star health and allied insurance co. ltd. presentation on star unique health policy presentation on...
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Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Presentation on
Star Unique Health Insurance Policy
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Why Unique??
• This policy is Unique because it covers
Certain Pre-Existing diseases as well as any future ailments –
------- all under one policy
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Major Features• Pre Existing Diseases (other than those for which
specific time periods have been mentioned separately) covered after complete of 11 months
• The policy provides coverage to HIV positive persons.
• Premium payable in installments
• No pre acceptance medical examination
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Coverages
Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accidental injuries
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Pre Existing Disease
• Pre-Existing Disease/ Condition will be covered after 11 months of continuous coverage
• Does this mean that any PED is covered after 11 months?
• No – only certain diseases that are Pre-Existing
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Coverage for HIV positive persons
• The policy extends coverage to HIV positive persons.
• Minimum CD 4 count at entry level should be 350
• Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not covered
• Expenses for treatment of HIV / AIDS not covered
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Period of Insurance• The policy is for a two year period.
• Even renewal will be for a two year period
• Advantages are :Customer retentionClaims loading, if applicable will happen only once in two years
• However, Sum insured will be available afresh for each year.
• For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for first yr and 2 lacs for the second yr.
• However sum insured cannot be cumulated or carried forward
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Installment Premium• The premium can be paid in 2 annual installments.
• The grace period of 15 days for benefit of continuity will be available for instalment premium also. However, the expiry date of the policy will not change.
• Where a claim is made in the first year itself the premium towards the next installment would be deducted from the claim amount.
• The policy would lapse if the installment is not paid on or before the due date.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Age Limits
Entry age 18 Years to 65 Years
Policies can be renewed up to 70 years
Beyond 70 yrs the insured person would be eligible to move to any other health insurance policy that the Company offers
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Sum Insured
The following Sum Insured options are available
Sum Insured Options (Rs)
Sub-limit for PED Cover (Rs)
100000 50000
200000 100000
300000 150000
Note : The sum insured is for each year of insurance and cannot be cumulated or carried forward
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Allowable Expenses
Room rent, nursing & boarding charges @ 1% of the sum insured subject to a maximum of Rs. 3000/- per day.
Surgeons, Anesthetist, Consultants and Specialists fees
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 up to a maximum of Rs 1,500/- per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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/-
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Day Care TreatmentMinimum of 24 hours Hospitalization is not necessary for the following • Dialysis• Chemotherapy• Radiotherapy• Cataract surgery• Dental Surgery following accident• Lithotripsy• Tonsillectomy• Treatment of Fracture/Dislocation• Incision and Draining of Abscess• Liver Aspiration• Pleural Effusion Aspiration• Colonoscopy• Sclerotheraphy• Tympanoplasty• Chalazion
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Day-Care………
• The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Sub LimitsName of the Ailment / Surgery /
ProcedureSub Limit
Cataract surgery Rs. 12,000/- in respect of one eye and
Rs. 24,000/- in the entire policy period
Lithotripsy (Kidney stone removal) Rs. 20,000/- per policy year
Tonsillectomy Rs. 15,000/- per policy year
Incision and Draining of Superficial Abscess Rs. 1,500/- per policy year
Incision and Draining of Deep seated Abscess Rs. 4,000/- per policy year
Liver Aspiration Rs. 2,000/- per policy year
Pleural Effusion Aspiration Rs. 2,000/- per policy year
Sclerotheraphy Rs. 5,000/- per policy year
Treatment of Fracture / Dislocation Rs. 2,000/- per policy year
Chalazion Rs. 3,000/- per policy year
Tympanoplasty Rs. 20,000/- per policy year
Dialysis Rs. 1,200/- per sitting
Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Premium ….. approach
• We have introduced a dual pricing concept
- Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Ahmedabad will have a slightly higher premium
• Rest of India will have comparatively lower premium
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Annual Installment PremiumApplicable for offices in Ahmedabad, Bangalore, Mumbai (including Thane) and New Delhi (including Faridabad, Gurgaon & Noida)
Note : Premium figures are excluding Service Tax.
Sum Insured Options
(Rs)
Sub-limit for PED
Cover(Rs)
Age18yrs-25yrs
26yrs-40yrs
41yrs-55yrs
56yrs-60yrs
61yrs-65yrs
66yrs-70yrs
100000 50000 5880 6720 10080 11760 14170 16100
200000 100000 7585 9840 14760 17220 20745 23575
300000 150000 10625 13800 20010 22770 23805 26450
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Annual Installment PremiumApplicable for rest of India
Note : Premium figures are excluding Service Tax.
