STAR HEALTH GAIN
INSURANCE
Major Product Features
Flat premium of only Rs. 14,725/Coverage for both inpatient and outpatient treatment
Policy can be given for both individual and family floater basis.
Any unutilised amount under outpatient benefit can be
carried forward to the next one year
Coverages
Under section – I
Hospitalization Expenses incurred as an
inpatient for
Sickness/Illness/Diseases
Accidental injuries
Under section – II
Hospitalization Expenses incurred as an
outpatient treatment subjects to the limits
Family Means
Proposer
Spouse
Dependent Children
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
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
Dependent Children can be covered only with
any one of their Parents
Sum Insured
Minimum Sum Insured - Rs. 1,00,000/Maximum Sum Insured - Rs. 5,00,000/The following Sum Insured options are available
•
•
•
•
•
Rs. 1,00,000/Rs. 2,00,000/Rs. 3,00,000/Rs. 4,00,000/Rs. 5,00,000/-
Allowable Expenses
Room rent & boarding charges as follows
•
Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 4,000/- per
day
(Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane,
Pune, New Delhi & NCR and Secunderabad)
•
Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per
day
(Baroda, Indore, Ludhiana, Coimbatore , Cochin and all State Capitals other than
those falling under Class A)
•
Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per
day
(Other Cities)
Nursing charges
Surgeons, Anesthetist, Consultants and Specialists fees
Allowable Expenses (Contd.)
Operation Theatre charges, drugs and medicines diagnostic
materials, cost of pace maker etc
Emergency Ambulance charges to go to Hospital for
treatment @ Rs 750/- per hospitalisation upto maximum of Rs
1,500/- per policy period
Pre-hospitalization expenses incurred 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/-
Sub limits
Name of the Ailment / Surgery /
Procedure
Cataract surgery
Sub Limit
Rs. 15,000/- in the entire policy period
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,
• 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.
Limit of Outpatient benefits for individual
Sum insured for
IP(Rs)
100000
200000
300000
400000
500000
5m-45
8700
7750
7000
6250
5750
46-55
7900
6350
5200
3000
NA
56-60
7500
5800
3700
NA
NA
IP – Inpatient NA – Not Available
Limit of Outpatient benefits for family floater
Sum insured for
IP(Rs)
2A
1A+1C
1A+2C
1A+3C
Age
100000
200000
300000
400000
500000
5mths-35yr
36y-45y
46-55y
56-60y
5mths-35yr
36y-45y
46-55y
56-60y
5mths-35yr
36y-45y
46-55y
56-60y
5mths-35yr
36y-45y
46-55y
56-60y
8400
8400
NA
NA
8500
8500
NA
NA
8450
8450
NA
NA
8350
8350
NA
NA
7400
7400
5650
5000
7700
7500
5850
5200
7500
7250
5750
5150
7400
7200
5500
4750
6750
6500
4000
2250
6950
6750
4500
2250
6900
6650
4450
2250
6650
6450
4000
2250
5900
5500
2000
NA
5750
5750
2400
NA
6000
5750
2250
NA
5750
5500
NA
NA
5250
4900
NA
NA
5500
5250
NA
NA
5500
5000
NA
NA
5250
4750
NA
NA
A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)
Limit of Outpatient benefits for family floater (contd.)
