Micro Presentation

Star Health and Allied Insurance Co. Ltd.

Presentation on Micro Health Insurance

Presentation on

MICRO HEALTH INSURANCE



Coverages

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accident



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

It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner

or

Should comply with minimum criteria as under• Fully qualified nursing staff under its employment

round the clock• Fully qualified Doctor(s) should be in charge round the

clock.



Age Limits

5 Years – 50 Years

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

Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required.



Sum Insured

Sum Insured :

Rs.30,000, Rs.20,000 and Rs.10,000

Per Hospitalization Maximum - Rs. 15,000/-, Rs.10,000/- & Rs.5000/- for a SI of Rs.30,000/-, Rs.20000/- & Rs.10,000 respectively



Allowable ExpensesSI – Rs.30,000

Room rent & boarding charges & Nursing expenses @ Rs.150/- per day and Rs. 5,000/- per hospitalisation

Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 4,500/- per hospitalisation

Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 4,500/- per hospitalisation

Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period




Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 3333/- per hospitalisation

Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 3000/- per hospitalisation

Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 3000/- per hospitalisation





Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 1667/- per hospitalisation

Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 1,500/- per hospitalisation

Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 1,500/- per hospitalisation




Day Care Treatment Expenses on Hospitalization for minimum period of 24 hours are

admissible. However, this time limit will not apply for • Dialysis, • Chemotherapy, • Radiotherapy, • Eye surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, taken in the Hospital / Nursing Home and the Insured is discharged

on the same day.



Rating

Age

Premium

SI Rs.30,000

Premium

SI Rs.20,000

Premium

SI Rs.10,000

5 Years to 25 Years

275 185 95

26 Years to 35 Years

350 230 115


425 280 140


500 330 165



Other Benefits

Benefits under Section 80-D of the IT Act

Cashless Service without intervention of TPA

Direct Tie up with hospitals on an All India Basis

24 X 7 In-House Call center

Toll Free Telephone line assistance

Full knowledge based website to offer medical information, including Health Tips.

Health Check-up benefits

Frequent health meets to disseminate info on the health related topics



Group policies can be given

Group Discount of 5% of the premium for a Group Exceeding 100 members

Group Policies



ExclusionsPre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break)Any Disease contracted during first 30 daysCataractFirst 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• Hysterectomy following Menorrhia or Fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery



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 Treatment



Claim Procedure

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 Hospital

Based on the intimation a field visit will be done by the Star Doctor

Pre Authorization will be issued to the Hospital

Based 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)

Claim form will be sent to the Insured.

Based on the intimation a field visit will be done by the Star Doctor

Bills 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

Date post:	06-May-2015
Category:	Economy & Finance
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Micro Presentation

Economy & Finance