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Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accident
Coverages
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Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuriesIt 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.
What is a Hospital?
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• Self• Spouse• Dependent Children up to 25 Years• Dependent Parents up to 55 Years• Proposals from persons above 45 yrs, age proof in
the form of DL, Pass Port, Ration Card or School Certificate is required
Family Means
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Entry Age 5 Months – 55 Yrs renewable upto 70 yrs
Dependent Children can be covered only with any one of their Parents
Age Limits
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Minimum Sum Insured - Rs. 30,000/-
Maximum Sum Insured - Rs. 80,000/-
The following Sum Insured options are available
• Rs. 30,000/-• Rs. 40,000/-• Rs. 60,000/-• Rs. 70,000/-• Rs. 80,000/-
Sum Insured
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Room rent & boarding charges @ 2% of the sum insured
Nursing charges
Surgeons, Anesthetist, Consultants and Specialists fees
Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc
Allowable Expenses
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Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for
• Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is
discharged on the same day.
Day Care Treatment
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Name of the Ailment / Surgery / Procedure
Sub Limit
Cataract surgery Rs. 15,000/-
Sub limits
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Age Sum Insured (Rs.)
30000 40000 60000 70000 80000
5 Months to 25 Years
340 400 550 600 660
26 Years to 35 Years
375 450 620 710 850
36 Years to 45 Years
475 525 700 900 1005
46 Years to 55 Years
NA NA 1275 1515 1800
Rating
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If two persons are Covered – 10% Discount
If more than two persons are covered 15% Discount
Family Discount
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Cumulative Bonus at 5% for every Claim Free Year
Upto a maximum of 10 Claim Free Years i.e.,
50%
Cumulative Bonus
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To obtain the following benefits there should be a continuous renewal of the expiring policy
(a) Renewal with Cumulative Bonus details• Cumulative Bonus as shown in the Renewal
Notice is given
(b) No Renewal Notice or Renewal Notice without cumulative Bonus details
• Cumulative Bonus as shown in the Previous Policy is given
• A declaration stating No Claim has to be obtained from the insured
Transfer of Policy
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Benefits under Section 80-D of the IT ActCashless Service without intervention of TPADirect Tie up with hospitals on an All India Basis24 X 7 In-House Call centerToll Free Telephone line assistanceFull knowledge based website to offer medical information, including Health Tips. Frequent health meets to disseminate info on the health related topics
Other Benefits
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Pre and Post Hospitalisation Treatment Pre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break)Any Disease contracted during first 30 daysFirst Year Exclusions
• Benign prostate hypertrophy• Hernia, Hydrocele, Fistula in Anus, Piles• Sinusitis• Renal stone and Gall stone removal
First Two Years Exclusions• Cataract• hysterectomy following menorrhia or fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery• Prolapse of intervertibral• Vericose veins/ulcers
Congenital internal disease/defect
Exclusions
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Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operationsCircumcision unless necessary for treatment of a diseaseCost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aidsDental treatment or surgeryConvalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcoholNaturopathy Treatment Expenses incurred on Lasik Laser or Refractive Error Correction treatment
Exclusions (Contd.)
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Hospital registration charges, record charges, telephone charges and such
other similar charges.
Expenses incurred on Non Allopathic treatment.
Exclusions (Contd.)
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In case of Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)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
Claim Procedure
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In case of Non Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)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.)
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Thank You