Presentation on MICRO HEALTH INSURANCE
Coverages <ul><li>Hospitalization Expenses incurred as an  inpatient  for </li></ul><ul><li>Sickness/Illness/Diseases </li...
What is a Hospital? <ul><li>Hospital, Nursing Home  means any institution in India established for indoor care and treatme...
Age Limits <ul><li>5 Years – 50 Years </li></ul><ul><li>Dependent Children can be covered only with any one of their Paren...
Sum Insured <ul><li>Sum Insured : </li></ul><ul><li>Rs.30,000, Rs.20,000 and Rs.10,000 </li></ul><ul><li>Per Hospitalizati...
Allowable Expenses SI – Rs.30,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.150/- per day and Rs. 5,000...
Allowable Expenses SI – Rs.20,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 3333/...
Allowable Expenses SI – Rs.10,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 1667/...
Day Care Treatment <ul><li>Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time l...
Rating Age Premium SI Rs.30,000 Premium SI Rs.20,000 Premium SI Rs.10,000 5 Years to 25 Years 275 185 95 26 Years to 35 Ye...
Other Benefits <ul><li>Benefits under Section 80-D of the IT Act </li></ul><ul><li>Cashless Service without intervention o...
<ul><li>Group policies can be given </li></ul><ul><li>Group Discount of 5% of the premium for a Group Exceeding 100 member...
Exclusions <ul><li>Pre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break) </li></ul><ul><...
Exclusions (Contd.) <ul><li>Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations </li><...
Exclusions (Contd.) <ul><li>Hospital registration charges, record charges, telephone charges and such other similar charge...
Claim Procedure <ul><li>In case of  Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 ...
<ul><li>In case of  Non Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li><...
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  1. 1. Presentation on MICRO HEALTH INSURANCE
  2. 2. Coverages <ul><li>Hospitalization Expenses incurred as an inpatient for </li></ul><ul><li>Sickness/Illness/Diseases </li></ul><ul><li>Accident </li></ul>
  3. 3. What is a Hospital? <ul><li>Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries </li></ul><ul><li>It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner </li></ul><ul><li>or </li></ul><ul><li>Should comply with minimum criteria as under </li></ul><ul><li>Fully qualified nursing staff under its employment round the clock </li></ul><ul><li>Fully qualified Doctor(s) should be in charge round the clock. </li></ul>
  4. 4. Age Limits <ul><li>5 Years – 50 Years </li></ul><ul><li>Dependent Children can be covered only with any one of their Parents </li></ul><ul><li>Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required. </li></ul>
  5. 5. Sum Insured <ul><li>Sum Insured : </li></ul><ul><li>Rs.30,000, Rs.20,000 and Rs.10,000 </li></ul><ul><li>Per Hospitalization Maximum - Rs. 15,000/-, Rs.10,000/- & Rs.5000/- for a SI of Rs.30,000/-, Rs.20000/- & Rs.10,000 respectively </li></ul>
  6. 6. Allowable Expenses SI – Rs.30,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.150/- per day and Rs. 5,000/- per hospitalisation </li></ul><ul><li>Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 4,500/- per hospitalisation </li></ul><ul><li>Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 4,500/- per hospitalisation </li></ul><ul><li>Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period </li></ul>
  7. 7. Allowable Expenses SI – Rs.20,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 3333/- per hospitalisation </li></ul><ul><li>Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 3000/- per hospitalisation </li></ul><ul><li>Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 3000/- per hospitalisation </li></ul><ul><li>Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period </li></ul>
