Presentation on Star Unique Health Policy
Presentation on
Star Unique Health
Insurance Policy
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Why Unique??
• This policy is Unique because it
covers
Certain Pre-Existing diseases as well
as any future ailments –
------- all under one policy
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Major Features
• Pre Existing Diseases (other than those for
which specific time periods have been
mentioned separately) covered after complete of
11 months
• The policy provides coverage to HIV positive
persons.
• Premium payable in installments
• No pre acceptance medical examination
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Coverages
Hospitalization Expenses incurred as an
inpatient for
Sickness/Illness/Diseases
Accidental injuries
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Pre Existing Disease
• Pre-Existing Disease/ Condition will be covered
after 11 months of continuous coverage
• Does this mean that any PED is covered after 11
months?
• No – only certain diseases that are Pre-Existing
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Coverage for HIV positive persons
• The policy extends coverage to HIV positive
persons.
• Minimum CD 4 count at entry level should be
350
• Opportunistic infections (eg : Tuberculosis,
Gastroenterology, etc) not covered
• Expenses for treatment of HIV / AIDS not
covered
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Period of Insurance
• The policy is for a two year period.
• Even renewal will be for a two year period
• Advantages are :
Customer retention
Claims loading, if applicable will happen only once in two
years
• However, Sum insured will be available afresh for each
year.
• For example if a person opts for a SI of Rs. 2 lacs – it
means it is 2 lacs for first yr and 2 lacs for the second yr.
• However sum insured cannot be cumulated or carried
forward
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Installment Premium
• The premium can be paid in 2 annual installments.
• The grace period of 15 days for benefit of continuity will
be available for instalment premium also. However, the
expiry date of the policy will not change.
• Where a claim is made in the first year itself the premium
towards the next installment would be deducted from the
claim amount.
• The policy would lapse if the installment is not paid on or
before the due date.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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 Star Unique Health Policy
Age Limits
Entry age 18 Years to 65 Years
Policies can be renewed up to 70 years
Beyond 70 yrs the insured person would
be eligible to move to any other health
insurance policy that the Company offers
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Sum Insured
The following Sum Insured options are available
Sum Insured Options
(Rs)
Sub-limit for PED Cover (Rs)
100000
50000
200000
100000
300000
150000
Note : The sum insured is for each year of insurance and
cannot be cumulated or carried forward
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Allowable Expenses
Room rent, nursing & boarding charges @ 1% of the
sum insured subject to a maximum of Rs. 3000/- per
day.
Surgeons, Anesthetist, Consultants and Specialists fees
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 up to a
maximum of Rs 1,500/- per policy period
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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/-
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Day Care Treatment
Minimum of 24 hours Hospitalization is not necessary for the following
• Dialysis
• Chemotherapy
• Radiotherapy
• Cataract surgery
• Dental Surgery following accident
• Lithotripsy
• Tonsillectomy
• Treatment of Fracture/Dislocation
• Incision and Draining of Abscess
• Liver Aspiration
• Pleural Effusion Aspiration
• Colonoscopy
• Sclerotheraphy
• Tympanoplasty
• Chalazion
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Day-Care………
• The above treatments 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 Star Unique Health Policy
Sub Limits
Name of the Ailment / Surgery /
Procedure
Sub Limit
Cataract surgery
Rs. 12,000/- in respect of one eye and
Rs. 24,000/- in the entire policy period
Lithotripsy (Kidney stone removal)
Rs. 20,000/- per policy year
Tonsillectomy
Rs. 15,000/- per policy year
Incision and Draining of Superficial Abscess
Rs. 1,500/- per policy year
Incision and Draining of Deep seated Abscess
Rs. 4,000/- per policy year
Liver Aspiration
Rs. 2,000/- per policy year
Pleural Effusion Aspiration
Rs. 2,000/- per policy year
Sclerotheraphy
Rs. 5,000/- per policy year
Treatment of Fracture / Dislocation
Rs. 2,000/- per policy year
Chalazion
Rs. 3,000/- per policy year
Tympanoplasty
Rs. 20,000/- per policy year
Dialysis
Rs. 1,200/- per sitting
Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Premium ….. approach
• We have introduced a dual pricing concept
- Delhi, Faridabad, Gurgaon, Mumbai,
Bangalore, Ahmedabad will have a slightly
higher premium
• Rest of India will have comparatively lower
premium
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Annual Installment Premium
Applicable for offices in Ahmedabad, Bangalore, Mumbai (including
Thane) and New Delhi (including Faridabad, Gurgaon & Noida)
Sum
Insured
Options
(Rs)
Sub-limit for
PED
Cover(Rs)
100000
50000
5880
6720
10080
11760
14170
16100
200000
100000
7585
9840
14760
17220
20745
23575
300000
150000
10625
13800
20010
22770
23805
26450
Age
18yrs25yrs
26yrs40yrs
41yrs55yrs
56yrs60yrs
61yrs65yrs
Note : Premium figures are excluding Service Tax.
Star Health and Allied Insurance Co. Ltd.
