Medi Classic Presentation

Star Health and Allied Insurance Co. Ltd.

Presentation on Medi-Classic

Presentation on

MEDI-CLASSIC



Coverages

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accidental injuries



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.



Age Limits

5 Months – 80 Yrs

Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required.

Dependent Children can be covered only with any one of their Parents



Medical Examination

For persons with adverse medical history

and

For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.



Sum InsuredMinimum Sum Insured - Rs. 50,000/-

Maximum Sum Insured - Rs. 10,00,000/-

The following Sum Insured options are available• Rs. 50,000/-• Rs. 1,00,000/-• Rs. 1,50,000/-• Rs. 2,00,000/-• Rs. 2,50,000/-• Rs. 3,00,000/-• Rs. 3,50,000/-• Rs. 4,00,000/-• Rs. 5,00,000/-• *Rs.10,00,000/- * for members from 5 months to 65 yrs only



Allowable Expenses

Room rent & boarding charges @ 2% of the sum insured up-to a maximum of Rs. 4,000/- per day

Nursing charges

Surgeons, Anesthetist, Consultants and Specialists fees

Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc

Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- 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/-



Day Care TreatmentMinimum of 24 hours Hospitalization is not necessary for the following • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, The above treatment shall be taken in the Hospital / Nursing Home

and the Insured is discharged on the same day.



Sub limitsName of the Ailment / Surgery /

ProcedureSub 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. 7,500/-

Cutting and Draining of Abscess Rs. 1,500/-

Liver Aspiration Rs. 2,000/-

Pleural Effusion Aspiration Rs. 2,000/-

Colonoscopy Rs. 2,000/-

Sclerotheraphy Rs. 5,000/-



Premium Rating

Age Sum Insured (Rs.)50000 1 Lakh 1.5

Lacs2 Lacs 2.5

Lacs3 Lacs 3.5

Lacs4 Lacs 5 Lacs 10

Lacs

5 Months to 35 Years

575 1200 1800 2350 2800 3300 3750 4200 4900 7065

36 Years to 45 Years

700 1350 2000 2600 3150 3650 4150 4500 5400 7965


1320 2447 3400 4583 5548 6170 7408 8700 10700 13265


NA 3000 4200 5300 7200 8200 10196 11451 13958 16525


NA 4547 6717 8768 10696 12625 14434 16242 19859 NA


NA 4872 7284 9574 11744 13914 15964 18015 22113 NA


NA 6029 9284 12420 15433 18449 21341 24236 30023 NA



No Claim Discounts (NCD) in case of Renewal

5% Discount on Basic Premium for every Claim Free Year

Maximum 25%

In the event of a Claim

• One Step back in NCD for Age Group 5M – 35 Yrs

• Two Steps back for Age Group 36 – 45 Yrs

• Above 45 Yrs – No NCD



Transfer of Policy To obtain the following benefits there should be a

continuous renewal of the expiring policy

(a) Renewal with Cumulative Bonus details• Cumulative Bonus as shown in the Renewal Notice is

given• Additional 5% Discount on premium is also given

(b) No Renewal Notice or Renewal Notice without Cumulative Bonus details

• Cumulative Bonus as shown in the Previous Policy is given

• Additional 5% Discount on premium is also given• A declaration stating No Claim under the expiring policy

has to be obtained from the insured



Transfer of Policy – An Illustration

• Sum Insured – Rs. 1 Lac• Premium – Rs. 1,200/- + S.Tax• CB shown in the expiring Policy – Rs. 10,000/- (10%)• CB eligible at the time of Renewal – Rs. 15,000/- (15%)

• In Case of (a) – CB of Rs. 15,000/- will be given and additional 5% discount on Rs. 1,200/- will also be given.

• In Case of (b) – CB of Rs. 10,000/- as shown in the expiring policy will be given and additional 5% discount on Rs. 1,200/- will also be given.



Other BenefitsBenefits under Section 80-D of the IT ActCashless Service without involvement of TPADirect Tie up with hospitals on an All India Basis24 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. Health Check-up benefits in addition to NCDFrequent health meets to disseminate information on health related topics



Optional Benefits The following Optional benefits can be availed on

payment of Additional Premium

Hospital Cash :• This insurance provides for Cash benefit of Rs. 500/- for and

each and every completed day of Hospitalisation subject to a maximum of Rs. 1,500/- per hospitalisation and Rs. 3,000/- per policy period.

• Insured persons aged less than 21 years and more than 60 years are not entitled for this benefit.

• Premium Age Band Premium (Rs.)

0-35 Years 200

36-45 Years 250

46-55 Years 300

56-60 Years 350



Optional Benefits (contd.)Patient Care :

• Applicable for persons aged above 65 Years

• This insurance is extended to provide for the cost incurred for engaging one attendant at residence after discharge from the hospital of the Insured Person following a covered occurrence under the policy up to Rs. 400 per day for a maximum of 5 days per hospitalisation. Subject to Time excess of 2 days.

• Provided engagement of such an attendant is recommended by the attending physician and agreed to by the Company, in writing

• Premium – Rs.300/- per person



Covers Insured Person, Spouse and 2 Dependant Children

Age Limit : 5 Months to 45 Years

Sum Insured Equally apportioned among Insured family members

Rating

Family Package

Details

Sum Insured

2 Lacs 3 Lacs

2 Adults 2348 3400

2 Adults + 1 Child 2238 3825

2 Adults + 2 Children 2320 4080

1 Adult + 1 Child 2168 3230

1 Adult + 2 Children 2206 3280

• Provides cover to New Born from Birth up to expiry of policy period.

• The Sum Insured is restricted to 10% of the Mother’s Sum Insured on Payment of 10% of the Policy Premium.


Presentation on Medi-ClassicExclusions

Pre Existing Diseases (covers after 4 yrs of continuous renewal with us without break)Any Disease contracted during first 30 daysFirst 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• Cataract• hysterectomy following menorrhia or fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery• Prolapse of intervertibral• Vericose veins/ulcers



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



Exclusions (Contd.)

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

Non Allopathic shall be restricted to Rs. 25,000/- per occurrence and subject to an overall limit of 25% of the sum insured during the entire policy period.



Claim Procedure

In case of Network HospitalsImmediate intimation to the Call Centre

(1800 425 2255/044-28263300)The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network HospitalBased on the intimation a field visit will be done by the Star DoctorPre Authorization will be issued to the HospitalBased on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital



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.)



Thank You

Medi Classic Presentation

Health & Medicine

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