Comprehensive nandagopal-9994910202

Star Health and Allied Insurance Co. Ltd. CHI

S.V.NANDAGOPAL SENIOR SALES MANAGER

THANKS FOR OPPORTUNITY TO SERVEMOBILE

99949 10202 , 94431 86864 , 83000 20102

www.licnanda.blogspot.com [email protected] , [email protected]

வருமுன்னர்க்காவாதான்வாழ்க்கைகஎரிமுன்னர்

கைவத்தூறுப�ாலக்கெகடும். திருக்குறள்

mailto:[email protected],[email protected]


Star Comprehensive Insurance Policy

(Revised)

May 2, 20232


Scope of Cover• Section 1 - Hospitalisation Benefits

• Section 2 - Delivery and Newborn

• Section 3 - Outpatient : Dental and

Opthalmic Treatment

• Section 4 - Hospital Cash

• Section 5 - Health checkup

May 2, 20233


Scope of Cover (Contd..)

Newly added benefits

• Section 6 - Bariatric Surgery

• Section 7 - Accidental Death and

Permanent Total Disablement

• Section 8 - Second Medical Opinion

May 2, 20234


Entry Age

• 03 months to 65 years.

• Dependant children can be covered up to the age of 25

years.

• Life long renewals.

• No cap on exit age.

May 2, 20235


Sum Insured Options

• Rs.5,00,000/-

• Rs.7,50,000/-

• Rs.10,00,000/-

• Rs.15,00,000/-

• Rs.20,00,000/-

• Rs.25,00,000/-

May 2, 20236


Family Size• 1 Adult (New) : (1 A)

• 1Adult + 1 Children : (1 A +1 C)

• 1Adult + 2 Children : (1A + 2 C)

• 1Adult + 3 Children : (1A + 3 C)

• 2 Adult : (2 A)

• 2 Adult + 1 Children : (2A + 1 C)

• 2 Adult + 2 Children : (2A + 2 C)

• 2 Adult + 3 Children : (2A + 3 C)May 2, 2023

7


CoverageSection 1 – Hospitalisation

a. Room Rent (Single Standard A/C room), Boarding and

Nursing Charges

b. Surgeon, Anesthetist, Medical Practitioner, Consultants,

Specialist Fees.

c. Anesthesia, Blood, Oxygen, Operation Theatre charges,

Surgical Appliances, Medicines and Drugs, Diagnostic

Materials and X-ray, Dialysis, Chemotherapy,

Radiotherapy, cost of Pacemaker and similar expenses.May 2, 2023

8


CoverageSection 1 – Hospitalisation (Contd..)

d (i). Emergency Ambulance Charges

d (ii) Air Ambulance Charges (new) : For sum insured of

Rs.7.5 lacs and above ; up to 10% of the sum insured May 2, 2023

9

Sum Insured (Rs.) Limit per policy period (Rs.)

5,00,000 2,0007,50,000 3,000

10,00,000 3,50015,00,000 4,00020,00,000 4,50025,00,000 5,000



e. Pre Hospitalisation : 30 days

f. Post Hospitalisation : 60 days

g. Medical Consultations as Outpatient other than Dental and

Opthalmic.h. Domiciliary Hospitalisation(New)

• Deductible / Excess : 3 days

• Pre and Post hospitalisation not applicable for this.

May 2, 202310



Domiciliary Hospitalisation not applicable for :

Asthma, Bronchitis, Chronic Nephritis and Nephritic Syndrome,

Diarrhoea and all types of Dysentries including Gastro-enteritis,

Diabetes Melitus and Insipidus, Epilepsy, Hypertension,

Influenza, Cough and Cold, All psychiatric or Psychosomatic

Disorders, Pyrexia of unknown origin for less than 10 days,

Tonsillitis and Upper Respiratory Tract infection inlcuding

Laryngitis and Pharingitis, Arthritis, Gout and Rheumatism.

May 2, 202311



j. Limit for medical consultation as Outpatient Benefit : upto

Rs.300/- per consultation and upto the following annual

limits.

May 2, 202312

Sum Insured (Rs.) Limit per policy period (Rs.)

5,00,000 1,2007,50,000 1,500

10,00,000 2,10015,00,000 2,40020,00,000 3,00025,00,000 3,300


CoverageSection 2 – Delivery and New Born

a. Expenses for delivery includes (for both Normal and Caesarean).

b. Pre and Post Natal expenses covered within the

maternity limits.

c. Covered up to maximum 2 deliveries in the life time of

the insured, subject to policy in force.

d. Vaccination expenses up to Rs.1000/- for the new born

baby until the new born baby completes one year and

is added in the policy on renewal.May 2, 2023

13


CoverageSection 2 – Delivery and New Born (Contd..)

e. Waiting Period

• 36 months from the date of commencement of policy

subject to continuous renewal.

• 24 months gap between the coverage of the first delivery

and second delivery.

• Cover is available only when both Self and Spouse are

covered.

May 2, 202314


CoverageSection 2 – Delivery and New Born (Contd..)

May 2, 202315

Sum Insured (Rs.)

Normal Delivery (Rs.)

Caesarean (Rs.)

Limit of Company’s Liability for New Born

(Rs.)

