Star Health and Allied Insurance Co. Ltd. Presentation on Medi-Classic Presentation on MEDI-CLASSIC.

Star Health and Allied Insurance Co. Ltd.

Presentation on Medi-Classic

Presentation on

MEDI-CLASSIC



Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accidental injuries



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.



5 Months – 59 Yrs (age last Birthday)

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

Single person in the family will not be covered-

unless ALL other family members are covered with Star Health .

Renewable up to 80 yrs



For persons with adverse medical historyand

For all persons above 51 years All Sum Insured acceptance subject to Medical Examination at Company’s

Cost.

* The Procedure for Acceptance of Medical Proposals



TMT required : Age is above 51 years – S.I. of Rs.10

lacs and above

BMI = Weight in Kgs. (Height in meter)2

More than 35 BMI – NOT Accepted



Heart Brain Chronic Kidney Problems, Paralysis Diabetes- ( Type- I) Alzheimer Parkinson Cancer problems Polio at the inception (in the lifetime)



Non Medical Proposals:- Proposal Form-Completely Filled- ONE Photograph- For all proposals from persons above 45 years, age proof

in the form of School Certificate/Pan Card/Driving License/Passport/Ration Card is required.

Medical Proposals:- Proposal Form-Completely Filled- TWO Photographs- only for those who require to

undergo medical tests- For all proposals from persons above 45 years, age proof

in the form of School Certificate/Pan Card/Driving License/Passport/Ration Card is required.



Room rent & boarding charges @ 2% of the sum insured up-to a maximum of Rs. 5,000/- 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



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 Hospitalization expenses incurredComprising of Nursing Charges,Surgeon/Consultant fees, Diagnostic Charges, Medicines and Drugs onlySubject to a maximum of Rs 5,000/- perOccurrence.



Reasonable & Customary Charges: Means a charge which: is charged for medical treatment, supplies or

medical services that are necessary to treat Your condition

Does not exceed the usual level of charges for similar medical treatment, supplies or medical services in the locality where the expenses is incurred and

Does not include charges that would not have been made if no insurance existed.



Minimum 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.



Name of the Ailment / Surgery / Procedure

Sub 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/-



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



Benefits 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 / 1800 102 4477)Full knowledge based website to offer medical information, including Health Tips.



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



Pre-existing Diseases ( for first 4 yrs. with Star Health without Break )

Any Disease contracted during first 30 days

First 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 menorrhea or fibromyoma Knee Replacement Surgery ( unless caused by accident ) Joint Replacement Surgery ( unless caused by accident ) Prolapse of intervertibral Disc Varicose veins / Ulcers



Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations

Cost 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



Hospital registration charges, record charges, telephone charges and such other similar charges.Non Allopathic shall be restricted to 25% of the sum insured subject to a maximum of Rs. 25,000/- for the entire policy period.



In case of Network HospitalsImmediate intimation to the Call Centre

(1800 425 2255 / 1800 102 4477 / 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

Note: Late Intimation / No Intimation of the claim will not be entertained



Immediate intimation to the Call Centre (1800 425 2255 / 1800 102 4477 / 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 IPD PAPERS ( Indoor Patient ) Note: Late Intimation of the claim will not be entertained. Claim file / Documents need to be submitted within 15

days



Agents Role ( Renewal, Service, Premium collection, training, utmost good faith, Disclosure of material facts)

Cashless is Direct settlement – Not without cash Admission in network Hospitals ONLY Rewards : Blackberry July-Aug-Sept’11, LCD TV,

Foreign Trip etc. Group Insurance



1. Which policy is suitable for an individual? Ans - Medi-classic policy is suitable for an individual. It provides

cover on an Individual basis. 2. What is the entry age for Medi-classic? Ans: The minimum entry age for Medi-classic is minimum

5months and maximum 60 yrs. 3. Which type of hospitalization is covered under this

policy? Ans – Medi-classic covers hospitalization due to sickness, illness

or diseases and due to accident.



4. What is the minimum required period of hospitalization? Ans - The minimum required period of hospitalization is at least 24

hours. This rule has some exceptions which are called day care treatments.

