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India – Health

India – Health. Presentation on MEDI - Classic. Coverages:- Hospitalization due illness/sickness/disese. What is a Hospital?. Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which Either

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India – Health

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  1. India – Health

  2. Presentation on MEDI-Classic

  3. Coverages:- Hospitalization due illness/sickness/disese

  4. What is a Hospital? 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 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.

  5. Age Limits 5 Months – 60 Yrs, renewal 80 years Dependent Children can be covered only with any one of their Parents

  6. Medical Examination For persons with adverse medical history and For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.

  7. Sum Insured Minimum Sum Insured - Rs. 100000/- Maximum Sum Insured - Rs. 10,00,000/- The following Sum Insured options are available Rs. 1,00,000/- Rs. 1,50,000/- Rs. 2,00,000/- Rs. 2,50,000/- Rs. 3,00,000/- Rs. 3,50,000/- Rs. 4,00,000/- Rs. 5,00,000/- Rs.10,00,000/-

  8. Allowable expenses Room Rent 2% of S.I. Max.4000/- Per Day

  9. Allowable Expenses (Contd.) 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 the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs. 5,000/-

  10. Working for post-hospitalization • Room rent 1200*10 = 12000 • Nursing 350*10 = 3500 • Dr. Con. 1000*10 = 10000 • Medicine = 12000 • Pathology = 7500 • Total = 45000 • 45000-12000=33,000 • 7% of 33,000= 2310/- or Actuals • Max. 5000/

  11. Day Care Treatment 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.

  12. Sub limits

  13. Premium Rating (Excluding.s.t.)(Old Premium)

  14. Premium Rating Revised Premium w.e.f. 1st Sept., 2011(excluding S.T.)

  15. No Claim Discounts (NCD) in case of Renewal 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

  16. NCD 5 % TO 25 % • AGE 33 1200 • AGE 34 1200-60=1140(5%) • AGE 35 1200-120=1080(10%) • AGE 36 1350-202=1148(15%) • AGE 37 1350-270=1080(20%) • AGE 38 1350-337=1013(25%) • AGE 39 1350-337=1013(25%) • AGE 40 1350-337=1013(25%)

  17. Transfer of Policy NO TRANSFERS ARE ALLOWED AFTER AGE 45. Transfer from other company is allowed upto age 45 only and there should not be any claim in previous policy. In transfer polices only only 30 day and 1st year excusion will be excluded if the is one year old, if policy has completed 2 years 2nd year exclusion is also waived off.

  18. Optional Benefits 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

  19. Optional Benefits (contd.) This insurance is extended to provide for the cost incurred for engaging one attendant at residence after discharge from the hospital of the Insured Person following a covered occurrence under the policy up to Rs. 400 per day for a maximum of 5 days per occurrence. Subject to Time excess of 2 days. Provided engagement of such an attendant is recommended by the attending physician and agreed to by the Company, in writing Premium – Rs.300/- per person

  20. Exclusions Pre Existing Diseases (covers after 4 yrs of continuous renewal with us 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 menorrhia or fibromyoma Knee Replacement Surgery Joint Replacement Surgery Prolapse of intervertibral Vericose veins/ulcers

  21. 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

  22. Exclusions (Contd.) 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/- per occurrence for the entire policy period.

  23. Claim Procedure In case of Network Hospitals Immediate intimation to the Call Centre (1800 425 2255/044-28263300) 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

  24. In case of Non Network Hospitals Immediate intimation to the Call Centre (1800 425 2255 /044-28263300) 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 Claim Procedure (Contd.)

  25. Thank You

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