Presentation on Medi-Classic
Presentation on
MEDI-CLASSIC
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
COVERAGES
Hospitalization Expenses incurred as an inpatient for
Sickness/Illness/Diseases
Accidental injuries
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
WHAT IS A HOSPITAL?
Hospital, Nursing Home means any institution in India
established for indoor care and treatment of sickness and
injuries and which
Either
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
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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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
AGE LIMITS
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5 Months – 59 Yrs (age last Birthday)
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Dependent Children can be covered only with any one of
their Parents.
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Single person in the family will not be coveredunless ALL other family members are covered with Star
Health .
Renewable up to 80 yrs
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Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
MEDICAL EXAMINATION
For persons with adverse medical history
and
For all persons above 51 years
All Sum Insured
acceptance subject to Medical Examination at
Company’s Cost.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
PRE MEDICAL EXAM
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TMT required :
Age is above 51 years – S.I. of Rs.10 lacs and
above
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BMI = Weight in Kgs. (Height in meter)2
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More than 35 BMI – NOT Accepted
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
DECLINED RISKS:
 Heart
 Brain
 Chronic Kidney Problems,
 Paralysis
 Diabetes- ( Type- I)
 Alzheimer
 Parkinson
 Cancer problems
 Polio at the inception (in the lifetime)
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
DOCUMENTATION:
 Non Medical Proposals:
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Proposal Form-Completely Filled
ONE Photograph
For all proposals from persons above 45 years, age proof in the form
of School Certificate/Pan Card/Driving License/Passport/Ration
Card is required.
 Medical Proposals:
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Proposal Form-Completely Filled
TWO Photographs- only for those who require to undergo medical
tests
For all proposals from persons above 45 years, age proof in the form
of School Certificate/Pan Card/Driving License/Passport/Ration
Card is required.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES
Room rent & boarding charges @ 2% of the sum insured up-to a
maximum of Rs. 5,000/- per day
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES
Nursing charges
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES
Surgeons, Anesthetist, Consultants
and Specialists fees
Operation Theatre charges,
drugs and medicines,
diagnostic materials,
cost of pace maker etc
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES
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Emergency Ambulance charges to go to Hospital for treatment
@ Rs 750/- per hospitalisation upto a maximum of Rs 1,500/per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES (CONTD.)
Pre-Hospitalization expenses incurred for a period of
30 days prior to the date
of hospitalization
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES (CONTD.)
Post Hospitalization expenses
On a lump-sum basis @ 7% of
Hospitalization expenses incurred
Comprising of Nursing Charges,
Surgeon/Consultant fees, Diagnostic
Charges, Medicines and Drugs only
Subject to a maximum of Rs 5,000/- per
Occurrence.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
ALLOWABLE EXPENSES (CONTD.)
 Reasonable & Customary Charges:
Means a charge which:
 is charged for medical treatment, supplies or medical
services that are necessary to treat Your condition
 Does not exceed the usual level of charges for similar
medical treatment, supplies or medical services in the
locality where the expenses is incurred and
 Does not include charges that would not have been
made if no insurance existed.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
SUB LIMITS
Name of the Ailment / Surgery /
Procedure
Sub 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/-
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
OTHER BENEFITS
Benefits under Section 80-D of the IT Act
Cashless Service without involvement of TPA
Direct Tie up with hospitals on an All India Basis
24 X 7 In-House Call center (044-2826 3300)
Toll Free Telephone line assistance
(1800 425 2255 / 1800 102 4477)
Full knowledge based website to offer medical
information, including Health Tips.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
OPTIONAL BENEFITS
The following Optional benefits can be availed on payment of
Additional Premium
Hospital Cash :
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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.
Age Band
Premium (Rs.)
Premium
0-35 Years
200
36-45 Years
250
46-55 Years
300
56-60 Years
350
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
EXCLUSIONS

Pre-existing Diseases
( for first 4 yrs. with Star Health without Break )
 Any Disease contracted during first 30 days
 First Year Exclusions
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Benign prostate hypertrophy
Hernia, Hydrocele, Fistula in Anus, Piles
Sinusitis
congenital internal disease/defect
Renal stone and Gall stone removal
 First Two Years Exclusions
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Cataract
hysterectomy following menorrhea or fibromyoma
Knee Replacement Surgery ( unless caused by accident )
Joint Replacement Surgery ( unless caused by accident )
Prolapse of intervertibral Disc
Varicose veins / Ulcers
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
EXCLUSIONS (CONTD.)
Injury / Disease arising due to War, Invasion, Act of Foreign
Enemy, Warlike operations
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
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/- for the
entire policy period.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
CLAIM PROCEDURE
In case of Network Hospitals
Immediate intimation to the Call Centre
(1800 425 2255 / 1800 102 4477 / 044-28263300)
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
Note: Late Intimation / No Intimation of the claim will not be
entertained
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
IN CASE OF NON NETWORK HOSPITALS - CLAIM PROCEDURE
Immediate intimation to the Call Centre
(1800 425 2255 / 1800 102 4477 / 044-28263300)
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
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Original Discharge Summary
Main Hospital Bill with Break Up
Investigation Reports with X-Ray Film
Medical Bills with Prescriptions
IPD PAPERS ( Indoor Patient )
Note:
Late Intimation of the claim will not be entertained.