Sum Insured Options
(Rs)
Sub-limit for PED Cover
(Rs)
Age
18yrs-25yrs
26yrs-40yrs
41yrs-55yrs
56yrs-60yrs
61yrs-65yrs
66yrs-70yrs
100000 50000 4900 5600 8400 9800 12320 14000
200000 100000 6320 8200 12300 14350 18040 20500
300000 150000 8855 11500 16675 18975 20700 23000
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions
Pre-Existing Disease/ Condition within 11 months of commencement of this insurance
Any Disease contracted during first 30 days
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Year Exclusions• Deviated Nasal Septum• Benign Prostate Hypertrophy• Nasal Polyps• Hernia• Hydrocele• Congenital Internal diseases/defects• Fistula in anus, Piles, Sinusitis, and related disorders• Post trauma non union / mal union• Cholecystectomy and Renal Calculi /Gall bladder calculi are not payable.
If these diseases (other than congenital internal disease /defects) are Pre-Existing at the time of proposal they are payable after 24 months of continuous coverage with the Company.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)First Two Years Exclusions
• Cataract, • Hysterectomy (abdominal and Vaginal), • Dysfunctional Uterine Bleeding (DUB)• Fibroid Uterus • Prolapsed Uterus• Myomectomy• Cystectomy• Treatment of Internal Derangement of Knee (other than caused by an
accident)• Treatment for Joints (other than caused by an accident)• other Arthroscopic Surgeries
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Two Years Exclusions (Contd.)• Inter-Vertebral Disc Prolapse (other than caused by accident)• Degenerative Vertebral and Disc diseases• Varicose veins and Varicose ulcers• Thyroiditis• Treatment of Goitre• Tympnoplasty• Mastoidectomy Glaucoma are not payable irrespective of whether they are Pre-Existing or not.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)First Four Years Exclusions
• Stapedectomy• Bone marrow transplant• Cirrhosis of liver with or without portal Hypertension• Hepatitis• Loss of vision partial / total including Retinopathy• Retinal Detachment• Macular degeneration and Papill Oedema• all types of Cancer• Nephropathy and Chronic Kidney diseases • Implant Removal The above shall not be payable during the first four years only if these are
Pre-Existing at the commencement of this insurance
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)• 30% on all claims including PED claims. This copayment would
apply on the sub limit mentioned for PED claims• War and allied perils including nuclear risks• Circumcision unless necessary for treatment of a disease not
excluded hereunder • or as may be necessitated due to an accident, • vaccination or inoculation (except as a post-bite treatment)• change of life or cosmetic or aesthetic treatment of any description, • plastic surgery other than as may be necessitated due to an
accident or as a part of any illness.• Cost of spectacles and contact lens, hearing aids, walkers, crutches
wheel chairs and such other aids.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)• Dental treatment or surgery of any kind unless necessitated due to
accidental injuries and requiring hospitalization.
• Convalescence, general debility, Run-down condition or rest cure, Psychosomatic disorders, Congenital external disease or defects or anomalies, infertility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol.
• Treatment for HIV / AIDS and opportunistic infections.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• Purely diagnostic expenses• Expenses on vitamins and tonics not forming part of
treatment• Maternity expenses (other than ectopic pregnancy)• Naturopathy Treatment• Hospital registration charges, admission charges, record
charges, telephone charges and such other charges
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• Lasik Laser or Refractive Error Correction treatment• weight control or treatment for obesity • Non allopathic treatment is limited to 25% of the sum
insured per occurrence subject to an overall limit of Rs. 25000/- for each year of insurance.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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.)
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Other BenefitsBenefits under Section 80-D of the IT Act
Cashless Service without involvement 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.
Information on health through free health magazine
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Value added services
Consult our Expert Doctor for Free Medical Advice on Toll Free Number 1800 425 2255 / 1800 102 4477
Quarterly Health Magazine to all policy holders providing an insight into health related issues.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Target segment
Who can be the target segment for selling this insurance?
• Persons who are hypertensive
• Diabetics with no complications set in as yet
• Persons who have undergone CABG
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Who should be avoided?
• Proposals from Cancer patients
• Persons with Chronic kidney failure
• Persons suffering from Alzhemiers
• Persons with Psycho somatic disorders
• Stroke affected persons
• Paralytic patients
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Transfer of Policy from Star Health to this policy
• Only waiver of 30 days waiting period is allowed.
• For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Transfer of Policy from other Insurers
• Only waiver of 30 days waiting period is allowed. This waiver will not be provided even if there is one day gap.
• For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Thank You