Presentation on FAMILY HEALTH OPTIMA
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Transcript of Presentation on FAMILY HEALTH OPTIMA
Presentation on Family Health Optima
Presentation onPresentation on
FAMILY HEALTH OPTIMAFAMILY HEALTH OPTIMA
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accident For the entire family on floater basis
CoveragesCoverages
Note: Please avoid the acceptance of the following risk Heart Disease Cancer
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Proposer
Spouse
Dependent Children
Family MeansFamily Means
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
What is a Hospital ?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
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.
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Age LimitsAge Limits
5 Months – 65 Yrs
Renewal upto 65 Yrs
Dependent Children can be covered only with any one of their Parents
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Sum InsuredSum Insured
Minimum Sum Insured - Rs. 2,00,000/-
Maximum Sum Insured - Rs. 10,00,000/-
The following Sum Insured options are available
• Rs. 2,00,000/-• Rs. 3,00,000/-• Rs. 4,00,000/-• Rs. 5,00,000/-• Rs. 10,00,000/-
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Allowable ExpensesAllowable ExpensesRoom rent & boarding charges as follows
• Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 4,000/- per day
(Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi and Secunderabad)
• Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day
(Baroda, Coimbatore and all State Capitals other than those falling under Class A)
• Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day
(Other Cities)
Nursing charges
Surgeons, Anesthetist, Consultants and Specialists fees
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Allowable Expenses (Contd.)Allowable Expenses (Contd.)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 maximum of Rs 1,500/- per policy period
Pre-hospitalization expenses incurred 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/-
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Name of the Ailment / Surgery / Procedure
Sub Limit
Cataract surgery Rs. 12,000/- in the entire policy period
Sub limits
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Day Care TreatmentDay Care TreatmentExpenses on Hospitalization for minimum period of 24 hours
are admissible. However, this time limit will not apply for • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is
discharged on the same day.
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Sum Insured Rs. 2,00,000/-Age Band 5 Months
– 35 yrs36 yrs – 45 yrs
46 yrs – 55 yrs
56 yrs – 60 yrs
61 yrs – 65 yrs
2A 3778 4087 6789 7776 NA
1A + 1C 3292 3623 6149 7109 NA
1A + 2C 3452 3701 6309 7225 NA
1A + 3C 3701 4076 6646 7688 NA
2A + 1C 4224 4544 7219 8399 NA
2A + 2C 4401 4677 7798 8835 NA
2A + 3C 4588 5101 8179 9342 NA
A – Adult
C – Children upto 25 yrs
Rating (Contd.)Rating (Contd.)S.tax includedS.tax included
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Sum Insured Rs. 3,00,000/-Age Band 5 Months
– 35 yrs36 yrs – 45 yrs
46 yrs – 55 yrs
56 yrs – 60 yrs
61 yrs – 65 yrs
2A 4395 4809 8388 11063 18450
1A + 1C 4092 4346 7644 10131 NA
1A + 2C 4219 4533 7897 10727 NA
1A + 3C 4550 4897 8416 11135 NA
2A + 1C 4622 5327 8675 11719 NA
2A + 2C 4754 5636 9265 12232 NA
2A + 3C 5090 5868 9607 12966 NAA – Adult
C – Children upto 25 yrs
Rating (Contd.)Rating (Contd.)S.tax includedS.tax included
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Sum Insured Rs. 4,00,000/-Age Band 5 Months
– 35 yrs36 yrs – 45 yrs
46 yrs – 55 yrs
56 yrs – 60 yrs
61 yrs – 65 yrs
2A 5730 6138 11593 14907 22170
1A + 1C 5239 5592 10655 14041 NA
1A + 2C 5416 5791 11195 14571 NA
1A + 3C 5918 6315 12111 15172 NA
2A + 1C 5840 6370 12431 15762 NA
2A + 2C 6226 6883 13093 16424 NA
2A + 3C 6646 7214 13881 17444 NAA – Adult
C – Children upto 25 yrs
Rating (Contd.)Rating (Contd.)S.tax includedS.tax included
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Sum Insured Rs. 5,00,000/-Age Band 5 Months
– 35 yrs36 yrs – 45 yrs
46 yrs – 55 yrs
56 yrs – 60 yrs
61 yrs – 65 yrs
2A 6530 7197 13247 17488 25740
1A + 1C 5923 6568 12740 16793 NA
1A + 2C 6210 6932 13087 17256 NA
1A + 3C 6657 7467 13666 17951 NA
2A + 1C 6999 7771 14135 18475 NA
2A + 2C 7583 8466 14571 19247 NA
2A + 3C 8008 9039 15288 19970 NAA – Adult
C – Children upto 25 yrs
Rating (Contd.)Rating (Contd.)S.tax includedS.tax included
Presentation on Family Health Optima
Rating (Contd.)Rating (Contd.)
Sum Insured Rs. 10,00,000/-Age Band 5 Months
– 35 yrs36 yrs – 45 yrs
46 yrs – 55 yrs
56 yrs – 60 yrs
61 yrs – 65 yrs
2A 9287 9910 16501 20554 NA
1A + 1C 9061 9668 16098 20053 NA
1A + 2C 9194 9811 16341 20356 NA
1A + 3C 9513 10148 16903 21056 NA
2A + 1C 9966 10633 17709 22060 NA
2A + 2C 10418 11118 18514 23058 NA
2A + 3C 10638 11355 18916 23560 NA
Star Health and Allied Insurance Co. Ltd.
S.tax includedS.tax included
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Renewal DiscountRenewal Discount
10% Discount on Basic Premium is allowed on renewal for every Claim Free Year
It is not Cumulative
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Other BenefitsOther Benefits
Benefits under Section 80-D of the IT ActCashless Service without intervention of TPADirect Tie up with hospitals on an All India Basis24 X 7 In-House Call centerToll Free Telephone line assistanceFull knowledge based website to offer medical information, including Health Tips. Health Check-up benefitsFrequent health meets to disseminate info on the health related topics
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
ExclusionsExclusionsPre Existing Diseases10% Co-Pay for each and every claim where the entry age is between 60-65Yrs.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
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Exclusions (Contd.)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
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Exclusions (Contd.)Exclusions (Contd.)
Hospital registration charges, record charges, telephone charges and such other similar charges.Expenses incurred on Non Allopathic Treatment.
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Claim ProcedureClaim 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 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
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Claim Procedure (Contd.)Claim Procedure (Contd.)
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 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
Presentation on Family Health Optima
Star Health and Allied Insurance Co. Ltd.
Thank You