Health
Content
Premium Chart for Zone 1: Plan
2A
2A+1C
2A+2C
2A+3C
1A+1C
1A+2C
Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
2 LACS 3 LACS 4 LACS 5 LACS 10 LACS 15 LACS
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80
Above 80 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
Size 589.0 mm x 210.0 mm
5,595 6,955 10,595 13,240 15,890 20,655 24,785 29,745 35,690 42,830
5,895 7,320 11,150 13,940 16,725 21,745 26,090 31,310 37,570 45,085
6,770 8,120 11,640 14,550 17,460 22,700 27,240 32,685 39,220 47,065
7,535 9,165 14,500 18,125 21,750 26,100 31,320 37,585 45,100 54,120
9,800 11,915 18,850 23,565 28,275 33,930 40,715 48,860 58,630 70,355
11,610 14,120 22,335 27,920 33,505 40,205 48,250 57,900 69,480 83,375
6,930 8,070 11,400 14,250 17,100 22,230 26,675 32,010 38,415 46,095
7,2 95 8,495 12,000 15,000 18,000 23,400 28,080 33,695 40,435 48,520
8,315 9,500 13,230 16,440 19,725 24,655 29,590 35,505 42,605 51,125
9,850 10,850 15,750 19,690 23,625 28,350 34,020 40,825 48,990 58,785
12,215 14,105 20,475 25,595 30,715 36,855 44,225 53,070 63,685 76,425
14,475 16,715 24,265 30,330 36,395 43,675 52,410 62,890 75,465 90,560
8,885 10,160 13,205 16,505 19,810 23,770 28,525 34,225 41,075 49,285
9,355 10,695 13,900 17,375 20,850 25,020 30,025 36,030 43,235 51,880
10,225 11,300 14,995 18,445 22,135 26,560 31,870 38,245 45,895 55,075
12,350 13,500 17,950 22,440 26,925 32,310 38,770 46,525 55,830 67,000
15,560 18,440 17,550 20,795 23,335 27,650 29,170 34,565 35,005 41,480 42,005 49,775 50,405 59,730 60,485 71,675 72,580 86,010 87,095 1,03,210
10,220 11,685 15,185 18,980 22,780 27,335 32,800 39,360 47,235
10,76 0 12,300 15,985 19,980 23,975 28,775 34,530 41,435 49,720
11,760 12,995 17,245 20,890 25,110 30,545 36,650 43,980 52,780
14,200 15,525 20,645 25,805 30,965 37,155 44,590 53,505 64,205
18,465 20,185 26,835 33,545 40,255 48,305 57,965 69,555 83,470
56,680 5,040 5,785 8,905 10,935 13,865 18,590 22,310 26,770 32,125 38,550
59,665 5,305 6,090 9,375 11,510 14,595 19,570 23,480 28,180 33,815 40,575
63,335 6,095 6,910 9,635 11,930 14,995 20,230 24,275 29,130 34,955 41,945
77,050 1,00,160 1,18,690 6,785 8,820 10,450 7,790 10,130 12,710 12,235 15,905 20,105 14,900 19,370 24,970 18,490 24,035 30,155 23,490 30,535 36,185 28,190 36,645 43,425 33,825 43,975 52,110 40,590 52,770 62,530 48,710 63,320 75,035
6 ,235 7,005 10,195 12,825 15,390 20,005
6,56 5 7,485 7,375 8,550 10,730 11,490 13,500 13,940 16,200 17,040 21,060 22,190
8,865 9,645 14,175 17,720 20,290 25,515
11,525 12,540 18,430 23,035 26,375 33,170
13,025 15,045 21,835 27,295 32,755 39,305
24,010 28,810 34,570 41,485
25,270 26,630 30,325 31,955 36,390 38,345 43,670 46,015
30,620 36,740 44,090 52,910
39,805 47,765 57,315 68,780
47,165 56,600 67,920 81,505
21,205 23,915 31,800 39,750 47,700 57,240 68,690 82,425 98,910
Plan
1A+3C
Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
2 LACS
3 LACS 4 LACS
5 LACS 10 LACS 15 LACS
7,940 8,695 11,505 13,905 16,860 21,390 25,670 30,805 36,965 44,360
8,360 9,150 12,110 14,640 17,745 22,520 27,020 32,425 38,910 46,695
11,735 12,825 17,055 20,195 23,200 29,080 34,895 41,875 50,250 60,300
9,205 9,570 12,520 15,055 18,175 23,405 28,085 33,700 40,440 48,530
14,300 15,675 22,170 26,250 30,155 37,805 45,365 54,435 65,325 78,390
16,595 18,715 24,885 31,110 37,330 44,795 53,755 64,505 77,410 92,890
Plan
1A+1C
Service Tax Extra
Premium Chart for Zone 2: Plan
2A
2A+1C
2A+2C
2A+3C
Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
2 LACS
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
3 LACS 4 LACS
1A+2C
5 LACS 10 LACS 15 LACS
4,510 5,600 8,530
5,010 6,225 9,480
6,095 7,310 10,475
6,405 7,790 12,325
8,820 10,725 16,965
10,450 12,710 20,105
10,660 13,505 17,925 22,975 27,335 32,800 39,360
