STAR HEALTH INSURANCE COIMBATORE SALES MANAGER NANDAGOPAL 9994910202

1. Family Health Optima

2. Age at Entry : 5 months to 65 years
Restricted admissibility
for age between 61 and 65 years
Family size : 2A + 3C ( Maximum)
Dependant children less than 25
years of age
Renewability : Up to 65 years
Coverage : Family Floater Coverage
(SI is used either individually or
collectively)
Features

3. Features
Sum Insured Options
Rs. 200,000
Rs. 300,000
Rs. 400,000
Rs. 500,000
Rs. 10,00,000
Rs. 15,00,000
For entry age between 61 and 65 years,
only 2 Adults is allowed for Sum Insured
of Rs.300,000 and above

4. Features
Two Tier rating of Premium according to Zone
Zone 1 - Mumbai, Delhi ( Delhi city, Noida, Gurgoan,
Ghaziabad, Faridabad) and the entire State of Gujarat
Zone 2 - Rest of India
Premium would be charged according to the residential
address of the customer.
When a policy is charged as per Zone 2 rate and a
claim is taken in one of the Zone 1 cities, the difference
in the premium is recovered in the claim amount

5. Hospitalization Benefit
Cashless treatment or Reimbursement of expenses
incurred owing to disease, illness, sickness or
accidents as inpatient in a registered hospital for a
minimum period of 24 hours.
Pre Hospitalization
30 days prior to hospitalization covered for
reasonable expenses.
Post Hospitalization - 7% of the Hospital expenses
excluding room rent subject to
a maximum of Rs.5000/-
Benefits

6. Benefits
Nursing charges, Surgeons, Anesthetist,
Consultants and Specialists fees, Operation Theatre
Charges, Drugs and medicines diagnostic materials,
cost of pace maker etc…
Ambulance Charges
Rs. 750 per hospitalization subject to a maximum of
Rs. 1500 per policy period
Co Pay
20% Co pay on each and every eligible
claim amount for insured between 61- 65
years at entry level

7. Day Care Procedure - 101 treatments covered as day
care in case of less than 24 hours hospitalization.
Limit for Cataract is based on the Sum Insured
SI Option Limit for Cataract
Rs.200,000 Rs.12,000 Per policy period
Rs.300,000
Rs.400,000 Rs.20,000 per eye subject to
Rs.500,000 Rs.30,000 per policy period
Rs.10,00,000
Rs.15,00,000 Rs.30,000 per eye subject to
Rs.40,000 per policy period
Benefits

8. Benefits
Automatic Restoration of SI
Where the sum insured is exhausted during the
policy period, there is an automatic top up of Sum
insured for the rest of the policy period
SI option % of Restoration
Rs.300,000 50% of Sum insured
Rs.400,000 & Above 100% of Sum insured
Automatic restoration operates only when the basic
Sum insured is Rs.300,000 & above

9. Benefits
Automatic Restoration of SI – An Illustration
Mr. A has a Rs.5,00,000 policy and a claim is made in
full for treatment of an ailment by him.
Rs.500,000 is again reinstated in the policy for the rest
of the policy period.
No extra Premium is charged.
This is automatic restoration.
This amount can now be availed by each or any
member covered in the policy including Mr. A.
The restored amount cannot be used for the treatment
of the same ailment again in the policy period by Mr. A

10. Benefits
Bonus Additions
The policy holder is now bestowed with additional SI in
case of a claim free year.
Different % age of bonus additions for Different SI
options.
A maximum of 35% of Basic SI is accumulated as
Bonus.
Ex: A policy with Sum insured of Rs.10,00,000 will now
automatically become Rs.13,50,000 in the third year
without any extra premium

11. Benefits
Bonus Additions
Basic Sum
Insured
% age of
Bonus
in 1st
Renewal
% age of
Bonus
in 2nd
Renewal
Maximum
% age
of Bonus
100,000 10 5 15
200,000 10 5 15
300,000 25 10 35
400,000 25 10 35
500,000 25 10 35
10,00,000 25 10 35
15,00,000 25 10 35

