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It is a fully loaded Top end Floater Policy for the entire family with High Sum Insured Extended Benefits No Sub Limits No Capping on Room Rent Restoration.

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Presentation on theme: "It is a fully loaded Top end Floater Policy for the entire family with High Sum Insured Extended Benefits No Sub Limits No Capping on Room Rent Restoration."— Presentation transcript:

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2 It is a fully loaded Top end Floater Policy for the entire family with High Sum Insured Extended Benefits No Sub Limits No Capping on Room Rent Restoration of Sum Insured Unique Features Star Comprehensive Insurance Policy

3 Sum Insured Options Sum Insured 5 Lakhs 7.5 Lakhs 10 Lakhs 15 Lakhs 20 Lakhs 25 Lakhs

4  18 years – 65 Years.  Children of 5 months can be Covered if Parent is Covered.  Beyond the age of 65 years only renewals are accepted. But sum insured options will be limited to a max of Rs7.5 lacs.  Guaranteed renewal. Star Comprehensive Insurance Policy Age Eligibility

5 Cover can be given to HIV + persons whose CD 4 count is not less than 350 at entry point No claim payable for Opportunistic infections No claim on treatment for HIV / AIDS Star Comprehensive Insurance Policy Eligibility

6 SectionCoverage Section - IIn-patient Hospitalization Section - II Delivery Charges, New Born Baby coverage and Vaccination benefits Section - III Out-Patient Dental / Ophthalmic coverage Section - IVHospital Cash Section - VCost of Health Check-up Star Comprehensive Insurance Policy Coverage

7 Section I - HOSPITALISATION Room Rent,Boarding and Nursing Expenses - No Cap ICU and Operation Theatre Expenses - No Cap Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees - No Cap Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses - No Cap Star Comprehensive Insurance Policy

8 Sum Insured (Rs.)Ambulance Charges Per Policy Period (Rs.) 5 Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs5000  Pre Hospitalization Expenses - 30 Days  Post Hospitalization Expenses - 60 days  For both these benefits prescriptions, bills / receipts / copy of reports to be submitted.

9 Section II Delivery and New Born Baby Cover  Waiting period 36months  Maximum 2 deliveries. Waiting period between the first delivery claim and the second one is 24 months. Delivery Benefit Limits  No Pre and Post Hospitalisation benefits for this Section  Both Insured and Spouse should be covered in the same policy for identical sum insured throughout. Star Comprehensive Insurance Policy Sum Insured (Rs.) Normal Delivery (Rs.) Caesarean Section Delivery (Rs.) 5 Lakhs10,00015, Lakhs20,00040, Lakhs -25 Lakhs 25,00040,000

10 New Born Baby Coverage for the remaining policy period Vaccination expenses up to Rs 1000/- incurred on the new born baby Subject to Valid claim for Delivery Covers congenital defects also Claim Made under this Section will not reduce the policy Sum Insured, adversely affect Health Check-up benefit or add on for Claims loading Star Comprehensive Insurance Policy Section II Delivery and New Born Baby Cover For Sum Insured (Rs.)Limit of Coverage (Rs.) 5,00,000/-50,000/- 7,50,000/- & above1,00,000/-

11 Section - III OP Dental and Ophthalmic Treatment  Non Allopathic Treatment Rs 20000/Per Policy Period upto Sum Insured of Rs / Rs 25000/Per policy Period for Sum Insured of Rs /and above  Dental Treatment Rs 5000/Per Policy Period for Sum Insured of Rs /&Rs / Rs 10000/Per Policy Period for Sum Insured of Rs /and Above  Day Care Procedure 101 Procedures Dental & Ophthalmology Treatment is covered after a waiting period 36 Months Can be taken as an Out-patient Payable even if there is claim in the three year period Can be claimed for Root Canal Treatment also Purchase of spectacles Limits The claimant must have been insured continuously. Claim Made under this Section will not reduce the policy Sum Insured, adversely affect Health Check-up benefit or add on for Claims loading Star Comprehensive Insurance Policy Sum Insured (Rs) Amount payable subject to production of Prescription and supporting Bills (Rs.) 5,00,000/- & 7,50,000/-Upto ,00,000/- & aboveUpto 10000

12 Section - III OP Dental and Ophthalmic Treatment For example : A family of three persons 2A + 1C covered for a Sum Insured of Rs. 5 lakhs for 2 years and In another Child is added. In a claim is made for Ophthalmic Section for the Child added in Not admissible because the waiting period has not been completed by the child. Star Comprehensive Insurance Policy

13 Section – IV Hospital Cash Cash Benefit -maximum of 7 days per hospitalisation, provided there is an admissible claim under Section I. Maximum during one policy period – 120 days First one day will not be paid Claim for Hospital cash will not affect the policy sum insured Star Comprehensive Insurance Policy Sum Insured (Rs.)Limits per day (Rs.) 5 Lakhs Lakhs – 10 Lakhs Lakhs – 20 Lakhs Lakhs1500