11,845 14,215 18,480 23,480 28,180 33,815 40,575
13,595 16,215 20,430 24,515 29,415 35,300 42,360
15,405 18,490 23,490 26,620 31,945 38,335 46,005
21,205 25,450 30,535 36,645 43,975 52,770 63,320
25,130 30,155 36,185 43,425 52,110 62,530 75,035
5,580 6,500 9,180 11,475 14,380 19,295 24,730 29,415 35,300 42,360
6,200 7,220 10,200 12,750 15,300 19,890 25,270 30,325 36,390 43,670
7,485 8,550 11,905 14,795 18,740 22,190 26,630 31,955 38,345 46,015
8,375 9,225 13,390 16,735 21,265 24,100 27,310 32,775 39,325 47,195
10,995 12,695 18,430 23,035 27,640 33,170 39,805 47,765 57,315 68,780
13,025 15,045 21,835 27,295 32,755 39,305 47,165 56,600 67,920 81,505
7,155 7,700 10,635 13,290 16,305 20,630 26,440 31,455 37,745 45,295
7,950 8,555 11,815 14,770 17,725 21,265 27,020 32,425 38,910 46,695
9,205 10,170 13,495 16,600 19,920 23,905 28,685 34,420 41,305 49,565
10,500 11,475 15,260 19,070 22,885 27,465 31,125 37,350 44,820 53,785
14,005 15,795 21,000 26,250 31,500 37,805 45,365 54,435 65,325 78,390
16,595 18,715 24,885 31,110 37,330 44,795 53,755 64,505 77,410 92,890
8,230 9,410 12,230 14,385 18,225 22,865 29,310 34,865 41,840 50,205
9,145 10,455 13,585 15,985 19,180 24,455 31,075 37,290 44,750 53,695
10,585 11,695 15,520 18,800 22,600 27,490 32,985 39,585 47,500 57,000
12,070 13,195 17,545 21,935 26,320 31,585 35,795 42,955 51,545 61,850
16,615 18,165 24,150 30,190 36,230 43,475 52,170 62,600 75,120 90,145
19,085 21,525 28,620 35,775 42,930 51,515 61,820 74,185 89,020 1,06,825
1A+3C
Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
16days-35
2 LACS
3 LACS 4 LACS
5 LACS 10 LACS 15 LACS
3,820 4,190 6,225 7,550 9,980 14,970 19,185 22,825 27,390 32,865
4,245 4,870 7,500 9,205 11,675 16,635 21,135 25,360 30,435 36,520
5,765 6,625 10,400 12,590 15,715 19,965 22,630 27,155 32,585 39,100
5,485 6,220 8,670 10,735 13,495 18,205 21,845 26,215 31,460 37,750
5,025 5,580 7,640 9,290 11,290 15,880 20,350 24,210 29,050 34,860
5,580 6,270 8,585 10,800 13,770 17,900 22,745 27,295 32,755 39,305
6,735 7,695 10,345 12,545 15,335 19,970 23,965 28,760 34,510 41,415
7,535 8,200 12,050 15,060 17,245 21,690 24,580 29,495 35,395 42,475
7,935 9,115 14,315 17,435 21,630 27,485 32,980 39,575 47,490 56,990
9,405 11,440 18,095 22,470 27,140 32,570 39,080 46,900 56,275 67,530
2A+2C
10,370 11,285 16,585 20,730 23,735 29,855 35,825 42,990 51,585 61,900
11,725 13,540 19,655 24,565 29,480 35,375 42,450 50,940 61,130 73,355
6,395
7,105
8,280
9,975
12,870
14,935
36-45
6,590
7,320
8,615
10,390
14,105
16,845
46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
8,885 10,735 12,870 16,845 21,590 25,680 30,820 36,980
9,870 11,930 14,460 19,140 24,320 29,185 35,020 42,025
11,270 13,400 16,265 21,065 25,275 30,330 36,395 43,675
13,640 16,460 19,020 24,715 28,015 33,615 40,340 48,405
19,950 23,625 27,140 34,020 40,825 48,990 58,790 70,550
22,400 28,000 33,595 40,315 48,380 58,055 69,665 83,600
Plan
2A
2A+1C
2 LACS
3 LACS 4 LACS
5 LACS 10 LACS 15 LACS
4,060 5,040 7,675 9,595 12,155 16,135 20,680 24,600 29,520 35,425
4,510 5,600 8,530 10,660 12,795 16,635 21,605 25,360 30,435 36,520
5,485 6,580 9,430 12,235 14,595 18,385 22,060 26,475 31,770 38,125
5,765 7,015 11,095 13,865 16,640 21,140 23,960 28,750 34,500 41,405
7,935 9,655 15,270 19,085 22,905 27,485 32,980 39,575 47,490 56,990
9,405 11,440 18,095 22,615 27,140 32,570 39,080 46,900 56,275 67,530
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
5,025 5,850 8,260 10,330 12,945 17,365 22,255 26,475 31,770 38,125
5,580 6,500 9,180 11,475 13,770 17,900 23,250 27,295 32,755 39,305
6,735 7,695 10,715 13,315 16,865 19,970 23,965 28,760 34,510 41,415
7,535 8,300 12,050 15,060 19,135 21,690 24,580 29,495 35,395 42,475
