STAR HEALTH INSURANCE COIMBATORE

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Family Health Optima

description

STAR HEALTH INSURANCE COIMBATORE SALES MANAGER NANDAGOPAL 9994910202

Transcript of STAR HEALTH INSURANCE COIMBATORE

Page 1: STAR HEALTH INSURANCE COIMBATORE

Family Health Optima

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Age at Entry : 5 months to 65 yearsRestricted admissibility for age between 61 and 65 years

Family size : 2A + 3C ( Maximum)Dependant children less than 25years of age

Renewability : Up to 65 years

Coverage : Family Floater Coverage(SI is used either individually or collectively)

Features

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Features

Sum Insured OptionsRs. 200,000Rs. 300,000Rs. 400,000Rs. 500,000Rs. 10,00,000Rs. 15,00,000

For entry age between 61 and 65 years, only 2 Adults is allowed for Sum Insured of Rs.300,000 and above

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Two Tier rating of Premium according to Zone

Zone 1 - Mumbai, Delhi ( Delhi city, Noida, Gurgoan, Ghaziabad, Faridabad) and the entire State of Gujarat

Zone 2 - Rest of India

Premium would be charged according to the residential address of the customer.

When a policy is charged as per Zone 2 rate and a claim is taken in one of the Zone 1 cities, the difference in the premium is recovered in the claim amount

Features

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Hospitalization Benefit

Cashless treatment or Reimbursement of expenses incurred owing to disease, illness, sickness or accidents as inpatient in a registered hospital for a minimum period of 24 hours.

Pre Hospitalization

30 days prior to hospitalization covered for reasonable expenses.

Post Hospitalization - 7% of the Hospital expenses excluding room rent subject to a maximum of Rs.5000/-

Benefits

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Nursing charges, Surgeons, Anesthetist, Consultants and Specialists fees, Operation Theatre Charges, Drugs and medicines diagnostic materials, cost of pace maker etc…

Ambulance Charges

Rs. 750 per hospitalization subject to a maximum of Rs. 1500 per policy period

Co Pay20% Co pay on each and every eligible claim

amount for insured between 61- 65 years at entry level

Benefits

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Day Care Procedure - 101 treatments covered as day care in case of less than 24 hours hospitalization.

Limit for Cataract is based on the Sum InsuredSI Option Limit for Cataract

Rs.200,000 Rs.12,000 Per policy period

Rs.300,000Rs.400,000 Rs.20,000 per eye subject to Rs.500,000 Rs.30,000 per policy period

Rs.10,00,000 Rs.15,00,000 Rs.30,000 per eye subject to

Rs.40,000 per policy period

Benefits

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Automatic Restoration of SI

Where the sum insured is exhausted during the policy period, there is an automatic top up of Sum

insured for the rest of the policy period

SI option % of RestorationRs.300,000 50% of Sum insuredRs.400,000 & Above 100% of Sum insured

Automatic restoration operates only when the basic Sum insured is Rs.300,000 & above

Benefits

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Automatic Restoration of SI – An Illustration

Mr. A has a Rs.5,00,000 policy and a claim is made in full for treatment of an ailment by him.

Rs.500,000 is again reinstated in the policy for the rest of the policy period. No extra Premium is charged. This is automatic restoration.This amount can now be availed by each or any

member covered in the policy including Mr. A. The restored amount cannot be used for the treatment of the same ailment again in the policy period by

Mr. A

Benefits

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Bonus Additions

The policy holder is now bestowed with additional SI in case of a claim free year.

Different % age of bonus additions for Different SI options.

A maximum of 35% of Basic SI is accumulated as Bonus.

Ex: A policy with Sum insured of Rs.10,00,000 will now automatically become Rs.13,50,000 in the third year without any extra premium

Benefits

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Bonus Additions

Benefits

Basic Sum Insured

% age of Bonus in 1st

Renewal

% age of Bonus in 2nd Renewal

Maximum % age

of Bonus

100,000 10 5 15

200,000 10 5 15

300,000 25 10 35

400,000 25 10 35

500,000 25 10 35

10,00,000 25 10 35

15,00,000 25 10 35

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What happens to Bonus Additions when there is claim in the subsequent year?

The Bonus additions is reduced by 50 % in the event of a claim

The Bonus additions becomes Zero when there is a claim in the successive year also

Bonus additions would continue according to slab for the further claim free year

Benefits

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Room Rent : Class A Cities2% of Sum Insured subject to maximum of Rs.5000 per day

Class B Cities1% of Sum Insured subject to maximum of Rs.3000 per day

Class C Cities1% of Sum Insured subject to maximum of Rs.1000 per day

Benefits

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Persons who are suffering from or have suffered

from the following ailments cannot be issued

policy –

Heart Problem (CVD)

Cancer

Kidney Failure

Stroke (CVA)

Declined Risk

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All Pre Existing Diseases Covered after

48 months of continuous coverage with STAR

Any Diseases contracted during the first

30 days of the first policy year

Exclusions

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First 2 years’ Exclusions

Cataract

Hysterectomy following menorrhagia or

fibromyoma,

Knee Replacement Surgery,

Joint Replacement Surgery

Prolapse of intervertibral disc

Varicose veins/ulcers

Exclusions

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First year Exclusions

Benign prostate hypertrophy,

Hernia

Hydrocele

Fissures, Fistula in Anus / Piles

Sinusitis

Congenital internal disease/defect

Treatment for Gall stone and

Treatment for Renal stone

Exclusions

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This policy is portable

Proposals from less than 45 years of age without any previous claim or PED, can be ported to this policy by the operating office.

The requisition has to be received 7 days before the date of expiry.

Beyond 45 years of age, portability acceptance routed through portability cell

Portability

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The sum insured is restricted to the one in the expiring policy

Continuity benefits of First 30 days, First year exclusions, First two years’ exclusions and PED allowed according to the previous policy

Cumulative Bonus of the previous insurer is notgiven credit

Portability

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Pre Insurance medical examination at our tie up diagnostic centre at the cost of the

company.

Test to taken as per the guidelines based upon the sum insured.

Acceptance based upon the medical officers’ opinion of the MER.

Persons with adverse medical history may also be referred for medical examination.

Pre Insurance Medical

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Deductions under Sec 80 D of Income Tax Act

is available for all modes of payment other

than cash

IT Benefit

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Renewal into revised FHO

Can the Sum insured be increased during renewals? If Yes , what is the limit ?

Increase in Sum insured is allowed only during a claim free year.

The increase is restricted to Next Slab of Sum Insured(subject to approval)

The No Claim Discount for a claim free year is withdrawn

The policy will now attract Bonus Additions as per slab

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Renewal (contd.,)

An illustration

Rs.400,000 claim free FHO policy is now renewed for Rs.500,000 Sum insured.

There will be a bonus addition of Rs.100,000. (25% of Basic Sum insured which is Rs.400,000)

Total Sum insured is Rs.600,000 (Rs.500,000 + Rs.100,000)

Premium is paid for Rs.500,000 Sum insured

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Documents required

Proposal form duly filled in all respects and signed by the proposer. Care to be taken to capture the PED details, if any.

One individual Photograph of each person to be insured

Two photographs for those who have to undergo medical examination

Age proof in case of age above 45 years

Full and Correct Premium of the plan

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USP’s of Revised FHO 101 day care procedures covered

Revised limits for Cataract

Inclusion of Goa, Rajkot, Allahabad in B Cities

Automatic Restoration of SI up to 100% of Sum insured

Bonus additions for claim free year

Bonus additions is reduced by only 50% in case of a claim in the successive year

No decrease in Basic SI

No loading on claims

Two tier pricing

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Happy Selling