Transcript Presentation

Unique Features
It is a fully loaded Top end Floater Policy for
the entire family with
 High Sum Insured
 Extended Benefits
 No Sub Limits
 No Capping on Room Rent
 Restoration of Sum Insured
 101 Day care Procedures
Star Comprehensive Insurance Policy
Sum Insured Options
Sum Insured (Rs.)
5 Lakhs
7.50Lakhs
10 Lakhs
15 Lakhs
20 Lakhs
25 Lakhs
Star Comprehensive Insurance Policy
Age Eligibility
 18 years – 65 Years. ( For entry age 61 yrs – 65 yrs Sum Insured
restricted to a maximum of Rs. 7.50 Lakhs only which cannot be
enhanced at any point of time subsequently)
 Children of above 5 months can be Covered if Parent is Covered.
 Beyond the age of 65 years only renewals are accepted.
 Guaranteed renewal for life time.
Star Comprehensive Insurance Policy
Eligibility
 Cover can be given to HIV + persons whose
CD 4 count is not less than 350 at entry
point
 No claim payable for Opportunistic
infections
 No claim for treatment of HIV / AIDS
Star Comprehensive Insurance Policy
Coverage
Section
Coverage
Section - I
In-patient Hospitalization
Section - II
Delivery Charges, New Born Baby
coverage and Vaccination benefits
Out-Patient Dental / Ophthalmic
Section - III
coverage
Section - IV Hospital Cash
Section - V
Cost of Health Check-up
Star Comprehensive Insurance Policy
Section I - HOSPITALISATION
 Room Rent ,Boarding and Nursing Expenses - No Cap
 ICU and Operation Theatre Expenses - No Cap
 Surgeon, Anaesthetist, Medical Practitioner, Consultants,
Specialist Fees - No Cap
 Anaesthesia, Blood, Oxygen, Operation Theatre charges,
Surgical Appliances, Medicines and Drugs, Diagnostic
Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, cost of Pacemaker and similar expenses No Cap
Star Comprehensive Insurance Policy
Ambulance Charges and
Pre / Post Hospitalisation
Sum Insured (Rs.)
Ambulance Charges Per Policy Period (Rs.)
5 Lakhs
2000
7.5 Lakhs
10 Lakhs
3000
3500
15 Lakhs
4000
20 Lakhs
25 Lakhs
4500
5000
 Pre Hospitalization Expenses
- 30 Days
 Post Hospitalization Expenses - 60 days
 For these benefits prescriptions, bills / receipts / copy of reports to
be submitted.
Star Comprehensive Insurance Policy
Section II
Delivery and New Born Baby Cover
 Waiting period 36months
 Maximum 2 deliveries. Waiting period between the
first delivery claim and the second one is 24 months.
Delivery Benefit Limits
Sum Insured
(Rs.)
Normal Delivery
(Rs.)
Caesarean Section
Delivery (Rs.)
5 Lakhs
10,000
15,000
7.5 Lakhs
20,000
40,000
10 Lakhs -25 Lakhs
25,000
40,000
 No Pre and Post Hospitalisation benefits for this Section
 Both Insured and Spouse should be covered in the same policy
throughout.
Star Comprehensive Insurance Policy
Section II
Delivery and New Born Baby Cover
 New Born Baby Coverage for the remaining policy period
For Sum Insured (Rs.)
Limit of Coverage (Rs.)
5,00,000/-
50,000/-
7,50,000/- & above
1,00,000/-
 Vaccination expenses up to Rs 1000/- incurred on the new
born baby
 Subject to Valid claim for Delivery
 Covers congenital defects both internal and external
 Claim made under this Section:
 will not reduce the Sum Insured
 will not affect Health Check-up benefit
 will not be taken into account for Claims loading
Star Comprehensive Insurance Policy
Section - III
OP Dental and Ophthalmic Treatment
• Dental & Ophthalmology Treatment is covered after a waiting period
36 Months
• Can be taken as an Out-patient
• Payable even if there is claim under Section I in the three year period
• Can be claimed for Root Canal Treatment also
• Purchase of spectacles
Limits
•
Sum Insured (Rs)
Amount payable subject to production of
Prescription and supporting Bills (Rs.)
5,00,000/- & 7,50,000/-
Up to Rs.5,000/-
10,00,000/- & above
Upto Rs.10,000/-
The claimant must have been insured continuously.
Claim made under this Section:
will not reduce the Sum Insured
will not affect Health Check-up benefit
will not be taken into account for Claims loading
Star Comprehensive Insurance Policy
Section - III
OP Dental and Ophthalmic Treatment
For example :
 A family of three persons 2A + 1C covered for a Sum
Insured of Rs. 5 lakhs for 2 years : 2010-11 and 2011-12.
 In 2012-13 another Child is added.
 In 2013-14 a claim is made for Ophthalmic Section for
the Child added in 2012 - 13.
 Claim Not admissible because the 3 year waiting
period has not been completed by the child.
Star Comprehensive Insurance Policy
Section – IV
Hospital Cash
 Cash Benefit -maximum of 7 days per hospitalisation,
provided there is an admissible claim under Section I.
 Maximum during one policy period – 120 days
 Time excess : One Day
Sum Insured (Rs.)
Limits per day (Rs.)
5 Lakhs
500
7.5 Lakhs – 10 Lakhs
750
15 Lakhs – 20 Lakhs
1000
25 Lakhs
1500
 Claim for Hospital cash will not affect the policy sum
insured
Star Comprehensive Insurance Policy
Section – IV
Cost of Health Check-up
 Cost of Health Check-up up to the limits specified
after a block of 3 Claim free years of continuous
coverage
Sum Insured (Rs.)
