STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING STAR HEALTH AND ALLIED INSURANCE...

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING


Why Unique?Why Unique?

• This policy is Unique because it covers Certain Pre-Existing diseases as well This policy is Unique because it covers Certain Pre-Existing diseases as well

as any future ailments – ------- all under one policyas any future ailments – ------- all under one policy

Pre Existing Diseases (other than those for which specific time periods Pre Existing Diseases (other than those for which specific time periods have been mentioned separately) covered after complete of 11 monthshave been mentioned separately) covered after complete of 11 months

The policy provides coverage to HIV positive persons.The policy provides coverage to HIV positive persons.

Premium payable in installmentsPremium payable in installments

No pre acceptance medical examinationNo pre acceptance medical examination

Major Features..Major Features..


Coverages..Coverages..Hospitalization Expenses incurred as an inpatient forHospitalization Expenses incurred as an inpatient for

Sickness/Illness/DiseasesSickness/Illness/Diseases Accidental injuriesAccidental injuries

Pre Existing Disease..Pre Existing Disease..

Pre-Existing Disease/ Condition will be covered after 11 months of Pre-Existing Disease/ Condition will be covered after 11 months of

continuous coveragecontinuous coverage

Does this mean that any PED is covered after 11 months?Does this mean that any PED is covered after 11 months?

No – only certain diseases that are Pre-ExistingNo – only certain diseases that are Pre-Existing


Coverage for HIV positive personsCoverage for HIV positive persons

The policy extends coverage to HIV positive persons. The policy extends coverage to HIV positive persons.

Minimum CD 4 count at entry level should be 350Minimum CD 4 count at entry level should be 350

Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not

covered covered

Expenses for treatment of HIV / AIDS not coveredExpenses for treatment of HIV / AIDS not covered


Period of Insurance..Period of Insurance..

The policy is for a two year period. The policy is for a two year period.

Even renewal will be for a two year period Even renewal will be for a two year period

Advantages are :Advantages are :

Customer retentionCustomer retention

Claims loading, if applicable will happen only once in two yearsClaims loading, if applicable will happen only once in two years

However, Sum insured will be available afresh for each year. However, Sum insured will be available afresh for each year.

For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for

first yr and 2 lacs for the second yr.first yr and 2 lacs for the second yr.

However sum insured cannot be cumulated or carried forwardHowever sum insured cannot be cumulated or carried forward


Installment Premium..Installment Premium..

• The premium can be paid in 2 annual installments. The premium can be paid in 2 annual installments.

• The grace period of 15 days for benefit of continuity will be available for The grace period of 15 days for benefit of continuity will be available for instalment premium also. However, the expiry date of the policy will not instalment premium also. However, the expiry date of the policy will not change.change.

• Where a claim is made in the first year itself the premium towards the next Where a claim is made in the first year itself the premium towards the next installment would be deducted from the claim amount.installment would be deducted from the claim amount.

• The policy would lapse if the installment is not paid on or before the due The policy would lapse if the installment is not paid on or before the due date.date.


Age Limits..Age Limits.. Entry age 18 Years to 65 YearsEntry age 18 Years to 65 Years Life long renewalsLife long renewals

Sum InsuredSum Insured

The following Sum Insured options are availableThe following Sum Insured options are available

Sum Insured Sum Insured Options (Rs)Options (Rs)

Sub-limit for PED Sub-limit for PED Cover (Rs)Cover (Rs)

100000100000 5000050000

200000200000 100000100000

300000300000 150000150000

Note : The sum insured is for each year of insurance and cannot be Note : The sum insured is for each year of insurance and cannot be cumulated or carried forwardcumulated or carried forward


Allowable Expenses..Allowable Expenses.. Room rent, nursing & boarding charges @ Room rent, nursing & boarding charges @ 1% of the sum insured subject 1% of the sum insured subject

to a maximum of Rs. 3000/- per day.to a maximum of Rs. 3000/- per day.

Surgeons, Anesthetist, Consultants and Specialists feesSurgeons, Anesthetist, Consultants and Specialists fees

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

Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation up to a maximum of Rs 1,500/- per policy periodper hospitalisation up to a maximum of Rs 1,500/- per policy period

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

Post hospitalization expenses on a lump-sum basis @ 7% of the actual Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs. 5,000/-charges), subject to a maximum of Rs. 5,000/-


Day Care Treatment..Day Care Treatment..