  8. 8. Allowable Expenses SI – Rs.10,000 <ul><li>Room rent & boarding charges & Nursing expenses @ Rs.100/- per day and Rs. 1667/- per hospitalisation </li></ul><ul><li>Surgeons, Anesthetist, Consultants and Specialists fees subject to a maximum of Rs. 1,500/- per hospitalisation </li></ul><ul><li>Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc Rs. 1,500/- per hospitalisation </li></ul><ul><li>Emergency Ambulance charges to go to Hospital for treatment @ Rs 350/- per hospitalisation upto maximum of Rs 1,000/- per policy period </li></ul>
  9. 9. Day Care Treatment <ul><li>Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for </li></ul><ul><li>Dialysis, </li></ul><ul><li>Chemotherapy, </li></ul><ul><li>Radiotherapy, </li></ul><ul><li>Eye surgery, </li></ul><ul><li>Dental Surgery, </li></ul><ul><li>Lithotripsy (Kidney stone removal), </li></ul><ul><li>Tonsillectomy, </li></ul><ul><li>taken in the Hospital / Nursing Home and the Insured is discharged on the same day. </li></ul>
  10. 10. Rating Age Premium SI Rs.30,000 Premium SI Rs.20,000 Premium SI Rs.10,000 5 Years to 25 Years 275 185 95 26 Years to 35 Years 350 230 115 36 Years to 45 Years 425 280 140 46 Years to 50 Years 500 330 165
  11. 11. Other Benefits <ul><li>Benefits under Section 80-D of the IT Act </li></ul><ul><li>Cashless Service without intervention of TPA </li></ul><ul><li>Direct Tie up with hospitals on an All India Basis </li></ul><ul><li>24 X 7 In-House Call center </li></ul><ul><li>Toll Free Telephone line assistance </li></ul><ul><li>Full knowledge based website to offer medical information, including Health Tips. </li></ul><ul><li>Health Check-up benefits </li></ul><ul><li>Frequent health meets to disseminate info on the health related topics </li></ul>
  12. 12. <ul><li>Group policies can be given </li></ul><ul><li>Group Discount of 5% of the premium for a Group Exceeding 100 members </li></ul>Group Policies
  13. 13. Exclusions <ul><li>Pre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break) </li></ul><ul><li>Any Disease contracted during first 30 days </li></ul><ul><li>Cataract </li></ul><ul><li>First Year Exclusions </li></ul><ul><li>Benign prostate hypertrophy </li></ul><ul><li>Hernia, Hydrocele, Fistula in Anus, Piles </li></ul><ul><li>Sinusitis </li></ul><ul><li>Congenital internal disease/defect </li></ul><ul><li>Renal stone and Gall stone removal </li></ul><ul><li>First Two Years Exclusions </li></ul><ul><li>Hysterectomy following Menorrhia or Fibromyoma </li></ul><ul><li>Knee Replacement Surgery </li></ul><ul><li>Joint Replacement Surgery </li></ul>
  14. 14. Exclusions (Contd.) <ul><li>Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations </li></ul><ul><li>Circumcision unless necessary for treatment of a disease </li></ul><ul><li>Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids </li></ul><ul><li>Dental treatment or surgery </li></ul><ul><li>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 </li></ul><ul><li>Naturopathy Treatment </li></ul><ul><li>Expenses incurred on Lasik Laser or Refractive Error Correction treatment </li></ul>
  15. 15. Exclusions (Contd.) <ul><li>Hospital registration charges, record charges, telephone charges and such other similar charges. </li></ul><ul><li>Non Allopathic Treatment </li></ul>
  16. 16. Claim Procedure <ul><li>In case of Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li></ul><ul><li>The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital </li></ul><ul><li>Based on the intimation a field visit will be done by the Star Doctor </li></ul><ul><li>Pre Authorization will be issued to the Hospital </li></ul><ul><li>Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital </li></ul>
  17. 17. <ul><li>In case of Non Network Hospitals </li></ul><ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li></ul><ul><li>Claim form will be sent to the Insured. </li></ul><ul><li>Based on the intimation a field visit will be done by the Star Doctor </li></ul><ul><li>Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents </li></ul><ul><li>Original Discharge Summary </li></ul><ul><li>Main Hospital Bill with Break Up </li></ul><ul><li>Investigation Reports with X-Ray Film </li></ul><ul><li>Medical Bills with Prescriptions </li></ul>Claim Procedure (Contd.)
  18. 18. Thank You

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