9,895 11,425 16,585 20,730 24,875 29,855 35,825 42,990 51,585 61,900
11,725 13,540 19,655 24,565 29,480 35,375 42,450 50,940 61,130 73,355
7,155 7,700 10,635 13,290 15,950 19,140 24,860 29,185 35,020 42,025
8,280 9,155 12,145 14,940 17,925 21,515 25,815 30,980 37,175 44,610
9,450 10,330 13,730 17,165 20,600 24,715 28,015 33,615 40,340 48,405
12,605 14,215 18,900 23,625 28,350 34,020 40,825 48,990 58,790 70,550
14,935 16,845 22,400 28,000 33,595 40,315 48,380 58,055 69,665 83,600
7,405 8,470 11,005 12,950 16,400 20,580 26,380 31,380 37,655 45,185
8,230 9,410 12,230 14,385 17,265 22,010 28,590 33,560 40,275 48,330
9,525 10,525 13,970 16,920 20,340 24,740 29,690 35,625 42,750 51,300
10,865 11,875 15,790 19,740 23,685 28,425 32,215 38,660 46,390 55,665
14,955 16,350 21,735 27,170 32,605 39,125 46,950 56,340 67,610 81,130
17,175 19,370 25,760 32,195 38,635 46,365 55,635 66,765 80,115 96,140
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
3,435 3,770 5,605 6,795 8,985 13,475 17,270 20,540 24,650 29,580
3,820 4,385 6,750 8,285 10,505 14,970 19,445 22,825 27,390 32,865
4,935 5,595 7,805 9,665 12,145 16,385 21,040 25,245 30,295 36,355
5,190 5,960 9,360 11,330 14,145 17,970 21,790 26,150 31,380 37,655
7,145 8,205 12,885 15,690 19,465 24,735 29,680 35,620 42,740 51,290
8,465 10,295 16,285 20,225 24,425 29,310 35,175 42,210 50,650 60,780
1A+2C
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80
4,520 5,020 6,875 8,360 10,160 14,290 18,315 21,790 26,145
5,025 5,640 7,725 9,720 12,395 16,110 20,925 24,565 29,475
6,060 6,925 9,310 11,290 13,800 17,975 23,080 27,695 33,235
6,780 7,380 10,845 13,555 15,520 19,520 23,670 28,405 34,085
9,335 10,155 14,925 18,660 21,365 26,865 32,240 38,690 46,425
10,550 12,185 17,690 22,110 26,530 31,840 38,205 45,845 55,015
1A+3C
Above 80 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
31,375 5,755 5,930 7,995 9,665 11,585 15,160 19,430 23,115 27,735 33,285
35,375 6,395 6,590 8,885 10,735 13,015 17,225 22,375 26,265 31,520 37,820
39,880 7,455 7,750 10,140 12,060 14,640 18,955 24,340 29,210 35,050 42,060
40,900 8,975 9,350 12,280 14,810 17,120 22,245 26,975 32,370 38,845 46,615
55,710 11,580 12,695 17,955 21,265 24,425 30,620 36,745 44,095 52,910 63,495
66,020 13,445 15,160 20,160 25,200 30,235 36,285 43,540 52,250 62,700 75,240
2A+3C
1A+1C
Premium Chart for Zone 3: Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
6,440 6,930 9,570 11,965 14,675 18,565 23,795 28,310 33,970 40,765
Plan
2 LACS 3 LACS 4 LACS 5 LACS 10 LACS 15 LACS
16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
Service Tax Extra
Age inyears / SumInsured (inRs.) 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 Above 80
Service Tax Extra
Age of the oldest family member covered should be tak en for premium calculation. Zone 1means : Delhiinc luding NationalCapitalRegion , Mumbaiincluding Thane andthe State of Gujarat Zone 2 means : Bangalore, Chennai, Coimbatore, Pune and State ofKerala Zone 3 means: Rest of Indiaexcluding areasfalling under Zone 1 and Zone 2 Renewalpremium is subject to change with prior approvalfrom IRDA
Prohibitionof
rebates : rebates: (Section 41 of the InsuranceAct) No person shallallow or offer to allow either directlyor indirectly as inducement to take out renew or continue an insurance in respect of anykind of riskrelating to lives or propertyin India any rebate of the whole or part of the commission payable on the premium shown on the policynor shall anyperson taking out renewing or continuing a policyaccept rebate except such rebate asmaybe allowed in accordance with the published prospectusor tablesof the insurer. Anyperson making default in complying with the provision of thissection shallbe punishable with fine, which mayextend to five hundred rupees.