Limits (Rs.) on submission of
bills / receipts / report copies
5 Lakhs
7.5 Lakhs – 10 Lakhs
15 Lakhs – 25 Lakhs
5,000/7,500/12,000/-
 Benefit payable for insured persons who have been
continuously insured under the policy .
Star Comprehensive Insurance Policy
Automatic Restoration of Sum Insured
 Restoration facility in-built up to 100% for ALL
sum insured options.
 Restored Sum Insured can be utilized only for
illness /disease unrelated to the illness /diseases
for which claim/s was /were made.
 Restoration will be available for only Section I
after fully exhausting the Original Sum Insured.
Star Comprehensive Insurance Policy
Exclusions
Some important exclusions:
 First 30-days exclusion (other than for accidents)
 No First year exclusions- Only two year Exclusion.
 PED – waiting period 48months
 Non-allopathic treatments not covered
 Enhanced External Counter Pulsation therapy
and related therapies and Rotational Field
Quantum Magnetic Resonance Therapy excluded.
Star Comprehensive Insurance Policy
Claims Loading
 Where the claims ratio for the preceding 2
consecutive years exceeds 100%, premium loading
as per the table given below would be applicable.
Average claims ratio of preceding
2 consecutive years (%)
Loading on
Premium
>100 - 125
126-150
> 150
20%
30%
50%
 Claims under Section I alone will be considered for Claims
loading.
Star Comprehensive Insurance Policy
Co-payment
 10% co-payment for persons entering between
61 yrs and 65 yrs and continues thereafter
 Co-payment applicable only for Section I claims
Star Comprehensive Insurance Policy
Portability
 This policy is portable.
 Inward portability can be accepted for policies of
other Insurance Companies
 Portability procedure to be followed
 Continuity will be given ONLY for Section I
benefit and NOT for any other Section
Star Comprehensive Insurance Policy
Health is Wealth
Enhance your Wealth
Happy Selling with Star …
Migration from Star Policies
Migration permitted only for the following policies of Star Health:
 Mediclassic
 New Family Health Optima
 Criticare Policy
 Continuity of benefits will be given for Section I only
 Persons insured under this policy can migrate to any other policy of Star
with continuity of benefits again for in-patient hospitalization only.
Declined Risks*
 Migration not permitted for persons suffering from the following declined
risks :
* Cancer
* Stroke
* Heart Diseases
* Chronic Renal Diseases
Star Comprehensive Insurance Policy
Acceptance Limits
Acceptance Authority
Age (yrs)
Pre
Sum Insured Acceptance
(Rs.)
Medical
Examination
Fresh
Proposal
Migration permitted for
Mediclassic / New Family
Health Optima and Criticare
Policies of STAR only.
No Claims
≤ 50
> 50
Upto
15 Lakhs
Above
15 Lakhs
Upto
5 Lakhs
Above 5
Lakhs
With Claims
Operating
Operating
Corporate
Office
Office
Office
Corporate
Corporate
Corporate
N.A
Office
Office
Office
Yes - as per
Operating
Operating
Corporate
Package 1.4
Office
Office
Office
Corporate
Corporate
Corporate
Yes - as per
Office
Office
Office
Package 1.4 through Lab through Lab through Lab
Portal
Portal
Portal
N.A
Star Comprehensive Insurance Policy
Star Comprehensive v/s Apollo’s Easy Health
Both Price and benefit comparison given separately
Star Comprehensive
 Automatic Restoration of
100% of Sum Insured
 Premium less by 1% to 9%
Apollo’s Easy Health
 No Restoration facility
 More expensive than Star
 Star and Apollo
comparison
Star Comprehensive Insurance Policy
Benefit Illustration 1
Claim under Delivery and New Born Baby Cover:
Sum Insured for the 1st year
Rs. 5,00,000/Sum Insured for the 2nd Year
Rs. 7,50,000/Sum Insured for the 3rd year
Rs. 7,50,000/Sum Insured for the 4th Year
Rs. 5,00,000/ A claim is made in the 4th year
The eligibility will be as per 5 lakh Sum Insured
i.e. Rs 10,000/- for Normal and Rs 15,000/- for Caesarean delivery.
 Rs 50,000/- for New Born Baby
 Rs 1,000/- for Vaccination
 The limit is inclusive of pre-natal and post-natal expenses
Star Comprehensive Insurance Policy
Benefit Illustration 2
 Claim for Health Check Up
Sum Insured for the 1st year
Sum Insured for the 2nd Year
Sum Insured for the 3rd year
Sum Insured for the 4th Year
-
Rs. 5,00,000/Rs. 7,50,000/Rs. 7,50,000/Rs. 10,00,000/-
Benefits of Health Check Up will be as per Rs 10lakhs
i.e upto Rs 7,500/-
Star Comprehensive Insurance Policy
Benefit Illustration 3
Claim for OP treatment for Dental /Opthal
Sum Insured for the 1st year
Rs. 5,00,000/Sum Insured for the 2nd Year
Rs. 7,50,000/Sum Insured for the 3rd year
Rs. 7,50,000/Sum Insured for the 4th Year
Rs. 10,00,000/Benefit under this section in the fourth year will be as
per Rs 10 Lakh Sum Insured which will be Rs 10000/-
Star Comprehensive Insurance Policy
Benefit Illustration 4
Admission for Arthroscopic Repair during the 3 year.
Sum Insured for 1st Year
Rs. 5 Lakhs
Sum Insured for 2nd Year
Rs. 7.50 Lakhs
Sum Insured Limit for the above treatment will be
Rs 5 Lakhs/- (Refer Exclusion 3)
Star Comprehensive Insurance Policy