India – Health

Star Health and Allied Insurance Co. Ltd.

Presentation on Medi-Classic

India – Health





Presentation on

MEDI-Classic



Coverages:- Hospitalization due illness/sickness/disese



What is a Hospital?Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which

EitherIt 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.



Age Limits

5 Months – 60 Yrs, renewal 80 years

Dependent Children can be covered only with any one of their Parents



Medical Examination

For persons with adverse medical history

and

For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.



Sum Insured

Minimum Sum Insured - Rs. 100000/-

Maximum Sum Insured - Rs. 10,00,000/-

The following Sum Insured options are available

Rs. 1,00,000/- Rs. 1,50,000/- Rs. 2,00,000/- Rs. 2,50,000/- Rs. 3,00,000/- Rs. 3,50,000/- Rs. 4,00,000/- Rs. 5,00,000/- Rs.10,00,000/-



Allowable expenses

Room Rent 2% of S.I. Max.4000/- Per Day



Allowable Expenses (Contd.)

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/-



Working for post-hospitalization

Room rent 1200*10 = 12000 Nursing 350*10 = 3500 Dr. Con. 1000*10 = 10000 Medicine = 12000 Pathology = 7500 Total = 45000 45000-12000=33,000 7% of 33,000= 2310/- or Actuals Max. 5000/



Day Care Treatment

Minimum of 24 hours Hospitalization is not necessary for the following

Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy, The above treatment shall be taken in the Hospital /

Nursing Home and the Insured is discharged on the same day.



Sub limitsName of the Ailment / Surgery /

ProcedureSub Limit

Cataract surgery Rs. 20,000/- in respect of one eye and Rs. 30,000/- in the entire policy period

Lithotripsy (Kidney stone removal) Rs. 20,000/-

Tonsillectomy Rs. 7,500/-

Cutting and Draining of Abscess Rs. 1,500/-

Liver Aspiration Rs. 2,000/-

Pleural Effusion Aspiration Rs. 2,000/-

Colonoscopy Rs. 2,000/-

Sclerotheraphy Rs. 5,000/-



Premium Rating (Excluding.s.t.)(Old Premium)

Age Sum Insured (Rs.)1 Lakh 1.5 Lacs 2 Lacs 2.5 Lacs 3 Lacs 3.5 Lacs 4 Lacs 5 Lacs 10

Lacs

5 Months to 35 Years

1200 1800 2350 2800 3300 3750 4200 4900 7065

36 Years to 45 Years

1350 2000 2600 3150 3650 4150 4500 5400 7965


2447 3400 4583 5548 6170 7408 8700 10700 13265


3000 4200 5300 7200 8200 10196 11451 13958 16525


4547 6717 8768 10696 12625 14434 16242 19859 NA


4872 7284 9574 11744 13914 15964 18015 22113 NA


6029 9284 12420 15433 18449 21341 24236 30023 NA



Age Sum Insured (Rs.)

1 Lakh 1.5 Lacs 2 Lacs 2.5 Lacs 3 Lacs 3.5 Lacs 4 Lacs 5 Lacs 10 Lacs

5 Months to 35 Years

1530 2130 2680 2800 3300 3750 4200 4900 7065


1680 2330 2930 3150 3650 4150 4500 5400 7965


2780 3730 4915 5550 6170 7408 8700 10700 13265


3330 4530 5630 7200 8200 10196 11451 13958 16525


4880 7050 9100 10700 12625 14434 16242 19859 NA


5205 7615 9905 11745 13914 15964 18015 22113 NA


6360 9615 12750 15435 18449 21341 24236 30023 NA

Premium RatingRevised Premium w.e.f. 1st Sept., 2011(excluding S.T.)



No Claim Discounts (NCD) in case of Renewal

5% Discount on Basic Premium for every Claim Free Year

Maximum 25%

In the event of a Claim

One Step back in NCD for Age Group 5M – 35 Yrs

Two Steps back for Age Group 36 – 45 Yrs

Above 45 Yrs – No NCD



NCD 5 % TO 25 %

AGE 33 1200 AGE 34 1200-60=1140(5%) AGE 35 1200-120=1080(10%) AGE 36 1350-202=1148(15%) AGE 37 1350-270=1080(20%) AGE 38 1350-337=1013(25%) AGE 39 1350-337=1013(25%) AGE 40 1350-337=1013(25%)



Transfer of Policy

NO TRANSFERS ARE ALLOWED AFTER AGE 45.

Transfer from other company is allowed upto age 45 only and there should not be any claim in previous policy.

In transfer polices only only 30 day and 1st year excusion will be excluded if the is one year old, if policy has completed 2 years 2nd year exclusion is also waived off.



Optional Benefits

This insurance provides for Cash benefit of Rs. 500/- for and each and every completed day of Hospitalisation subject to a maximum of Rs. 1,500/- per hospitalisation and Rs. 3,000/- per policy period.

Insured persons aged less than 21 years and more than 60 years are not entitled for this benefit.

Premium Age Band Premium (Rs.)

0-35 Years 200

36-45 Years 250

46-55 Years 300

56-60 Years 350



Optional Benefits (contd.)

This insurance is extended to provide for the cost incurred for engaging one attendant at residence after discharge from the hospital of the Insured Person following a covered occurrence under the policy up to Rs. 400 per day for a maximum of 5 days per occurrence. Subject to Time excess of 2 days.

Provided engagement of such an attendant is recommended by the attending physician and agreed to by the Company, in writing

Premium – Rs.300/- per person


Presentation on Medi-ClassicExclusions

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 congenital internal disease/defect 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



Exclusions (Contd.)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.)

Hospital registration charges, record charges, telephone charges and such other similar charges.Non Allopathic shall be restricted to 25% of the sum insured subject to a maximum of Rs. 25,000/- per occurrence for the entire policy period.



Claim Procedure

In case of Network HospitalsImmediate intimation to the Call Centre

(1800 425 2255/044-28263300)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



In case of Non Network HospitalsImmediate intimation to the Call Centre

(1800 425 2255 /044-28263300)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.)



Thank You

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