12. Benefits
What happens to Bonus Additions when there is claim
in the subsequent year?
The Bonus additions is reduced by 50 % in the event of
a claim
The Bonus additions becomes Zero when there is a
claim in the successive year also
Bonus additions would continue according to slab for
the further claim free year

13. Room Rent : Class A Cities
2% of Sum Insured subject to
maximum of Rs.5000 per day
Class B Cities
1% of Sum Insured subject to
maximum of Rs.3000 per day
Class C Cities
1% of Sum Insured subject to
maximum of Rs.1000 per day
Benefits

14. Declined Risk
Persons who are suffering from or have suffered
from the following ailments cannot be issued
policy –
Heart Problem (CVD)
Cancer
Kidney Failure
Stroke (CVA)

15. Exclusions
All Pre Existing Diseases Covered after
48 months of continuous coverage with STAR
Any Diseases contracted during the first
30 days of the first policy year

16. Exclusions
First 2 years’ Exclusions
Cataract
Hysterectomy following menorrhagia or
fibromyoma,
Knee Replacement Surgery,
Joint Replacement Surgery
Prolapse of intervertibral disc
Varicose veins/ulcers

17. Exclusions
First year Exclusions
Benign prostate hypertrophy,
Hernia
Hydrocele
Fissures, Fistula in Anus / Piles
Sinusitis
Congenital internal disease/defect
Treatment for Gall stone and
Treatment for Renal stone

18. Portability
This policy is portable
Proposals from less than 45 years of age
without any previous claim or PED, can be
ported to this policy by the operating office.
The requisition has to be received 7 days
before the date of expiry.
Beyond 45 years of age, portability acceptance
routed through portability cell

19. Portability
The sum insured is restricted to the one in the
expiring policy
Continuity benefits of First 30 days, First year
exclusions, First two years’ exclusions and PED
allowed according to the previous policy
Cumulative Bonus of the previous insurer is not
given credit

20. Pre Insurance Medical
Pre Insurance medical examination at our tie
up diagnostic centre at the cost of the
company.
Test to taken as per the guidelines based upon
the sum insured.
Acceptance based upon the medical officers’
opinion of the MER.
Persons with adverse medical history may also
be referred for medical examination.

21. IT Benefit
Deductions under Sec 80 D of Income Tax Act
is available for all modes of payment other
than cash

22. Renewal into revised FHO
Can the Sum insured be increased during renewals?
If Yes , what is the limit ?
Increase in Sum insured is allowed only during a claim
free year.
The increase is restricted to Next Slab of Sum Insured
(subject to approval)
The No Claim Discount for a claim free year is
withdrawn
The policy will now attract Bonus Additions as per slab

23. Renewal (contd.,)
An illustration
Rs.400,000 claim free FHO policy is now renewed for
Rs.500,000 Sum insured.
There will be a bonus addition of Rs.100,000. (25% of
Basic Sum insured which is Rs.400,000)
Total Sum insured is Rs.600,000
(Rs.500,000 + Rs.100,000)
Premium is paid for Rs.500,000 Sum insured

24. Documents required
Proposal form duly filled in all respects and signed by
the proposer. Care to be taken to capture the PED
details, if any.
One individual Photograph of each person to be
insured
Two photographs for those who have to undergo
medical examination
Age proof in case of age above 45 years
Full and Correct Premium of the plan

25. USP’s of Revised FHO
 101 day care procedures covered
 Revised limits for Cataract
 Inclusion of Goa, Rajkot, Allahabad in B Cities
 Automatic Restoration of SI up to 100% of Sum
insured
 Bonus additions for claim free year
 Bonus additions is reduced by only 50% in case of
a claim in the successive year
 No decrease in Basic SI
 No loading on claims
Two tier pricing

26. Happy
Selling