STAR HEALTH GAIN INSURANCE

Major Product Features

Flat premium of only Rs. 14,725/-

Coverage for both inpatient and outpatient treatment

Policy can be given for both individual and family floater basis.

Any unutilised amount under outpatient benefit can be carried forward to the next one year

CoveragesUnder section – I

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases Accidental injuries

Under section – II

Hospitalization Expenses incurred as an outpatient treatment subjects to the limits

Family MeansFamily Means

Proposer

Spouse

Dependent Children

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.

Age Limits

5 Months – 60 Yrs

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

Sum Insured

Minimum Sum Insured - Rs. 1,00,000/-

Maximum Sum Insured - Rs. 5,00,000/-

The following Sum Insured options are available

• Rs. 1,00,000/-• Rs. 2,00,000/-• Rs. 3,00,000/-• Rs. 4,00,000/-• Rs. 5,00,000/-

Allowable 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 & NCR and Secunderabad)

• Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day

(Baroda, Indore, Ludhiana, Coimbatore , Cochin 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

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/-

Sub limits

Name of the Ailment / Surgery / Procedure

Sub Limit

Cataract surgery Rs. 15,000/- in the entire policy period

Day Care Treatment

Expenses 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.

Limit of Outpatient benefits for individual

Sum insured for IP(Rs)

100000 200000 300000 400000 500000

5m-45 8700 7750 7000 6250 5750

46-55 7900 6350 5200 3000 NA

56-60 7500 5800 3700 NA NA

IP – Inpatient NA – Not Available

Limit of Outpatient benefits for family floater

Sum insured for IP(Rs)

Age 100000 200000 300000 400000 500000

2A5mths-35yr 8400 7400 6750 5900 5250

36y-45y 8400 7400 6500 5500 490046-55y NA 5650 4000 2000 NA56-60y NA 5000 2250 NA NA

1A+1C5mths-35yr 8500 7700 6950 5750 5500

36y-45y 8500 7500 6750 5750 525046-55y NA 5850 4500 2400 NA56-60y NA 5200 2250 NA NA

1A+2C5mths-35yr 8450 7500 6900 6000 5500

36y-45y 8450 7250 6650 5750 500046-55y NA 5750 4450 2250 NA56-60y NA 5150 2250 NA NA

1A+3C5mths-35yr 8350 7400 6650 5750 5250

36y-45y 8350 7200 6450 5500 475046-55y NA 5500 4000 NA NA56-60y NA 4750 2250 NA NA

A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)

Limit of Outpatient benefits for family floater (contd.)

Sum insured for IP(Rs)

Age 100000 200000 300000 400000 500000

2A+1C5mths-35yr 8250 7250 6600 5750 5000

36y-45y 8250 7000 6150 5450 450046-55y NA 5250 3750 NA NA56-60y NA 4500 1500 NA NA

2A+2C5mths-35yr 8250 7000 6500 5500 4650

36y-45y 8250 7000 5950 5000 375046-55y NA 5000 3500 NA NA56-60y NA 4250 1500 NA NA

2A+3C5mths-35yr 8250 7000 6250 5250 4250

36y-45y 8250 6700 5750 4900 370046-55y NA 4750 3250 NA NA56-60y NA 4000 1150 NA NA

A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given

Renewal Discount

Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart

It is not Cumulative

For Individuals Sum Insured in Rupees

Age 100000 200000 300000 400000 500000

5 Months – 35 Years 120 235 330 420 490

36 Years – 45 Years 135 260 365 450 540

46 Years – 55 Years 245 458 617 870 NA

56 Years – 60 Years 300 530 820 NA NA

No Claim Discount for Individual basis

No Claim Discount for family floater basis

FAMILY COVER ON Floater Basis (FAMILY SIZE)

Sum Insured in Rupees

100000 200000 300000 400000 500000

2 Adults Discount in Rupees5 Months – 35 Years 177 289 399 520 59236 Years – 45 Years 177 314 436 557 65346 Years – 55 Years NA 554 761 1051 NA56 Years – 60 Years NA 640 1003 NA NA

1 Adult + 1 Child5 Months – 35 Years 152 272 371 475 53736 Years – 45 Years 152 301 394 507 59646 Years – 55 Years NA 527 693 966 NA56 Years – 60 Years NA 612 919 NA NA

1 Adult + 2 Child5 Months – 35 Years 164 284 383 491 56336 Years – 45 Years 164 308 411 525 62946 Years – 55 Years NA 541 716 1015 NA56 Years – 60 Years NA 623 973 NA NA

Discount for family floater basis ( Contd. )

FAMILY COVER ON Floater Basis (FAMILY

SIZE)

Sum Insured in Rupees

100000 200000 300000 400000 500000

1 Adult + 3 Child Discount in Rupees5 Months – 35 Years 179 309 413 537 60436 Years – 45 Years 179 342 444 573 67746 Years – 55 Years NA 572 763 NA NA56 Years – 60 Years NA 665 1010 NA NA

2 Adult + 1 Child5 Months – 35 Years 189 330 419 530 63536 Years – 45 Years 189 356 483 578 70546 Years – 55 Years NA 593 787 NA NA56 Years – 60 Years NA 697 1063 NA NA

2 Adult + 2 Child5 Months – 35 Years 203 346 431 565 68836 Years – 45 Years 203 368 511 624 76846 Years – 55 Years NA 645 840 NA NA56 Years – 60 Years NA 736 1109 NA NA

2 Adult + 3 Child5 Months – 35 Years 217 363 462 603 72636 Years – 45 Years 217 406 532 654 82046 Years – 55 Years NA 680 871 NA NA56 Years – 60 Years NA 782 1176 NA NA

Other 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

Exclusions (IP Section)Pre Existing DiseasesAny Disease contracted during first 30 daysFirst Year Exclusions

• Benign prostate hypertrophy• Hernia, Hydrocele, Fistula in Anus, Piles• Sinusitis• 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

congenital internal disease/defect

Exclusions (IP Section)(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 (IP Section) (Contd.)

Hospital registration charges, record charges, telephone charges and such other similar charges.Expenses incurred on Non Allopathic Treatment.

Claim ProcedureIn case of Network Hospitals

Immediate 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

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

How is ‘Star Health Gain’ different from ICICI’s Tax Advantage

•ICICI’s Tax Advt OP claim cannot be made after 90 days from the date of the policy- No such restriction in Star Health Gain policy•ICICI Tax Advt allows only ONE OP claim per year - Any number of OP claims allowed in one year under Star Health Gain policy•Residue OP amount can be carried forward to next one year under Star Health Gain policy•OP benefit can be taken even for PED, Maternity, dental, diagnostics under Star Health Gain policy

How is different from MediclassicMediclassic Health Gain

Coverage under one section Coverage under 2 sections

Covers only Hospitalisation expenses as an Inpatient

Covers medical expenses as on outpatient also

Premium varies depending on the age The premium does not vary depending on the age

Individual sum insured has to be chosen for each insured person

Sum Insured floats for all the family members

Room rent flat 2% of SI maximum of Rs.4000/-

Room rent varies depending of the location of the hospital

There is a limit for day care procedures No limit for day care procedure except Cataract

For persons aged between 5mnths to 80 yrs

For persons aged between 5months to 60 yrs

How is it different from FHOFHO Health Gain

OP Treatment not covered OP Treatment Covered

Premium varies the size of the family and Sum Insured

Premium does not vary depending on the size of the family and Sum Insured

Cataract Limit Rs.12000/- Cataract Limit 15000/-

Thanks