5,00,000 10,000 15,000 50,000

7,50,000 20,000 40,000 1,00,000

10,00,000 25,000 40,000 1,00,000

15,00,000 25,000 40,000 1,00,000

20,00,000 25,000 40,000 1,00,000

25,00,000 25,000 40,000 1,00,000


Coverage• Section 3 – Outpatient Dental and Opthalmic

Treatment a. Available after every block of 3 years.

May 2, 202316

Sum Insured (Rs.) Limit for Out Patient and Opthalmic Treatments (upto Rs.)

5,00,000 5,0007,50,000 5,000

10,00,000 10,00015,00,000 10,00020,00,000 10,00025,00,000 10,000


CoverageSection 4 – Hospital Cash

a. Maximum 7 days per occurrence. b. Excess : 24 hoursc. Maximum 120 days during the policy period.

May 2, 202317

Sum Insured (Rs.) Limit of Company’s Liability per day (Rs.)

5,00,000 5007,50,000 750

10,00,000 75015,00,000 100020,00,000 100025,00,000 1000


CoverageSection 5 – Health Checkup

a. After every block of 3 claim free years b. Policy must be in force

May 2, 202318

Sum Insured (Rs.) Limit of Company’s Liability per day (Rs.)

5,00,000 5,0007,50,000 7,500

10,00,000 7,50015,00,000 12,00020,00,000 12,00025,00,000 12,000


CoverageSection 6 – Bariatric surgery

a. Maximum benefit : Rs.2,50,000/- including Pre and Post Hospitalisation

b. Waiting Period 36 monthsc. Applicable for persons above 18 years at the time of

surgery.d. Subject to BMI more than 40 or more than 35 with Co-

Morbidity (e.g., Diabetes, High BP) and traditional methods do not help.

e. Opinion by two qualified surgeons.f. Only on cashless basis.g. Part of sum insured under Section I.

May 2, 202319


Coverage

Section 7 – Accidental Dealth and Permanent Total Disablement

a. Cover for the chosen one person b. Dependant children cannot be chosen for this cover. c. Maximum age 70 years.d. Sum insured equal to Section I sum insured.

May 2, 202320


Coverage

Section 8 – Option for Second Opinion

a. Second opinion from a Doctor in Company’s network.b. Opinion based upon the medical records only.c. No physical examination of the patient. d. Opinion for medical reasons only and not for medico-

legal purposes.e. No liability on the part of Star for any errors or

omissions. f. Does not affect No Claim Bonus.

May 2, 202321


Automatic Restoration of Sum Insured

a. Limit : 100% of the sum insured.b. Upon the exhaustion of the limit of coverage.c. Only once during the policy period.d. For illnesses / diseases unrelated to the illnesses /

diseases for which claim was made earlier.e. Available under Section 1 (excluding 1G)

May 2, 202322


Bonus a. For every claim free year.b. Limit• For Rs.5 lacs Sum Insured : 50% per year, maximum

100%• For Sum Insured of above Rs.7.5 Lacs & above : 100%

per year, maximum 100%.• Calculated on the basic sum insured.• Available at the time of renewal, (including renewals

made within the grace period)• Bonus amount cannot exceed the basic sum insured, if

there is a reduction of sum insured at the time of renewal. Bonus applicable under Section 1 (excluding 1 G)

May 2, 202323


Other Featuresa. 405 Day Care procedures.b. Pre acceptance medical examination for people above

50 years.c. PED cover after 48 months.d. First two year exclusions.e. Waiting period of 30 days (waived if covered earlier

under individual / group policy).f. First two year exclusions.g. 10 % co-pay for person above 60 years at entry level as

well as for renewals (under Section 1 only, excluding 1 G)

May 2, 202324


May 2, 202325

ComparisonFeatures Existing New

Day Care Procedures 101 405

Medical Consultation as outpatient (other than

Dental and Opthal)

Not Available Available

Domiciliary Hospitalisation


Bariatric Surgery Not Available Available

Accidental Death and PTD


Option for Second Medical Opinion


Entry Age 05 months 03 months

Air Ambulance Charges Not Available Available

Option for 1 A Not Available Available


Declined Risks• Cerebrovascular Attack (CVA)

• Cardio Vascular Diseases (CVD)

• Cancer

• Chronic Kidney Diseases

• Parkinson’s Diseases

• Alzheimer’s Disease• Psycho-somatic Disorders (mentally

challenged)

May 2, 202326


Declined Risks (Contd..)

• Cirrohosis of Liver• COPD• Auto immune diseases / Connective tissue

disorders requiring long term steroids and immunosuppressants

• Patients on long term anti-coagulants therapy

• BMI above 35

• Any other serious illness as per underwriting policy.

May 2, 202327

Star Health and Allied Insurance Co. Ltd. CHIFHO-rev2014/cpu/ver1.4/16 Oct 2014 28

• ALSO WE PROVIDE • LIFE INSURANCE• HEALTH INSURANCE• CHILD FUTURE PLANS• TAX SAVING & PLANNING• PAN CARD & PASSPORT • MOTOR VEHICLE INSURANCE• IMPORT & EXPORT INSURANCE• INDIVIDUAL,FAMILY,GROUP &

CORPORATE INSURANCE NEEDS


Thank You

May 2, 202329

Health & Medicine

Comprehensive nandagopal-9994910202