Free
Look Period: Afree look period of 15 daysfrom th e date of receipt of the policy isavail able to the i nsured to review the termsand conditi onsof the policy. In case the insured isnot satisfied with the terms and conditions, the insured mayseek cancellation of the policyand in such an event the Companyshall allow refund of premium paid after adjusting the costof pre-acceptance medicalscreenin g, stamp dutycharges and proportionate riskpremium for the period concerned provided no claim hasbeen made untilsuch cancellati on.
Free lookcancellation isnot applicable at thetime ofrenewalof the policy
The information provided in this brochure isonlyindicative. Please refer to the policydocument for complete information.
REGISTERED & CORPORATE OFFICE: NO.1, NEW TANK STREET, VALLUVARKOTTAM HIGH ROAD, NUNGAMBAKKAM,CHENNAI–600034. IRDAREGISTRATION NO:129, FOR MORE DETAILS ON THE RISK FACTORS, TERMS AND CONDITIONS, PLEASEREADTHESALESBROCHURECAREFULLYBEFORECONCLUDINGASALE. “IRDAOR ITS OFFICIALS DONOT INVOLVE IN ACTIVITIES LIKE SALE OFANY KIND OFINSURANCE OR FINANCIAL PRODUCTS NOR INVEST PREMIUMS”;”IRDAD OES NOTANNOUNCE ANY BONUS””THOSE RECEIVINGSUCH PHONE CALLS ARE REQUESTED TOLODGE APOLICE COMPLAINTALONG WITH DETAILS OFPHONE CALLAND NUMBER
Unique Identification No. : IRDA/NL-HLT/SHAI/P-H/V.II/129/14-15 Family Health Optima Insurance Plan
3 3 1 : O P L 1 4 1 1 1 7 1 C P S
ForZone1:
Minimum period of hospitalisation is 24 hours. Thistime limit is waived where the treatment istaken for specified daycare treatments.
Unique Identification No. : IRDA/NL-HLT/SHAI/P-H/V.II/129/14-15
FamilyHealth Optima from Star Health isa health insurance plan that gives protection for the entire familyon the payment of a single premium under a single sum insured. The Single sum insured coversallyour familymembers. It's just one more wayto tighten the familybonds.
ASuperSaverPolicy Single Sum Insured
Extra Benefits
Coverage for entire family
Considerable saving in premium asthe familyiscovered under one policy.
Any person aged between 18 years and 65 years, residing in India, can take thisinsurance
Beyond 65 years, It can be renewed for life time.
Child from 16th dayof age ca n be covered as part of the family.
Family : Proposer, spouse, dependent children from 16 days up to 25 years (those whoare economicallydependent ontheir parents)
HospitalisationBenefits: A) Room, Boarding,Nursing Expensesasgiven below :-
Zone 1 Sum InsuredRs.
Class A Cities
Upto 4 lacs
2% of the sum insured subject to a maximum of Rs.5000/per day
5 lacs 10 lacs and15 lacs
Zone 2 and Zone 3
Class B Other Cities Locations 1% of the sum insured subject to a maximum of Rs.3000/per day
1% of the sum insured subject to a maximum of Rs.2000/per day
The condition of the patient is such that he/she is not in a condition to be
removed to a Hospital, or The patient takes treatment at home on account of non-availability of room in hospital.
