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

Under section – I

Coverages

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.

5 Months – 60 Yrs

Age Limits

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)

5m-45 46-55 56-60

100000

8700 7900 7500

200000

7750 6350 5800

300000

7000 5200 3700

IP – Inpatient NA – Not Available 400000

6250 3000 NA

500000

5750 NA NA

Limit of Outpatient benefits for family floater Sum insured for

IP(Rs)

2A 1A+1C 1A+2C 1A+3C

Age 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

100000

8400 8400 NA NA 8500 8500 NA NA 8450 8450 NA NA 8350 8350 NA NA

200000

7500 7250 5750 5150 7400 7200 5500 4750 7400 7400 5650 5000 7700 7500 5850 5200

300000

6750 6500 4000 2250 6950 6750 4500 2250 6900 6650 4450 2250 6650 6450 4000 2250

400000

6000 5750 2250 NA 5750 5500 NA NA 5900 5500 2000 NA 5750 5750 2400 NA

A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given) 500000

5250 4900 NA NA 5500 5250 NA NA 5500 5000 NA NA 5250 4750 NA NA

Limit of Outpatient benefits for family floater (contd.) Sum insured for IP(Rs) 2A+1C 2A+2C 2A+3C Age

5mths-35yr 36y-45y 46-55y 56-60y 5mths-35yr 36y-45y 46-55y 56-60y 5mths-35yr 36y-45y 46-55y 56-60y

100000

8250 8250 NA NA 8250 8250 NA NA 8250 8250 NA NA

200000

7250 7000 5250 4500 7000 7000 5000 4250 7000 6700 4750 4000

300000

6600 6150 3750 1500 6500 5950 3500 1500 6250 5750 3250 1150

400000

5750 5450 NA NA 5500 5000 NA NA 5250 4900 NA NA

500000

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 Age

5 Months – 35 Years 36 Years – 45 Years 46 Years – 55 Years 56 Years – 60 Years

100000

120 135 245 300

Sum Insured in Rupees 200000 300000 400000

235 330 420 260 458 530 365 617 820 450 870 NA

500000

490 540 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

100000

177 177 NA NA 152 152 NA NA 164 164 NA NA

Sum Insured in Rupees 200000 300000 400000

289 314 554 640

Discount in Rupees

399 436 761 1003 520 557 1051 NA 272 301 527 612 284 308 541 623 371 394 693 919 383 411 716 973 475 507 966 NA 491 525 1015 NA

500000

592 653 NA NA 537 596 NA 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

100000

179 179 NA NA 189 189 NA NA 203 203 NA NA 217 217 NA NA

200000 Sum Insured in Rupees 300000 400000

309 342 572 665

Discount in Rupees

413 444 763 1010 537 573 NA NA 330 356 593 697 346 368 645 736 363 406 680 782 419 483 787 1063 431 511 840 1109 462 532 871 1176 530 578 NA NA 565 624 NA NA 603 654 NA NA

500000

604 677 NA NA 635 705 NA NA 688 768 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

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

Coverage under one section Covers only Hospitalisation expenses as an Inpatient Premium varies depending on the age Individual sum insured has to be chosen for each insured person Room rent flat 2% of SI maximum of Rs.4000/ There is a limit for day care procedures For persons aged between 5mnths to 80 yrs

Health Gain

Coverage under 2 sections Covers medical expenses as on outpatient also The premium does not vary depending on the age Sum Insured floats for all the family members Room rent varies depending of the location of the hospital No limit for day care procedure except Cataract 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