Sum insured for
IP(Rs)
2A+1C
2A+2C
2A+3C
Age
100000
200000
300000
400000
500000
5mths-35yr
36y-45y
46-55y
56-60y
5mths-35yr
36y-45y
46-55y
56-60y
5mths-35yr
36y-45y
46-55y
56-60y
8250
8250
NA
NA
8250
8250
NA
NA
8250
8250
NA
NA
7250
7000
5250
4500
7000
7000
5000
4250
7000
6700
4750
4000
6600
6150
3750
1500
6500
5950
3500
1500
6250
5750
3250
1150
5750
5450
NA
NA
5500
5000
NA
NA
5250
4900
NA
NA
5000
4500
NA
NA
4650
3750
NA
NA
4250
3700
NA
NA
A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given
Renewal Discount
Renewal Discount on Basic Premium is
allowed on renewal for every Claim Free Year
as per chart
It is not Cumulative
No Claim Discount for Individual basis
For Individuals
Sum Insured in Rupees
Age
100000
200000
300000
400000
500000
5 Months – 35 Years
120
235
330
420
490
36 Years – 45 Years
135
260
365
450
540
46 Years – 55 Years
245
458
617
870
NA
56 Years – 60 Years
300
530
820
NA
NA
No Claim Discount for family floater basis
FAMILY COVER ON
Floater Basis (FAMILY
SIZE)
2 Adults
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
1 Adult + 1 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
1 Adult + 2 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
Sum Insured in Rupees
100000
200000
300000
400000
500000
177
177
NA
NA
289
314
554
640
Discount in Rupees
399
436
761
1003
520
557
1051
NA
592
653
NA
NA
152
152
NA
NA
272
301
527
612
371
394
693
919
475
507
966
NA
537
596
NA
NA
164
164
NA
NA
284
308
541
623
383
411
716
973
491
525
1015
NA
563
629
NA
NA
Discount for family floater basis ( Contd. )
FAMILY COVER ON
Floater Basis (FAMILY
SIZE)
1 Adult + 3 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
2 Adult + 1 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
2 Adult + 2 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
2 Adult + 3 Child
5 Months – 35 Years
36 Years – 45 Years
46 Years – 55 Years
56 Years – 60 Years
Sum Insured in Rupees
100000
200000
300000
400000
500000
179
179
NA
NA
309
342
572
665
Discount in Rupees
413
444
763
1010
537
573
NA
NA
604
677
NA
NA
189
189
NA
NA
330
356
593
697
419
483
787
1063
530
578
NA
NA
635
705
NA
NA
203
203
NA
NA
346
368
645
736
431
511
840
1109
565
624
NA
NA
688
768
NA
NA
217
217
NA
NA
363
406
680
782
462
532
871
1176
603
654
NA
NA
726
820
NA
NA
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
Exclusions (IP Section)
Pre Existing Diseases
Any Disease contracted during first 30 days
First Year Exclusions
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•
•
•
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 (IP Section)(Contd.)
Injury / Disease arising due to War, Invasion, Act of
Foreign Enemy, Warlike operations
Circumcision unless necessary for treatment of a
disease
Cost of spectacles and contact lens, hearing aids,
walkers, crutches wheel chairs and such other aids
Dental treatment or surgery
Convalescence, 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/alcohol
Naturopathy Treatment
Expenses incurred on Lasik Laser or Refractive Error
Correction treatment
Exclusions (IP Section) (Contd.)
Hospital registration charges, record charges,
telephone charges and such other similar
charges.
Expenses incurred on Non Allopathic
Treatment.
Claim Procedure
In case of Network Hospitals
Immediate 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
Claim Procedure (Contd.)
In case of Non Network Hospitals
Immediate 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
How is ‘Star Health Gain’ different
from ICICI’s Tax Advantage
•ICICI’s Tax Advt OP claim cannot be made
after 90 days from the date of the policy- No
such restriction in Star Health Gain policy
•ICICI Tax Advt allows only ONE OP claim per
year - Any number of OP claims allowed in
one year under Star Health Gain policy
•Residue OP amount can be carried forward to
next one year under Star Health Gain policy
•OP benefit can be taken even for PED,
Maternity, dental, diagnostics under Star
Health Gain policy
How is different from Mediclassic
Mediclassic
Health Gain
Coverage under one section
Coverage under 2 sections
Covers only Hospitalisation expenses as
an Inpatient
Covers medical expenses as on
outpatient also
Premium varies depending on the age
The premium does not vary depending
on the age
Individual sum insured has to be chosen
for each insured person
Sum Insured floats for all the family
members
Room rent flat 2% of SI maximum of
Rs.4000/-
Room rent varies depending of the
location of the hospital
There is a limit for day care procedures
No limit for day care procedure except
Cataract
For persons aged between 5mnths to 80
yrs
For persons aged between 5months to
60 yrs
How is it different from FHO
FHO
Health Gain
OP Treatment not covered
OP Treatment Covered
Premium varies the size of the family and
Sum Insured
Premium does not vary depending on the
size of the family and Sum Insured
Cataract Limit Rs.12000/-
Cataract Limit 15000/-
Thanks