Class A Cities 2% of the sum insured subject to a maximum of Rs.5000/per day
Class B Other Cities Locations 1% of the sum insured subject to a maximum of Rs.3000/per day
1% of the sum insured subject to a maximum of Rs.2000/per day
SingleStandardA/croom
Maximumof Rs.7,500/- perday
SingleStandardA/croom
Maximumof Rs.10,000/-per day
Class A cities means Ahmedabad, Bangalore, Chennai, Hyderabad including Secunderabad, Kolkata, Mumbaiincluding Thane, Pune, New Delhiincluding Noida, Gurgaon, Ghaziabad and Faridabad (otherwise called asNationalCapitalRegion)
D) Cost of Medicine and drugs E) Emergency ambulance charges for transporting the covered patient to the hospital up to a sum of Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policyperiod.
25%of the basicsum insured for sum insured option of Rs.3 lacsand Rs.4 lacs.
30%of the basicsum insured for sum insured option of Rs.5 acs l
No recharge for Sum Insured up to Rs.2 lacs and more than Rs.5 lacs
The insured mayat any time cancelthis policyand in such event the Companyshall allow refund after retaining premium at Company'sshort Period rate only (table given below) provided no claim hasocc urred up to the date of cancellation
It being howeverunderstood that suchbonuss hallbe computed on the basicsu m Insured, under the expiring policy and such benefit of bonusshall be available onlyupon timely renewalwithout a break or upon renewalwithin the grace period allowed. In the event of a claim, such bonusso granted will be reduced in the same order der in which it was given. However the basicsum insured, willnot be reduced. The limit of such Bonuswillbe quantified in Rupeesand aggregated annuallyas long asno claim ismade tillthe maximum percentage isreached. If the Insured optsto reduce the basic Sum Insured at a subsequent renewal, the limitof indemnitybyway of such Bonusshallnot exceed such reducedsum insured. Pre existing diseasesare covered after 48 monthsof continuousinsurance with anyIndian Insurance Company Pre & PostHospitalization Pre-hospitalization medical expenses incurred up to 60 days prior to the date of hospitalization are payable.
Note: Intimation about the new born should be given tothe company and policyha sto be endorsed for thiscover to commence.
Post-hospitalization medical expenses incurred up to 90 days after discharge from the hospitalare payable.
If, at the commencement of the policy, the new born child asdefined in the policy clause isless than 16 daysof age, the proposer can opt to cover such child also inthe same policybyp aying the applicable premium in full. However, the cover or of r such child willcommence only from the 16th dayafter itsbirth and continue tillthe expiry date of the policy.
Limits forcataract surgery
the remaining policyperiod. Such additional indemnity can be utilized even for the same hospitalization or for the treatment of diseases/ illness / injury/ for which claim was paid / payable under the policy. Thisis in addition to the 'Restore' benefit available under the policy.
If these are pre-existing at the time of proposalthey willbe covered subject to Exclusion No 1 above.
Bonus : In respect of a claim free year of Insurance, for the Sum Insured options Rs.3,00,000/- and above, the insured would be entitled to a benefit of bonusof 25%of the expiring sum insured in thesecond year and additional10%of the expiring sum insured in the third year. Themaximum allowable bonusshallnot exceed 35%of the expiring sum insured.
Recharge Benefit: If the limit of coverage under the policyisexhausted / exceeded during the policyperiod, additional indemnityupto the limitsindicated below would be provided once for
Cancellation: The Companymaycancel thispolicy on groundsof misrepresentation, fraud,
registered letter at the Insured person'slast son'slast known address and no refund of premium willbe made.
Automatic Restorationof SumInsured : There shallbe automatic restoration of the Basic Sum Insured once immediatelyupon exhaustion of the limit of coverage which has otherwise been defined during the policy period subject to the following termsand extent thereof
The claim for such llnesses/diseases/disabilities i contracted/suffered if admitted ted will be processed asper the sum insured of the immediatelypreceding 24 monthspolicy only. Where there isa change in the sum insured in the second continuous policyyear the lower of the sum insured willapply.
moralhazard, non disclosure of materialfact asdeclared in proposalform / at the time of claim, or non-cooperation bythe insured person, bysending the Insured 30 daysnotice by
Coverage forNewbornBaby: Hospitalization expenses for treatment of New Born Baby, born during the policyperiod. This cover startsfrom the 16th dayafter birth and issubject to a limit of 10%of the Sum Insured or RupeesFiftythousand, whichever is less, subject to other exclusions.