Minimum of 24 hours Hospitalization is not necessary for the following Minimum of 24 hours Hospitalization is not necessary for the following • DialysisDialysis• ChemotherapyChemotherapy• RadiotherapyRadiotherapy• Cataract surgeryCataract surgery• Dental Surgery following accidentDental Surgery following accident• LithotripsyLithotripsy• TonsillectomyTonsillectomy• Treatment of Fracture/DislocationTreatment of Fracture/Dislocation• Incision and Draining of AbscessIncision and Draining of Abscess• Liver AspirationLiver Aspiration• Pleural Effusion AspirationPleural Effusion Aspiration• ColonoscopyColonoscopy• SclerotheraphySclerotheraphy• TympanoplastyTympanoplasty• ChalazionChalazion


Day-Care..Day-Care..

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


Sub Limits..Sub Limits..Name of the Ailment / Surgery / ProcedureName of the Ailment / Surgery / Procedure Sub LimitSub Limit

Cataract surgeryCataract surgery Rs. 12,000/- in respect of one eye and Rs. 12,000/- in respect of one eye and

Rs. 24,000/- in the entire policy periodRs. 24,000/- in the entire policy period

Lithotripsy (Kidney stone removal)Lithotripsy (Kidney stone removal) Rs. 20,000/- per policy yearRs. 20,000/- per policy year

TonsillectomyTonsillectomy Rs. 15,000Rs. 15,000/- per policy year/- per policy year

Incision and Draining of Superficial AbscessIncision and Draining of Superficial Abscess Rs. 1,500Rs. 1,500/- per policy year/- per policy year

Incision and Draining of Deep seated AbscessIncision and Draining of Deep seated Abscess Rs. 4,000/- per policy yearRs. 4,000/- per policy year

Liver AspirationLiver Aspiration Rs. 2,000/- per policy yearRs. 2,000/- per policy year

Pleural Effusion AspirationPleural Effusion Aspiration Rs. 2,000/- per policy yearRs. 2,000/- per policy year

SclerotheraphySclerotheraphy Rs. 5,000Rs. 5,000/- per policy year/- per policy year

Treatment of Fracture / DislocationTreatment of Fracture / Dislocation Rs. 2,000/- per policy yearRs. 2,000/- per policy year

ChalazionChalazion Rs. 3,000Rs. 3,000/- per policy year/- per policy year

TympanoplastyTympanoplasty Rs. 20,000/- per policy yearRs. 20,000/- per policy year

DialysisDialysis Rs. 1,200Rs. 1,200/- per sitting/- per sitting

Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.


Premium ….. approachPremium ….. approach

• We have introduced a dual pricing conceptWe have introduced a dual pricing concept

- - Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Ahmedabad will Ahmedabad will have a slightly higher premiumhave a slightly higher premium

• Rest of India will have comparatively lower premiumRest of India will have comparatively lower premium


Annual Installment PremiumAnnual Installment Premium

Applicable for offices in Ahmedabad, Bangalore, Mumbai (including Applicable for offices in Ahmedabad, Bangalore, Mumbai (including Thane) and New Delhi (including Faridabad, Gurgaon & Noida)Thane) and New Delhi (including Faridabad, Gurgaon & Noida)

Note : Premium figures are excluding Service Tax.Note : Premium figures are excluding Service Tax.

Sum Sum Insured Insured Options Options

(Rs)(Rs)

Sub-limit Sub-limit for PED for PED

Cover(Rs)Cover(Rs)

AgeAge

18yrs-18yrs-25yrs25yrs






100000100000 5000050000 58805880 67206720 1008010080 1176011760 1417014170 1610016100

200000200000 100000100000 75857585 98409840 1476014760 1722017220 2074520745 2357523575

300000300000 150000150000 1062510625 1380013800 2001020010 2277022770 2380523805 2645026450


Annual Installment PremiumAnnual Installment Premium

Applicable for rest of IndiaApplicable for rest of India

Note : Premium figures are excluding Service Tax.Note : Premium figures are excluding Service Tax.

