star health and allied insurance co. ltd. presentation on star super surplus presentation on star...

Star Health and Allied Insurance Co. Ltd.

Presentation on Star Super Surplus

Presentation On

Star Super Surplus



Major Product Features

Wider coverage option of Rs. 7 Lacs and Rs. 10 Lacs

Low Premium



Age Limits

5 Months – 60 Years (entry age)

Renewals can be effected up to 75 years



Pre - Insurance Medical Test

No Pre – Insurance Medical Test is required



Coverages

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accidental injuries



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

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.



Sum Insured

The following Sum Insured options are available

• Rs. 7,00,000/-

(Rs. 4,00,000/- in excess of Rs. 3,00,000/-)

• Rs. 10,00,000/-

(Rs. 7,00,000/- in excess of Rs. 3,00,000/-)

• Compulsory Deductible – Rs. 3,00,000/- per claim



Deductible

• This insurance will pay for the hospitalisation expenses, as per detailed policy terms, in excess of Rs. 3,00,000/-. This limit of Rs. 3,00,000/- is for each hospitalisation.

• For arriving at the cost per hospitalisation the expenses incurred on pre hospitalisation are to be excluded



Allowable Expenses

Room rent & boarding charges subject to a maximum of Rs.4,000/- per day

ICU expenses

Nursing charges

Surgeons, Anesthetist, Medical Practitioner, Consultants, Specialists fees



Allowable Expenses (Contd.)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

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. 30,000/-.

Note: The policy does not cover Pre Hospitalisation expenses



Premium Rating

Sum Insured (Rs.) Premium including S. Tax (Rs.)

7,00,000/- 3,309/-

10,00,000/- 4,412/-

10,00,000/-

family floater

6,287



Exclusions

Pre Existing Diseases

Any Disease contracted during first 30 days

First Two Years Exclusions• Knee Replacement Surgery• Joint Replacement Surgery

Congenetial Disease whether internal or external

Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations



Exclusions (Contd.)

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, rest cure, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol



Exclusions (Contd.)

Naturopathy Treatment

Expenses incurred on Lasik Laser or Refractive Error Correction treatment

Hospital registration charges, record charges, telephone charges and such other similar charges.

Expenses for Non Allopathic treatment.



Premium Ratingincl. of Service Tax

Medi Classic + Super SurplusAGE 3 Lacs 10 Lacs 10 Lacs

5 Months to 35 Years

3640 4412 8052

36 Years to 45 Years

4026 4412 8438


6805 4412 11217


9045 4412 13457

Sum Insured = 10 Lacs ( 3 + 7 )



Other BenefitsBenefits 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 (044-2826 3300)

Toll Free Telephone line assistance

(1800 425 2255)

Full knowledge based website to offer medical information, including Health Tips.

Frequent health meets to disseminate information on health related topics

Doctor on Call (Free Consultation with Doctor on phone)



Claim Procedure

In case of Network HospitalsImmediate 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



18

In case of Non Network HospitalsImmediate 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 DoctorBills 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.)



Thank You

star health and allied insurance co. ltd. presentation on star super surplus presentation on star...

Documents

star health

star super surplus slide

star super surplus sum

allied insurance

star super surplus deductible

star super surplus age

excess of rs

maximum of rs