Claim file / Documents need to be submitted within 15 days
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
DISCUSS
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Agents Role ( Renewal, Service, Premium collection, training,
utmost good faith, Disclosure of material facts)
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Cashless is Direct settlement – Not without cash
Admission in network Hospitals ONLY
Rewards : Blackberry July-Aug-Sept’11, LCD TV, Foreign Trip etc.
Group Insurance
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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1. Which policy is suitable for an individual?
Ans - Medi-classic policy is suitable for an individual. It provides cover on an
Individual basis.
2. What is the entry age for Medi-classic?
Ans: The minimum entry age for Medi-classic is minimum 5months and
maximum 60 yrs.
3. Which type of hospitalization is covered under this policy?
Ans – Medi-classic covers hospitalization due to sickness, illness or
diseases and due to accident.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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4. What is the minimum required period of hospitalization?
Ans - The minimum required period of hospitalization is at least 24 hours.
This rule has some exceptions which are called day care treatments.
5. What is meant by day care treatments?
Ans – The day care treatment means the treatment which does require 24
hours hospitalization. Following are the Day care treatments, which are
covered currently- Dialysis, Chemotherapy, Radiotherapy, Cataract surgery,
Dental Surgery(Only due to Accident), Lithotripsy (Kidney stone
removal),Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration,
Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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6. What are the options provided for Sum Insured, in Medi-classic?
Ans- In Medi-classic the minimum Sum Insured can be offered is of Rs.1
Lakh, maximum upto Rs.10 Lakhs.
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7. What is NO Claim Discount? How much is it?
Ans - In Medi-classic policy, Star Health gives discount on basic premium,
for each claim free year, at the time renewal of the policy. The No Claim
discount ranges from 5% to 25%.
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8. What is hospital Cash Benefit?
Ans - This is an optional benefit, provided in Medi-Classic on payment of
additional premium. It provides 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. This optional benefit
is available to the persons who are between 21 to 60 yrs
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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8. Is there any waiting period for the commencement of the cover?
Ans –There is a waiting period of 30 days from the date of issuance of the
policy A waiting period is the length of time the insured may have to wait
before being eligible for Health Policy benefits. It is applicable only for the
first policy period with Star Health.
9. Which diseases are not covered in the first year, only?
Ans - Following diseases are not coverd for the first year only- Benign
prostate hypertrophy,Hernia, Hydrocele, Fistula in Anus,
Piles,Sinusitis,congenital internal disease/defect,Renal stone and Gall
stone removal
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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10. Which diseases are not covered for the first two years, only?
Ans – Following diseases are not coverd for the first two yearsCataract,hysterectomy following menorrhea or fibromyoma,Knee
Replacement Surgery ( unless caused by accident ),Joint Replacement
Surgery ( unless caused by accident ),Prolapse of intervertibral
Disc,Varicose veins / Ulcers.
11. What if a person is already suffering from any disease/s?
Ans - If a person is already suffering from any of the diseases, that
disease/s(Pre-Existing Disease/s) will be covered only after the four years
with Star health without any break.
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12. Is any Naturopathy treatment covered under Medi-Classic?
Ans – Naturopathy treatments are not covered under Medi-Classic / any
other policy of Star Health
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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13. Is any kind of Dental Treament covered under Medi-classic?
Ans - Dental Treament is covered under Medi-classic / any other health
policy but only if it is due to Accident.
14. Do you cover Non Allopathic Treatments in Medi-Classic?
Ans – Non Allopathic Treatments are covered under Medi-classic policy.
There should be hospitalization of at least 24 hrs. They are covered up-to
25% of Sum Insured or Rs.25000/- or actual expenses whichever is less.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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15. What is the claim procedure?
Ans – First, You need to inform the 24-hour Toll Free no. 1800 425 2255 /
1800 102 4477 for assistance. One has to Inform the ID number / policy
number for easy reference.
In case of planned hospitalization, please inform 24 hours prior to
admission into the hospital.
In case of hospitalization due to emergency, information must be given
within 24 hours after hospitalization.
In case of non-network hospitals, payment must be made upfront by the
policy holder and then reimbursement will be effected on the submission of
documents.
Intimation on the Toll free Number is a must.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
FAQ: MEDI-CLASSIC
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16. Why should I take a Health Plan if I already have health insurance from
my employer?
Ans - Your employer will cover your medical expenses only as long as you are
in his services. Tomorrow, you may change your job, retire, or even start
something on your own. In all such cases you and your family will be
stranded if a medical emergency arises and you have not arranged for an
alternative health insurance policy. It is at this point of time that Health
Insurance policy will come to your rescue.
Health Insurance policy can also act as a supplement to your existing
medical cover in case the cost of medical treatment is higher than your
existing cover level.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
True or False
Mini and Max S.I. in Medi Classic is Rs one Lakh and 15 Lakh.
Med classic can be renewed for life long with some loading.
Hospital cash benefit is available up to max Rs 1500 per hospitalization.
Max cash benefit Rs 6000 per policy period for persons above 60 years.
No claim discount (NCD)is available from 5 to 25% cumulatively.
Once cash benefit opted No claim discount (NCD)is not available.
Covers starts immediately once policy is in force.
For PED cover is available only after 4 years.
For Non Allopathic treatment cover is available up to 25% of basic S.I.
Star Health and Allied Insurance Co. Ltd.
Presentation on Medi-Classic
Thank You
Star Health and Allied Insurance Co. Ltd.