group mediclaim
DESCRIPTION
gives overview for Health insuranceTRANSCRIPT
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
Benefits of your Group Tailor Made Policy
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
EXPENSES COVERED
Inpatient Hospitalization
Room rent , Boarding and nursing exp.,ICU Charges,Doctors feesDiagnostic chargesNursing charges SurgeonAnesthetistConsultant and Specialist feesBlood OxygenOT charges Surgical AppliancesMedicines and DrugsDiagnostic Materials X ray etc…
COVERAGE SCOPE
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
IN PATIENT DAY CARE PROCEDURES
An Insured Person who is admitted to Hospital and stays
there for a minimum period of 24 hours for the sole purpose of
receiving treatment.
Means medical treatment which is undertaken in a Hospital/day care
centre in less than 24 hours becauseof technological advancement, and
which would have otherwise required a Hospitalization of
more than 24 hours
MINIMUM DURATION REQUIRED DURING HOSPITALISATION
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
BENEFITS COVERED : (Example)
Period of Insurance 08/11/2013 to 13/09/2015Grade Sum Insured Rs.5,00,000/-
Family Floater Yes (Employee, Spouse, Children)
Hospitalization in a Non-Network Hospital
Yes( Only Incase of Accident or
Emergency)Hospitalization in a
Network HospitalYes
Pre-Existing Diseases Covered from Day 11 yr & 2 yr Exclusions Waived off
Maternity cover New Born Baby cover
Covered from Day 1Covered from Day 1
Day Care Procedures Yes
Pre & Post Hospitalization30 Days – 60 Days
Yes
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
ROOM RENT,BOARDING AND NURSING Exp.,
Ambulance – Not exceeding Rs.5,000/- if incurred
Room rent - For 5,00,000/- Sum Insured 2% of Sum Insured subject to
Maximum of Rs.5000/- per day
Stay in room other than eligibility -Expenses relating to the hospitalisation will be considered in
proportion to the room rent stated in the policy.
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
PRE & POST HOSPITALISATION EXPENSES
Pre - Hospitalization expenses - 30 days
Post – Hospitalization Expenses - 60 days
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
DAY CARE PROCEDURES :
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Policy specifies sub-limits to following procedures:
Cataract, Lithotripsy, Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion
Aspiration, Colonoscopy, Sclerotheraphy.
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
CORPORATE BUFFER
Sum Insured available – Rs.10,00,000/-
Corporate Buffer limit restricted to Individual/Individual Family Sum Insured
Further corporate buffer can be utilized only when there is a left over balance under the basic Sum Insured available only.
Corporate buffer benefit can be utilized only for treatment of major Diseases.
Major Diseases means - Cancer, Chronic Kidney Disease, Brain Tumour, Major Organ Transplant, Cerebro-Vascular Stroke causing Hemiplegia, Acute Myocardial Infarction, Established Irreversible Coma, Established Irreversible Paraplegia & Established Irreversible Quadriplegia.
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
MATERNITY & N EW BORN BABY COVER
For Caesarean Rs.50,000/-
For NormalRs.35,000/-
New Born baby cover From Day One
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
MIDTERM INCLUSION
In Case of Existing EmployeeOnly Newly Married Spouse and
Newborn Child can be added.
In Case of Newly joined Employee
Employee and Dependents can be added.
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
IN THE EVENT OF ANY CLAIM
Note:
• Treatment in our network hospitals only,
• Incase of Medical Emergencies & Accidents treatment
can
be taken in other Hospitals.
• In all cases immediate intimation shall be given to our
call center
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
IN THE EVENT OF ANY CLAIM (cont’d) CONTACT DETAILS
Please inform 24X7 call centre
Toll free : 1800 425 2255 / 1800 102 4477 (or)
044-28263300
Fax 1800 425 55 22
(or)044-28306700
Local Assistance
Cashless Hospitalization
Dr. Chandra Mohan - 9700000544Dr. Nagesh - 9849709522
Land line no: 040-44344801/802(Between 10.00 am to 8.30 pm)
Re-imbursementPavan – 040-44344806
(Between 10.00 am to 5.30 pm)
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
CLAIM PROCEDURE
In case of Network Hospitals
Intimate the hospitalization details immediately to the Call Centre on Toll Free No: 1800 424 2255 / 044 – 2826 3300.
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 Health 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.
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
CASH LESS CLAIM PROCESS
Claim Registration – 1800 425 2255
Field visit report
Initial Sanction
Final Bill submission
Rejection
Final Enhancement given
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
CLAIM PROCEDURE (CONT’D)
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In case of Non-Network Hospitals
Intimate the hospitalization details immediately to the Call Centre on Toll Free No: 1800 424 2255 / 044 – 2826 3300.
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 to concern person at your office, (Please remember to collect following documents from hospital without fail).
• Original Discharge Summary• Main Hospital Bill with Break Up• Investigation Reports with X-Ray Film• Medical Bills with Prescriptions
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
REIMBURSEMENT CLAIM PROCESS
Field visit report
Claim settlement
Claim Registration -1800 425 2255
Rejection
Submission of Claim Form
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
Claim form must be filled fully and sent to Star Health office along with the following documents in original where ever applicable.. • All columns of Claim form should be filled in properly and signed by the
Customer.• In the Claim form Medical Certificate to be filled in by Treating doctor
with Signature and Stamp.• Discharge summary.• Lab Investigation reports and Bills.• Medical bills with doctor’s prescriptions.• First consultation report.• Case sheet • Policy Bond/Id card.• Any Accident case: Self declaration ; FIR / MLC is mandatory for Motor
& Other Accidents.• X-rays, MRI, CT-Scan, USG Scan films and reports.• Any Fracture Case: Pre and Post Operative X- ray films.• Final break up bills with receipt Nos.
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REIMBURSEMENT CLAIM PROCESS (CONT’D)
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
ACCIDENT COVER
Sum Insured per employee - Rs.10,00,000/-
Coverage – Accidental Death , Permanent Total Disability, Permanent Partial Disability,
Temporary Total Disability (Weekly Compensation)
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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING
Thank You