5. What is meant by day care treatments? Ans – The day care treatment means the treatment which does

require 24 hours hospitalization. Following are the Day care treatments, which are covered currently- Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery(Only due to Accident), Lithotripsy (Kidney stone removal),Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy.



6. What are the options provided for Sum Insured, in Medi-classic?

Ans- In Medi-classic the minimum Sum Insured can be offered is of Rs.1 Lakh, maximum upto Rs.10 Lakhs.

7. What is NO Claim Discount? How much is it? Ans - In Medi-classic policy, Star Health gives discount on basic

premium, for each claim free year, at the time renewal of the policy. The No Claim discount ranges from 5% to 25%.

8. What is hospital Cash Benefit? Ans - This is an optional benefit, provided in Medi-Classic on payment of

additional premium. It provides 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. This optional benefit is available to the persons who are between 21 to 60 yrs



8. Is there any waiting period for the commencement of the cover?

Ans –There is a waiting period of 30 days from the date of issuance of the policy A waiting period is the length of time the insured may have to wait before being eligible for Health Policy benefits. It is applicable only for the first policy period with Star Health.

9. Which diseases are not covered in the first year, only? Ans - Following diseases are not coverd for the first year only-

Benign prostate hypertrophy,Hernia, Hydrocele, Fistula in Anus, Piles,Sinusitis,congenital internal disease/defect,Renal stone and Gall stone removal



10. Which diseases are not covered for the first two years, only? Ans – Following diseases are not coverd for the first two years-

Cataract,hysterectomy following menorrhea or fibromyoma,Knee Replacement Surgery ( unless caused by accident ),Joint Replacement Surgery ( unless caused by accident ),Prolapse of intervertibral Disc,Varicose veins / Ulcers.

11. What if a person is already suffering from any disease/s? Ans - If a person is already suffering from any of the diseases, that

disease/s(Pre-Existing Disease/s) will be covered only after the four years with Star health without any break.

12. Is any Naturopathy treatment covered under Medi-Classic? Ans – Naturopathy treatments are not covered under Medi-Classic / any

other policy of Star Health



13. Is any kind of Dental Treament covered under Medi-classic?

Ans - Dental Treament is covered under Medi-classic / any other health policy but only if it is due to Accident.

14. Do you cover Non Allopathic Treatments in Medi-

Classic? Ans – Non Allopathic Treatments are covered under Medi-classic

policy. There should be hospitalization of at least 24 hrs. They are covered up-to 25% of Sum Insured or Rs.25000/- or actual expenses whichever is less.



15. What is the claim procedure? Ans – First, You need to inform the 24-hour Toll Free no. 1800

425 2255 / 1800 102 4477 for assistance. One has to Inform the ID number / policy number for easy reference.

In case of planned hospitalization, please inform 24 hours prior to admission into the hospital.

In case of hospitalization due to emergency, information must be given within 24 hours after hospitalization.

In case of non-network hospitals, payment must be made upfront by the policy holder and then reimbursement will be effected on the submission of documents.

Intimation on the Toll free Number is a must.



16. Why should I take a Health Plan if I already have health insurance from my employer?

Ans - Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Health Insurance policy will come to your rescue.

Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.



True or False

Mini and Max S.I. in Medi Classic is Rs one Lakh and 15 Lakh.

Med classic can be renewed for life long with some loading.

Hospital cash benefit is available up to max Rs 1500 per hospitalization.

Max cash benefit Rs 6000 per policy period for persons above 60 years.

No claim discount (NCD)is available from 5 to 25% cumulatively.

Once cash benefit opted No claim discount (NCD)is not available.

Covers starts immediately once policy is in force.

For PED cover is available only after 4 years.

For Non Allopathic treatment cover is available up to 25% of basic S.I.



Thank You

Star Health and Allied Insurance Co. Ltd. Presentation on Medi-Classic Presentation on MEDI-CLASSIC.

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Transcript of Star Health and Allied Insurance Co. Ltd. Presentation on Medi-Classic Presentation on MEDI-CLASSIC.