This waiting period shallnot however applyin the case of theInsured person/shaving been covered under any Individual health insurance scheme with anyof the Indian Insurer for a continuousperiod of preceding 24 monthswithout anybreak.
In the event of thispolicy being withdrawn / modified with revised termsand/or msand/or premium with the prior approvalof the Competent Authority, the insured willbe intimated three monthsin advance and accommodated in anyother equivalent health insurancepolicyoffered by the Company, if requested for bythe Insured Person, at the relevant point of time.
Howeverboth the Recharge & Restorebenefits cannot beutilizedtogetherfor a single hospitalization
Pre ExistingDisease
It ismade clear that such restored Sum Insured can be utilized only for illness/disease unrelated to the illness/diseasesfor which claim/swas /were made. The restored suminsured cannot be carried forward
C) Anesthesia, Blood, Oxygen, Operation Theatre charges, cost of Pacemaker etc.,
No recharge for Sum Insured up to Rs.2 lacs and more than Rs.5 lacs
alreadycontracted under the preceding policy periods. Further, for illness/ disease / sickness alreadyc ontracted, the sum insured willbe restricted to that policysum insured when the signsor symptomswas diagnosed or receivedmedicaltreatment.
Recharge amount cannot be carriedforward.
For Rs.2 Lacs of suminsured, thelimit willbe Rs. 12,000/-per policyperiod. Above Rs. 2 Lacs up to Rs. 5 Lacs of sum insured, the limit will be Rs. 20,000/- per hospitalisation and Rs. 30,000/- for entire policyperiod. Above Rs. 5 Lacs of sum insured, the limit willbe Rs. 30,000/- per hospitalization and Rs. 40,000/- for entire policyperiod.
P ER I OD O N R S I K
R AT E O F PR E MI U M T O B E R ET AN I ED B Y T HE I N SU R ER
Up to one-month
1/3rd of annualpremium
Up to three Months
½of annualpremium
Up to sixmonths
3/4th of annualpremium
Exceeding sixmonths
Fullannualpremium
Exclusions 1. Pre ExistingDiseasesas defined in the policyuntil48 consecutive monthsof continuous coverage have elapsed; since inception of the first policywith any Indian Insurer. However the limit ofthe Company'sliability in respect of claimfor pre-existing diseasesshall be limited to the sum insured under the first policywith any Indian Insurance Company. 2. Any disease contracted by the insured person during the irst ifrst 30 daysfrom the commencement date of the policy.Thisex clusion shallnot apply in case of the insured person having been covered under anyhealth insurance policy(Individual or Group insurance policy) with anyof the Indian Insurance companiesfor a continuousperiod of preceding 12 monthswithout a break
However admissionfor accidentalinjuriouswillbe covered from1st day
3. During the firsttwo yearsof continuousoperation of insurance cover anyexpenseson a) Cataract, Disea ses of the Vitreous and Retina, Glaucoma, diseas es of ENT, Mastoidectomy, Tympanoplasty, Stapedectomy, diseasesrelated to Thyroid, Prolapse of intervertebraldisc(other than caused byaccident), varicose veinsand varicose ulcers, all diseases of prostate, e, Stricture ure Urethra, all obstructive-uropathies,all types of hernia, varicocele, hydrocele, fistula / fissure in ano, Hemorrhoids, Pilonidalsinus and fistula, RectalProlapse, stressincontinence and CongenitalInternaldisease / defect
HealthScreening: Allpersons HealthScreening: Allpersons proposed for insurance whoare above 50 yearsof age areto undergo Pre acceptance medicalscreening at the company nominated centers. The cost of such screening willbe borne by the Company. The age for screening and the cost are subject to change
RevisioninSum Insured: d: Any Any revision in sum insured is permissible onlyat the time of renewal. The Insured Person can propose such revision and maybe allowed subject to Company'sapproval and payment of appropriate premium
c) Alltreatments(conservative, interventional, laparoscopicand open) relatedto alldiseases of uterus, fallopian tubes, cervixan d ovaries, dysfunctionaluterine bleeding, pelvic inflammatorydiseases, benign breast diseases.
Tax Benefits: ts: Payment of premium byanymode other than cash for this insurance iseligible for relief under Section 80D of the Income TaxAct 1961.
d) Conservative, operative treatment eatment and alltypes of intervention fordiseases related to tendon, ligament, fascia, bonesand joint [other than caused by accident]
Renewal Condition: Lifelong renewalof the policyis offered, except on groundssuch as moralhazard, misrepresentation / non disclosure or fraud committed. Agrace period of30 daysfrom the dateof expiryof the policyisavailable for renewal.