66yrs70yrs
Presentation on Star Unique Health Policy
Annual Installment Premium
Applicable for rest of India
Sum
Insured
Options
(Rs)
Sub-limit for
PED Cover
(Rs)
100000
Age
18yrs25yrs
26yrs40yrs
41yrs55yrs
56yrs60yrs
61yrs65yrs
66yrs70yrs
50000
4900
5600
8400
9800
12320
14000
200000
100000
6320
8200
12300
14350
18040
20500
300000
150000
8855
11500
16675
18975
20700
23000
Note : Premium figures are excluding Service Tax.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions
Pre-Existing Disease/ Condition
within 11 months of commencement
of this insurance
Any Disease contracted during first
30 days
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Year Exclusions
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Deviated Nasal Septum
Benign Prostate Hypertrophy
Nasal Polyps
Hernia
Hydrocele
Congenital Internal diseases/defects
Fistula in anus, Piles, Sinusitis, and related disorders
Post trauma non union / mal union
Cholecystectomy and Renal Calculi /Gall bladder calculi
are not payable.
If these diseases (other than congenital internal disease /defects)
are Pre-Existing at the time of proposal they are payable after 24
months of continuous coverage with the Company.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Two Years Exclusions
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Cataract,
Hysterectomy (abdominal and Vaginal),
Dysfunctional Uterine Bleeding (DUB)
Fibroid Uterus
Prolapsed Uterus
Myomectomy
Cystectomy
Treatment of Internal Derangement of Knee (other than caused by an
accident)
Treatment for Joints (other than caused by an accident)
other Arthroscopic Surgeries
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Two Years Exclusions (Contd.)
• Inter-Vertebral Disc Prolapse (other than caused by accident)
• Degenerative Vertebral and Disc diseases
• Varicose veins and Varicose ulcers
• Thyroiditis
• Treatment of Goitre
• Tympnoplasty
• Mastoidectomy Glaucoma
are not payable irrespective of whether they are Pre-Existing or not.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
First Four Years Exclusions
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Stapedectomy
Bone marrow transplant
Cirrhosis of liver with or without portal Hypertension
Hepatitis
Loss of vision partial / total including Retinopathy
Retinal Detachment
Macular degeneration and Papill Oedema
all types of Cancer
Nephropathy and Chronic Kidney diseases
Implant Removal
The above shall not be payable during the first four years only if these are
Pre-Existing at the commencement of this insurance
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• 30% on all claims including PED claims. This copayment would
apply on the sub limit mentioned for PED claims
• War and allied perils including nuclear risks
• Circumcision unless necessary for treatment of a disease not
excluded hereunder
• or as may be necessitated due to an accident,
• vaccination or inoculation (except as a post-bite treatment)
• change of life or cosmetic or aesthetic treatment of any description,
• plastic surgery other than as may be necessitated due to an
accident or as a part of any illness.
• Cost of spectacles and contact lens, hearing aids, walkers, crutches
wheel chairs and such other aids.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• Dental treatment or surgery of any kind unless necessitated due to
accidental injuries and requiring hospitalization.
• Convalescence, general debility, Run-down condition or rest cure,
Psychosomatic disorders, Congenital external disease or defects or
anomalies, infertility, venereal disease, intentional self injury and
use of intoxicating drugs/alcohol.
• Treatment for HIV / AIDS and opportunistic infections.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• Purely diagnostic expenses
• Expenses on vitamins and tonics not forming part of
treatment
• Maternity expenses (other than ectopic pregnancy)
• Naturopathy Treatment
• Hospital registration charges, admission charges, record
charges, telephone charges and such other charges
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Exclusions (Contd.)
• Lasik Laser or Refractive Error Correction treatment
• weight control or treatment for obesity
• Non allopathic treatment is limited to 25% of the sum
insured per occurrence subject to an overall limit of Rs.
25000/- for each year of insurance.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Claim Procedure
In case of Network Hospitals
Immediate 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 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
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Claim Procedure (Contd.)
In case of Non Network Hospitals
Immediate 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 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
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
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)
Full knowledge based website to offer medical
information, including Health Tips.
Information on health through free health magazine
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Value added services
 Consult our Expert Doctor for Free Medical Advice on Toll
Free Number 1800 425 2255 / 1800 102 4477
 Quarterly Health Magazine to all policy holders providing an
insight into health related issues.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Target segment
Who can be the target segment for selling
this insurance?
• Persons who are hypertensive
• Diabetics with no complications set in as
yet
• Persons who have undergone CABG
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Who should be avoided?
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Proposals from Cancer patients
Persons with Chronic kidney failure
Persons suffering from Alzhemiers
Persons with Psycho somatic disorders
Stroke affected persons
Paralytic patients
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Transfer of Policy from Star Health
to this policy
• Only waiver of 30 days waiting period is allowed.
• For other things (viz. First year exclusion, First Two
years exclusion, PED, etc) it should be treated as a fresh
proposal only.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Transfer of Policy from other Insurers
• Only waiver of 30 days waiting period is allowed. This
waiver will not be provided even if there is one day gap.
• For other things (viz. First year exclusion, First Two
years exclusion, PED, etc) it should be treated as a fresh
proposal only.
Star Health and Allied Insurance Co. Ltd.
Presentation on Star Unique Health Policy
Thank You
Star Health and Allied Insurance Co. Ltd.