14 Section – IV Cost of Health Check-up Cost of Health Check-up Once in a block of every 3 claim- free Continuous renewals Benefit payable for insured persons who have been continuously insured under the policy. Star Comprehensive Insurance Policy Sum Insured (Rs.)Limits per day (Rs.) on submission of prescriptions bills / receipts / report copies 5 Lakhs Lakhs – 10 Lakhs Lakhs – 25 Lakhs12000

15 Automatic Restoration of Sum Insured Restoration facility in-built up to 100% for ALL sum insured options. Restored Sum Insured can be utilized only for illness /disease unrelated to the illness /diseases for which claim/s was /was made. Restoration will be available for section 1 only. Star Comprehensive Insurance Policy

16 Exclusions Some important exclusions: First 30-days exclusion (other than for accidents) No First year exclusions- Only two year Exclusion. PED – waiting period 48months Non-allopathic treatments not covered Enhanced External Counter Pulsation therapy and related therapies and Rotational Field Quantum Magnetic Resonance Therapy excluded. Star Comprehensive Insurance Policy

17 Claims Loading Where the claim ratio for the preceding 2 consecutive years exceeds 100%, premium loading as per the table given below would be applicable. Average claims ratio of preceding 2 consecutive years (%) Loading on Premium > % % > % Star Comprehensive Insurance Policy

18 Co-payment 10% co-payment for persons entering between 61 yrs and 65 yrs and continues thereafter Co-payment applicable only for Section I claims Star Comprehensive Insurance Policy

19 Portability This policy is portable. Inward portability can be accepted for policies of other Insurance Companies Portability procedure to be followed Continuity will be given ONLY for Section I benefit and NOT for any other Section Star Comprehensive Insurance Policy

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21 Migration allowed from any other health policy of Star except Senior Citizens Red Carpet Unique policy Diabetes Safe and Super Surplus - Individual & Floater Continuity of benefits will be given for Section I only Persons insured under this policy can migrate to any other policy of Star with continuity of benefits again for in-patient hospitalization only. Migration permitted upto the age of 60 yrs only. Migration permissible only on Renewal for Policies with 2 continuous Claims free years. Where claims have been made in the past case to be referred to Corporate office Star Comprehensive Insurance Policy Migration from Star Policies

22 Migration guidelines…. AGENO CLAIMWITH CLAIM REMARKS ≤ 50yrs Pre acceptance Medical Examination NOT required Refer to Head Office 51 yrs – 60 yrs Pre acceptance Medical Examination as per Package 1.4 Refer to Head Office No migration if MER reveals declined risks* > 60 yrsNo MigrationNo migration Star Comprehensive Insurance Policy Migration not permitted for persons suffering from the following declined risks : * Cancer * Stroke * Heart Diseases * Chronic Renal Diseases Declined Risks*

23 Underwriting Acceptance limits (FRESH PROPOSALS ) Branch < 50years and Sum Insured of Rs 15Lakhs. Branch > 50 Years Sum Insured upto 5 Lakhs. Beyond 5 lacs and > 50 yrs refer to Corporate office Star Comprehensive Insurance Policy

24 Star Comprehensive Apollo’s Easy Health Automatic Restoration of 100% of Sum Insured Premium less by 1% to 9% No Restoration facility More expensive than Star Star and Apollo comparison Star and Apollo comparison Star Comprehensive Insurance Policy Star Comprehensive v/s Apollo’s Easy Health Both Price and benefit comparison given separately

25 Benefit Illustration 1 Claim under Delivery and New Born Baby Cover: Sum Insured for 1st Year 5 Lakhs Sum Insured for 2 nd Year 7.50 Lakhs Sum Insured For 3 rd Year 7.50 Lakhs Sum Insured For 4 th Year5 Lakhs A claim is made in the 4th year The eligibility will be as per 5 lakh Sum Insured i.e Rs 10,000/- for Normal and Rs 15,000/- for Caesarean delivery. Rs 50,000/- for New Born Baby Rs 1000/- for Vaccination The limit is inclusive of pre-natal and post-natal expenses Star Comprehensive Insurance Policy

26 Benefit Illustration 2 Claim for Health Check Up Sum Insured for the 1 st year Rs /- Sum Insured for the 2 nd Year Rs /- Sum Insured for the 3 rd year Rs /- Sum Insured for the 4 th Year Rs /- Benefits of Health Check Up will be as per Rs 10lakhs i.e upto Rs 7500/- Star Comprehensive Insurance Policy

27 Benefit Illustration 3 Claim for OP treatment for Dental /Opthal Sum Insured for 1st Year 5 Lakhs Sum Insured for 2 nd Year 7.50 Lakhs Sum Insured For 3 rd Year 7.50 Lakhs Sum Insured For 4 th Year 10 Lakhs Benefit under this section in the fourth year will be as per Rs 10 Lakh Sum Insured which will be Rs 10000/- Star Comprehensive Insurance Policy

28 Benefit Illustration 4 Admission for Arthroscopic Repair during the 3 year. Sum Insured for 1st Year 5 Lakhs Sum Insured for 2 nd Year 7.50 Lakhs Sum Insured Limit for the above treatment will be Rs 5 Lakhs/- (Refer Exclusion 3) Star Comprehensive Insurance Policy


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