Otherlocations meansRest of India not falling under ClassA& ClassB abov e B) Surgeon, Anesthetist, MedicalPractitioner, Consultants& Specialist Fees.
15%of the basicsum insured for sum insured option of Rs.5 lacs.
Class B citiesmeans Allahabad, Amritsar, Agra, Baroda, Coimbatore, Cochin, Goa, Indore, Jalandhar , Jodhpur, Kanpur, Kota, Ludhiana, Mohali, Meerut, Nagpur, Pakhola, Rajkot, Surat, Udaipur, Varanasi, Vizag, Vijayawada and allState capitals other than those falling under ClassA.
25%of the basicsum insured for sum insured option of Rs.3 lacsand Rs.4 lacs.
Donorexpenses fororgan transplantation, where the insured person is the recipient, are payable up to a limit of 10%of the Sum Insured or RupeesOne lakh, whichever is less, provided the claim for transplantation ispayable and sub ject to the availabilityof the sum insured. Donor screening expensesand post-donation complications of the donor are not payable. Cost of healthcheck up, up to 1%of the average basic sum insured subject to a maximum of Rs.5000/-. The Insured Personsbecome eligible for thisbenefit after continuouscoverage under thispolicy after everyblocko f threeyearswith the Companyand payable on renewal. Thisbenefit isavailable for sum insured of Rupeesthree lakhsand above.
ForZone 2 andZone 3
Pre-hospitalisation and Post-hospitalisation expensesare not payable for thisco ver
POLICYBENEFITS:
Domiciliary hospitalization : hospitalization : Coverage for medicaltreatment for a period exceeding three days, for an illness/disease/injury, which in the normal course, would require care and treatment at a Hospitalbut isactually taken whilst confined at home under anyof the following circumstances:
However, thisbenefit shall not cover Asthma, Bronchitis, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and alltypesof Dysenteries including Gastro-enteritis, DiabetesMellitus and Insipidus, Epilepsy, Hypertension, Influenza, Cough and Cold, all Psychiatric or Psychosomatic Disorders, Pyrexia of unknown origin for lessthan 10 days, Tonsillitis and Upper RespiratoryTract infection including Laryngitis and Pharingitis, Arthritis, Gout and Rheumatism.
Eligibility
Day CareTreatment:405 daycare treatmentsare allowed .
If the policyis to be renewed or ported from other her Indian Insurance Companyfor enhanced sum insured, such enhanced sum insured willnot be available for an illness, disease, injury
b) Gall bladder and pancreatic diseases and all treatments(conservative, interventional, laparoscopic and open) related to Hepato-pancreato-biliaryincluding gallbladder and pancreaticcalculi. Alltypesof management for kidneyand genitourinarytract calculi.
19. Expenses incurred or of r treatment ment of diseases/illness/accidental injuries by systemsof medicinesother than Allopathy 20. Change of sex or cosmeticor aesthetic treatment of any description, plastic surgery (other than asnecessitated due to an accident or asa part of any illness), alltreatment for erectile dysfunctions. 21. Cost of spectaclesand contact lens, hearing aids, Cochlear implantswalkers and crutches, wheelchairs, CPAP, BIPAP,ContinuousAmbulatory Peritoneal Dialysis,, infusion pump and such other similar aids. Dialysis 22. Anysp ecifictime-bound or life time exclusionsapplied, specified and accepted bythe insured
4. Circumcision, Inoculation or Vaccination (except for post–bite treatment and for medical treatment other than for prevention of diseases.) 5. Dental treatment or surgeryunless necessitated due to accidentalinjuries and requiring hospitalization. (Dentalimplantsare not payable) 6. Convalescence, general debility, run-down down condition or rest cure, nutritional ritional deficiency states, psychiatric, mentaland behavioraldisorders, congenitalexternaldisease or defects or anomalies, venerealdisease and sexually transmitted diseases, intentionals entionals elf injury and use of intoxicating drugs/ alcohol, smoking and tobacco chewing
23. Other expensesas detailed in the policy. Co-payment:
Co-payment of 20%applicable for each and everyclaim amount for fresh aswellas renewalp oliciesfor insured persons whose age at the time ofentry isab ove 60 years. Thisco-payment willnot apply for those insured personswho have entered the policybefore 60 yearsand renew the policycontinuouslywithout anybreak. Portability:
