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Presentation on FAMILY HEALTH OPTIMA. Coverages. Hospitalization Expenses incurred as an inpatient for Sickness/Illness/Diseases Accident For the entire family on floater basis. Note: Please avoid the acceptance of the following risk Heart Disease Cancer. Family Means.

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Presentation on FAMILY HEALTH OPTIMA


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    1. Presentation on FAMILY HEALTH OPTIMA

    2. Coverages Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accident For the entire family on floater basis • Note: • Please avoid the acceptance of the following risk • Heart Disease • Cancer Star Health and Allied Insurance Co. Ltd.

    3. Family Means • Proposer • Spouse • Dependent Children Star Health and Allied Insurance Co. Ltd.

    4. 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 or • Should 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. Star Health and Allied Insurance Co. Ltd.

    5. Age Limits • 5 Months – 65 Yrs • Renewal upto 65 Yrs • Dependent Children can be covered only with any one of their Parents Star Health and Allied Insurance Co. Ltd.

    6. Sum Insured • Minimum Sum Insured - Rs. 2,00,000/- • Maximum Sum Insured - Rs. 10,00,000/- • The following Sum Insured options are available • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 4,00,000/- • Rs. 5,00,000/- • Rs. 10,00,000/- Star Health and Allied Insurance Co. Ltd.

    7. Allowable Expenses • Room 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 and Secunderabad) • Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Coimbatore 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 Star Health and Allied Insurance Co. Ltd.

    8. 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/- Star Health and Allied Insurance Co. Ltd.

    9. Sub limits Star Health and Allied Insurance Co. Ltd.

    10. 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. Star Health and Allied Insurance Co. Ltd.

    11. Rating (Contd.) S.taxincluded A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.

    12. Rating (Contd.) S.taxincluded A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.

    13. Rating (Contd.) S.taxincluded A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.

    14. Rating (Contd.) S.taxincluded A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.

    15. Rating (Contd.) S.tax included Star Health and Allied Insurance Co. Ltd.

    16. Renewal Discount • 10% Discount on Basic Premium is allowed on renewal for every Claim Free Year • It is not Cumulative Star Health and Allied Insurance Co. Ltd.

    17. Other Benefits • Benefits under Section 80-D of the IT Act • Cashless Service without intervention of TPA • Direct Tie up with hospitals on an All India Basis • 24 X 7 In-House Call center • Toll Free Telephone line assistance • Full knowledge based website to offer medical information, including Health Tips. • Health Check-up benefits • Frequent health meets to disseminate info on the health related topics Star Health and Allied Insurance Co. Ltd.

    18. Exclusions • Pre Existing Diseases • 10% Co-Pay for each and every claim where the entry age is between 60-65Yrs. • 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 menorrhia or fibromyoma • Knee Replacement Surgery • Joint Replacement Surgery • Prolapse of intervertibral • Vericose veins/ulcers Star Health and Allied Insurance Co. Ltd.

    19. Exclusions (Contd.) • Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations • Circumcision unless necessary for treatment of a disease • Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids • Dental treatment or surgery • Convalescence, 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/alcohol • Naturopathy Treatment • Expenses incurred on Lasik Laser or Refractive Error Correction treatment Star Health and Allied Insurance Co. Ltd.

    20. Exclusions (Contd.) • Hospital registration charges, record charges, telephone charges and such other similar charges. • Expenses incurred on Non Allopathic Treatment. Star Health and Allied Insurance Co. Ltd.

    21. Claim Procedure In 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 Hospital • Based on the intimation a field visit will be done by the Star Doctor • Pre Authorization will be issued to the Hospital • Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital Star Health and Allied Insurance Co. Ltd.

    22. Claim Procedure (Contd.) In case of Non Network Hospitals • Immediate 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 Doctor • Bills 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 Star Health and Allied Insurance Co. Ltd.

    23. Thank You Star Health and Allied Insurance Co. Ltd.