Star Health and Allied Insurance Co. Ltd. Presentation on DIABETES SAFE.

Star Health and Allied

Insurance Co. Ltd.

Presentation on

DIABETES SAFE


Insurance Co. Ltd.

• This cover is exclusively designed for people diagnosed with Diabetes Mellitus Type II

Presentation on Diabetes Safe

Who can take this policy ?


Insurance Co. Ltd.

Coverages

Hospitalization Expenses incurred as an inpatient for treatment of the following complications

Diabetic Retinopathy requiring Laser treatment

Diabetic Nephoropathy leading to Chronic Renal Failure

Diabetic Foot Ulcer requiring Micro Vascular Surgery



Insurance Co. Ltd.

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.



Insurance Co. Ltd.

Age Limits

Entry Age : 26 Years to 65 Years

Renewal will be accepted up to 70 years



Insurance Co. Ltd.

Pre Acceptance Medical Screening

The following medical examination will be done at the cost of the Insurer.

• Blood Urea• Serum Creatinine• Micro Albuminuria• Blood Pressure Recording• Peripheral artery pulsations in the lower limbs(Dorsalis

Pedis & Posterior Tibial)• General examination of Skin and Foot



Insurance Co. Ltd.

Sum Insured

Minimum Sum Insured - Rs. 50,000/-

Maximum Sum Insured - Rs. 5,00,000/- (However maximum Sum Insured shall be restricted to Rs. 3,00,000/-)

The following Sum Insured options are available• Rs. 50,000/-• Rs. 1,00,000/-• Rs. 2,00,000/-• Rs. 3,00,000/-• Rs. 4,00,000/-• Rs. 5,00,000/-



Insurance Co. Ltd.

Allowable Expenses

Room rent & boarding charges per day @ 2% of the sum insured up-to a maximum of Rs. 2,500/- in Class A cities and Rs. 1,250/- in other cities.

Class A Cities – Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai, Pune, New Delhi and Secunderabad.

Nursing charges

Surgeons, Anesthetist, Medical Practitioner, Consultants and Specialists fees

Laser Treatment, Peritoneal Dialysis (PD) and Haemodialysis (HD).



Insurance Co. Ltd.

Allowable Expenses (Contd.)

Anaesthesia, Blood, Oxygen and Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and Diagnostic Imaging modalities and X-ray

Hospital expenses on donor of kidney for renal transplant surgery

Post-renal complications on the insured person

Second transplant following failure of the first transplant covered



Insurance Co. Ltd.

Allowable Expenses (Contd.)

Pre-hospitalization expenses incurred for a period of 30 days prior to the date of hospitalization

Post hospitalization expenses for 15 days after the discharge from the hospital for the covered disease



Insurance Co. Ltd.

Day Care Treatment

Minimum of 24 hours Hospitalization is not necessary for the following

• Dialysis• Laser procedure for treatment

The above treatment shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.



Insurance Co. Ltd.

Special Conditions applicable to Diabetic Nephropathy leading to Chronic Renal Failure

Pre and Post Hospitalisation benefits not available for the purpose of Dialysis and/or Laser procedure under Diabetic Nephropathy Leading to Chronic Renal Failure

Expenses for dialysis following Chronic Renal Failure is restricted to 10% of the sum insured or Rs. 50,000/- whichever is less, in the year succeeding the one under which a claim for Chronic renal Failure has been admitted.

Expenses on Dialysis in the event of Insured Person developing Post-Transplant renal complications in the same policy period within which the transplant was undertaken, subject to a limit of 5% of the Sum Insured subject to a maximum of Rs. 25,000/-.



Insurance Co. Ltd.

Premium Rating

Age

Sum Insured (Rs.)

26 Years to 35 Years





50000 805 990 1235 1485 2225

100000 1140 1615 1900 2185 2470

200000 1885 2565 3420 3765 4105

300000 2300 3135 4180 4600 5020

400000 4655 4990 6650 7315 7980

500000 6385 6840 9120 10035 10945

Premium figures are in Rs. excluding S. Tax



Insurance Co. Ltd.

Other Benefits

Benefits under Section 80-D of the IT ActCashless Service without involvement of TPADirect Tie up with hospitals on an All India BasisFree advice from General Physician24 X 7 In-House Call center (044-2826 3300)Toll Free Telephone line assistance

(1800 425 2255) – for BSNL and MTNL NumbersFull knowledge based website to offer medical information, including Health Tips. Frequent health meets to disseminate information on health related topics



Insurance Co. Ltd.

Exclusions

Treatment of Cataract

Pre-existing diseases/conditions

Expenses on treament towards Diabetes Mellitus Type II

Expenses towards immuno suppressive drugs/medicines beyond what is allowed in post-hospitalisation benefit

Expenses towards post-donation complications of the donor

Expenses incurred in the first 90 days after taking policy

Cost of walkers, artificial limbs, crutches, wheel chairs and such other similar aids

Diagnostic charges



Insurance Co. Ltd.

Expenses on vitamins and tonics unless forming part of treatment for injury or disease

Naturopathy Treatment

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

Expenses for Non Allopathic Treatment

Expenses incurred for treatment on cosmetic or aesthetic treatment of any description and/or plastic surgery even if necessitated following any of the covered illness/disease

Exclusions (Contd.)



Insurance Co. Ltd.

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



Insurance Co. Ltd.

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.)



Insurance Co. Ltd.

Thank You

Star Health and Allied Insurance Co. Ltd. Presentation on DIABETES SAFE.

Documents

Transcript of Star Health and Allied Insurance Co. Ltd. Presentation on DIABETES SAFE.