Thispolicy isportable. If he ht e insured sdesirous i of portingthispolicyto another Insurer towardsrenewal, application in the appropriate form should be made to the Companyat least before 45 daysfrom the date when the renewalis due. Where the outcome of acceptance of portabilityis stillwaiting from the new insurer on the date of renewal, the existing policywillbe extended on the request of the Insured person, for a period not lessthan one month on pro rata premium. Such extended cover willbe cancelled only on the written request bythe Insured Person, subject to a minimum pro rata premium for one month. If the Insured Person requestsin writing to continue the policywith the Companywithout porting, it willbe allowed bycharging the regular premium with the sametermsas per the expiring policy. In case of a claim made by the Insured person and admitted bythe Company during such extension, the policywill be extended for the remaining period by charging the regularpremium. Portabilityis not possible duringthe policyperiod. For details contact “[email protected]” in” or call Telephone No +91-04428288869
7. Injury/disease directlyor indirectlycaused by or arising from orattributable to war,invasion, act of foreign enemy, warlike operations(whether war be declared or not) 8. Injury or disease direc tly or indirectly caused by or contributed to by nuclear weapons/materials 9
Allexpenses arising outof anycondition directlyor indirectlycaused due to orassociated with Human T-cellLympho TrophicVirustype III (HTLV-III) or LymphadenopathyAssociated Virus(LAV) or the MutantsDerivative or VariationsDeficiency Syndrome or anySyndrome or condition of a similar kind commonlyreferred to asAIDS. It ishowever made clear that such of those who are positive for HIV (Human Immuno Deficiency Virus) would be entitled for expensesincurred for treatment, other than for opportunisticinfectionsand for treatment of HIV/AIDS, provided at the time of first commencement of insurance under this policy, their CD4 count isnot lessthan 350.
10. Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of anyof these (other than ruptured ectopic gestation), family planning treatment and alltypesof treatment for infertilityand itscomplicationsthereof.
Claims
Procedure Callthe 24 hour help-line for assistance-1800 425 2255. Inform the ID/Policy Policy number foreasyreference In case of planned hospitalization, nform i 24 hoursprior to admission in the hospital In case of emergencyhospitalization, informationto be given within 24hoursof
11. Expensesincurred on weight controlservicesincluding surgicalprocedures for treatmentof obesity, medicaltreatment for weight control, treatment for metabolic, genetic and endocrine disorders 12. Expenses incurred on High IntensityFocused Ultra Sound, Uterine fibroid embolisation, Balloon Sinoplasty, Enhanced ExternalCounter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain Stimulation, HyperbaricOxygen Therapy, RotationalField Quantum MagneticResonance Therapy, Photodynamictherapy and such other therapies apies similar to those mentioned herein under exclusion No12 13. Expenses incurred on LasikLaser or Refractive Error or Correction and tscomplications i all treatment for disordersof eye requiring intra-vitrealinjectionsand related procedures.
hospitalization Cashlessfacilitycan be availed inallnetworkhospitals wherever possible In non-network hospitals payment must be made up-front and then reimbursement willbe effected onsubmission of documents. The Company
Star Health and Allied Insurance Co. Ltd., isa joint venture between Oman Insurance Company(UAE), leading NRIs and Indian business houses. It has a capitalbase of INR 549 Crores. Asan exclusive Health Insurance Companyand the first of its kind in India, the Company is committed to setting ing international benchmarksin service and personalcaring.
14. Chargesincurred at Hospital or Nursing Home primarilyfor diagnostic, X-rayor laboratory examinationsnot consistent with or incidentalto the diagnosisand treatment of the positive existence or presence of anyailment, sicknessor injury, for which confinement isrequired at hospital/nursing home. 15. Expenses on vitaminsand tonics unlessforming part of treatment or of r injuryor disease as certified bythe attending Physician.
StarAdvantages.
No Third PartyAdministrator, direct n-house i claimssettlement. Faster and hassle – free claim settlement. Cashlesshospitalization
16. NaturopathyTreatment, unconventional, untested, unproven, experimentaltherapies.
e) Deg enerative discand vertebraldiseasesincluding replacement ofbonesand jointsan d degenerative diseasesof the musculo-skeletalsystem
17. Stem cell Therapyand related transplantation, Chondrocyte Implantation, Immunotherapy, OralChemo Therapy.
f) Subcutaneous benign lumps, sebaceous cyst, dermoid cyst, lipoma , neurofibroma, fibroadenoma, ganglion and similar pathology
18. Hospitalregistration charges, admission charges, record charges, telephone chargesand such other charges\
24X7 TollFree Helpline
g) Anytransplant and related surgery
Network of morethan 6000 hospitalsacrossIndia
Information on health through free health magazine
Facility
for maintainingpersonalhealth recordsin electronicformat
