presentation on senior citizens red carpet health insurance

Presentation on

Senior Citizens Red Carpet

Health Insurance

Star Health and Allied Insurance Co. Ltd.

For People aged Between 60 and 69 Years

Guaranteed renewals beyond 69 years

No Pre Insurance Medical Test required

Covers Pre Existing Diseases

Major Product Features

Presentation on Senior Citizens Red Carpet Health Insurance


60 Years – 69 Years

Guaranteed Renewals beyond 69 years


Age Limits


No Pre – Insurance Medical Test is required

However 10% discount on premium will be allowed if the following reports are produced to the satisfaction of the Insurer

Stress Thallium Report BP report Sugar (Blood & Urine) Blood urea & creatinine Self-declaration or certification that surgeries related to

Heart / Brain / Cancer has / have not been done in the past.

The tests should have been taken not before 45 days from the date of proposal

Pre - Insurance Medical Test



Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accidental injuries


Coverages


Pre – Existing Diseases are covered except those

for which treatment was recommended or received during 12 Months preceding the date of proposal

Diseases mentioned under First year exclusions and first two year exclusions

The cover is subject to 50% Co-payment

Pre Existing Diseases Cover



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

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.

What is a Hospital?Presentation on Senior Citizens Red Carpet Health Insurance


The following Sum Insured options are available

Rs. 1,00,000/-

Rs. 2,00,000/-

Sum Insured



Room rent & boarding charges @ 1% of the sum insured per day

ICU expenses Per Day @ 2% of the Sum Insured

Nursing charges

Surgeons, Anesthetist, Medical Practitioner, Consultants, Specialists fees subject to a maximum of 25% of the Sum Insured per hospitalisation

Allowable Expenses



Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray Dialysis, Chemotheraphy, Radiotherapy, Cost of Pacemaker and similar expenses subject to a maximum of 50% of the Sum Insured per hospitalisation.

Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto a maximum of Rs 1,500/- per policy period

Allowable Expenses (Contd.)



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/-.

Note: The policy does not cover Pre- Hospitalisation expenses

Allowable Expenses (Contd.)



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.

Day Care Treatment Presentation on Senior Citizens Red Carpet Health Insurance


Sub LimitsPresentation on Senior Citizens Red Carpet Health Insurance

Name of the Ailment / Surgery / Procedure

Sub Limit

Cataract surgery Rs. 15,000/- in respect of one eye or both eyes in the entire policy period

Lithotripsy (Kidney stone removal) Rs. 20,000/-

Tonsillectomy Rs. 7,500/-

Cutting and Draining of Abscess Rs. 1,500/-

Liver Aspiration Rs. 2,000/-

Pleural Effusion Aspiration Rs. 2,000/-

Colonoscopy Rs. 2,000/-

Sclerotheraphy Rs. 5,000/-

Cardio-Vascular Diseases / Cerebro-Vascular Accident / Cancer and breakage of bones

Rs. 75,000/-

Renal Complication Rs. 75,000/-

All other Major Sugeries Rs. 60,000/-


Includes but not limited to

Intestinal obstruction – both acute and sub-acute, colon surgeries, bladder surgeries including Urethra, nephrectomy, pancreatic surgery, GJ Vagotomy, Knee/hip surgery

Major Surgeries



Premium Rating


Sum Insured (Rs.)

Premium Including S. Tax (Rs.)

1,00,000/- 5,000/-

2,00,000/- 9,500/-


50% co-payment applicable for Pre-Existing Diseases / Conditions

30% co-payment applicable for all other claims

Co-payment




Renewal Loading

Past Two Consecutive Years Claims Experience

Loading

100% to 125% 20%

126% to 150% 30%

Above 150% 50%


Treatment taken in Non Network Hospitals

Pre Existing Diseases for which treatment was recommended or received during 12 months preceding the date of proposalAny Disease contracted during first 30 daysFirst Year Exclusions

Benign prostate hypertrophy Hernia, Hydrocele, Fistula in Anus, Piles Congenital Internal Disease/defect 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

ExclusionsPresentation on Senior Citizens Red Carpet Health Insurance


Pre Hospitalisation ExpensesInjury / 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 (Contd.)Presentation on Senior Citizens Red Carpet Health Insurance


Hospital registration charges, record charges, telephone charges and such other similar charges.Expenses for Non Allopathic treatment.

Exclusions (Contd.)



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 center (044-2826 3300)Toll Free Telephone line assistance

(1800 425 2255) – only from BSNL and MTNLFull knowledge based website to offer medical information, including Health Tips. Frequent health meets to disseminate information on health related topics

Other Benefits



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 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



Thank You

presentation on senior citizens red carpet health insurance

Documents

sum insuredpresentation

sum insured options

years presentation

dayicu expenses

similar expenses subject

lumpsum basis

maximum of rs

operation theatre charges