Star unique health nandagopal-9994910202

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING

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 Unique Health


Why Unique?

• This policy is Unique because it covers Certain Pre-Existing diseases as well

as any future ailments – ------- all under one policy

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

Major Features..


Coverages..Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases Accidental injuries

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


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


Period of Insurance..

The policy is for a two year period.

Even renewal will be for a two year period

Advantages are :

Customer retention

Claims 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


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.


Age Limits.. Entry age 18 Years to 65 Years Life long renewals

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


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

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/-


Day Care Treatment..

Minimum 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


Day-Care..

• The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.


Sub Limits..Name of the Ailment / Surgery / Procedure Sub 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.


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


Annual Installment Premium

Applicable 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)

Age

18yrs-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


Annual Installment Premium

Applicable 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


Exclusions

Pre-Existing Disease/ Condition within 11 months of commencement of this insurance

Any Disease contracted during first 30 days 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.


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


First Two Years Exclusions (Contd.)

1. Inter-Vertebral Disc Prolapse (other than caused by accident)2. Degenerative Vertebral and Disc diseases3. Varicose veins and Varicose ulcers4. Thyroiditis5. Treatment of Goitre6. Tympnoplasty7. Mastoidectomy Glaucoma

are not payable irrespective of whether they are Pre-Existing or not.

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 Papil 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

Exclusions (Contd.)


30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims

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

Exclusions (Contd.)

Other Benefits Benefits under Section 80-D of the IT Act

Cashless Service without involvement of TPA

Direct Tie up with hospitals on an All India Basis

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARINGFHO-rev2014/cpu/ver1.4/16 Oct 2014 21

• 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


Healthcare

Star unique health nandagopal-9994910202