Sum Sum Insured Insured Options Options

(Rs)(Rs)

Sub-limit Sub-limit for PED for PED

Cover (Rs)Cover (Rs)

AgeAge







100000100000 5000050000 49004900 56005600 84008400 98009800 1232012320 1400014000

200000200000 100000100000 63206320 82008200 1230012300 1435014350 1804018040 2050020500

300000300000 150000150000 88558855 1150011500 1667516675 1897518975 2070020700 2300023000


ExclusionsExclusions

Pre-Existing Disease/ Condition within 11 months of commencement of this Pre-Existing Disease/ Condition within 11 months of commencement of this insuranceinsurance

Any Disease contracted during first 30 daysAny Disease contracted during first 30 days First Year ExclusionsFirst Year Exclusions

– Deviated Nasal SeptumDeviated Nasal Septum– Benign Prostate HypertrophyBenign Prostate Hypertrophy– Nasal PolypsNasal Polyps– HerniaHernia– HydroceleHydrocele– Congenital Internal diseases/defectsCongenital Internal diseases/defects– Fistula in anus, Piles, Sinusitis, and related disordersFistula in anus, Piles, Sinusitis, and related disorders– Post trauma non union / mal unionPost trauma non union / mal union– Cholecystectomy and Renal Calculi /Gall bladder calculi are not Cholecystectomy and Renal Calculi /Gall bladder calculi are not

payable. payable. If these diseases (other than congenital internal disease /defects) are Pre-If these diseases (other than congenital internal disease /defects) are Pre-

Existing at the time of proposal they are payable after 24 months of Existing at the time of proposal they are payable after 24 months of continuous coverage with the Company.continuous coverage with the Company.


Exclusions (Contd.)Exclusions (Contd.)

First Two Years ExclusionsFirst Two Years Exclusions– Cataract, Cataract, – Hysterectomy (abdominal and Vaginal), Hysterectomy (abdominal and Vaginal), – Dysfunctional Uterine Bleeding (DUB)Dysfunctional Uterine Bleeding (DUB)– Fibroid Uterus Fibroid Uterus – Prolapsed UterusProlapsed Uterus– MyomectomyMyomectomy– CystectomyCystectomy– Treatment of Internal Derangement of Knee (other than caused by an Treatment of Internal Derangement of Knee (other than caused by an

accident)accident)– Treatment for Joints (other than caused by an accident)Treatment for Joints (other than caused by an accident)– other Arthroscopic Surgeriesother Arthroscopic Surgeries


First Two Years Exclusions (Contd.)First Two Years Exclusions (Contd.)

1.1. Inter-Vertebral Disc Prolapse (other than caused by accident)Inter-Vertebral Disc Prolapse (other than caused by accident)2.2. Degenerative Vertebral and Disc diseasesDegenerative Vertebral and Disc diseases3.3. Varicose veins and Varicose ulcersVaricose veins and Varicose ulcers4.4. ThyroiditisThyroiditis5.5. Treatment of GoitreTreatment of Goitre6.6. TympnoplastyTympnoplasty7.7. Mastoidectomy Glaucoma Mastoidectomy Glaucoma

are not payable irrespective of whether they are Pre-Existing or not.are not payable irrespective of whether they are Pre-Existing or not.



First Four Years ExclusionsFirst Four Years Exclusions

– StapedectomyStapedectomy– Bone marrow transplantBone marrow transplant– Cirrhosis of liver with or without portal HypertensionCirrhosis of liver with or without portal Hypertension– HepatitisHepatitis– Loss of vision partial / total including RetinopathyLoss of vision partial / total including Retinopathy– Retinal DetachmentRetinal Detachment– Macular degeneration and Papil OedemaMacular degeneration and Papil Oedema– all types of Cancerall types of Cancer– Nephropathy and Chronic Kidney diseases Nephropathy and Chronic Kidney diseases – Implant RemovalImplant Removal

The above shall not be payable during the first four yearsThe above shall not be payable during the first four years only only if these are Pre if these are Pre

Existing at the commencement of this insuranceExisting at the commencement of this insurance



30% on all claims including PED claims. This copayment would 30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claimsapply on the sub limit mentioned for PED claims

Non allopathic treatment is limited to 25% of the sum insured per Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs. 25000/- for each year occurrence subject to an overall limit of Rs. 25000/- for each year of insuranceof insurance


Other BenefitsOther Benefits Benefits under Section 80-D of the IT ActBenefits under Section 80-D of the IT Act

Cashless Service without involvement of TPACashless Service without involvement of TPA

Direct Tie up with hospitals on an All India BasisDirect Tie up with hospitals on an All India Basis

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED PERSONAL & CARING STAR HEALTH AND ALLIED INSURANCE...

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