Insured For 4th Year 5 Lakhs

A claim is made in the 4th year The eligibility will be as per 5 lakh Sum Insured i.e Rs 10,000/- for Normal and Rs 15,000/- for Caesarean delivery.

Rs 50,000/- for New Born BabyRs 1000/- for VaccinationThe limit is inclusive of pre-natal and post-natal expenses


Benefit Illustration 2Claim for Health Check UpSum Insured for the 1st year Rs 500000/-Sum Insured for the 2nd Year Rs 750000/-Sum Insured for the 3rd year Rs 750000/-Sum Insured for the 4th Year Rs 1000000/-

Benefits of Health Check Up will be as per Rs 10lakhs

i.e upto Rs 7500/-


Benefit Illustration 3Claim for OP treatment for Dental /OpthalSum Insured for 1st Year 5 LakhsSum Insured for 2nd Year 7.50 LakhsSum Insured For 3rd Year 7.50 LakhsSum Insured For 4th Year 10 Lakhs

Benefit under this section in the fourth year will be as per Rs 10 Lakh Sum Insured which will be Rs 10000/-


Benefit Illustration 4

Admission for Arthroscopic Repair during the 3 year.

Sum Insured for 1st Year 5 LakhsSum Insured for 2nd Year 7.50 Lakhs

Sum Insured Limit for the above treatment will be Rs 5 Lakhs/- (Refer Exclusion 3)


It is a fully loaded Top end Floater Policy for the entire family with High Sum Insured Extended...

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