Comprehensive nandagopal-9994910202

Star Health and Allied Insurance Co. Ltd. CHI
S.V.NANDAGOPAL
SENIOR SALES MANAGER
THANKS FOR OPPORTUNITY TO SERVE
MOBILE
99949 10202 , 94431 86864 , 83000 20102
www.licnanda.blogspot.com
licnanda@gmail.com , starhealthwithu@gmail.com
வருமுன்னர்க் காவாதான் வாழ்க்கக எரிமுன்னர்
கவத்தூறு ப ாலக் ககடும். திருக்குறள்

Star Comprehensive Insurance
Policy
(Revised)
Aug-15
2

Scope of Cover
• Section 1 - Hospitalisation Benefits
• Section 2 - Delivery and Newborn
• Section 3 - Outpatient : Dental and
Opthalmic Treatment
• Section 4 - Hospital Cash
• Section 5 - Health checkup
Aug-15
3

Scope of Cover (Contd..)
Newly added benefits
• Section 6 - Bariatric Surgery
• Section 7 - Accidental Death and
Permanent Total Disablement
• Section 8 - Second Medical Opinion
Aug-15
4

Entry Age
• 03 months to 65 years.
• Dependant children can be covered up to the age of 25
years.
• Life long renewals.
• No cap on exit age.
Aug-15
5

Sum Insured Options
• Rs.5,00,000/-
• Rs.7,50,000/-
• Rs.10,00,000/-
• Rs.15,00,000/-
• Rs.20,00,000/-
• Rs.25,00,000/-
Aug-15
6

Family Size
• 1 Adult (New) : (1 A)
• 1Adult + 1 Children : (1 A +1 C)
• 1Adult + 2 Children : (1A + 2 C)
• 1Adult + 3 Children : (1A + 3 C)
• 2 Adult : (2 A)
• 2 Adult + 1 Children : (2A + 1 C)
Aug-15
7

Coverage
Section 1 – Hospitalisation
a. Room Rent (Single Standard A/C room), Boarding and
Nursing Charges
b. Surgeon, Anesthetist, Medical Practitioner, Consultants,
Specialist Fees.
c. Anesthesia, Blood, Oxygen, Operation Theatre charges,
Surgical Appliances, Medicines and Drugs, Diagnostic
Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, cost of Pacemaker and similar expenses.
Aug-15
8

Coverage
Section 1 – Hospitalisation (Contd..)
d (i). Emergency Ambulance Charges
d (ii) Air Ambulance Charges (new) : For sum insured of
Rs.7.5 lacs and above ; up to 10% of the sum insured
Aug-15
9
Sum Insured (Rs.) Limit per policy period
(Rs.)
5,00,000 2,000
7,50,000 3,000
10,00,000 3,500
15,00,000 4,000
20,00,000 4,500
25,00,000 5,000

Coverage
e. Pre Hospitalisation : 30 days
f. Post Hospitalisation : 60 days
g. Medical Consultations as Outpatient other than Dental and
Opthalmic.
h. Domiciliary Hospitalisation(New)
• Deductible / Excess : 3 days
• Pre and Post hospitalisation not applicable for this.
Aug-15
10

Coverage
Domiciliary Hospitalisation not applicable for :
Asthma, Bronchitis, Chronic Nephritis and Nephritic Syndrome,
Diarrhoea and all types of Dysentries including Gastro-enteritis,
Diabetes Melitus and Insipidus, Epilepsy, Hypertension,
Influenza, Cough and Cold, All psychiatric or Psychosomatic
Disorders, Pyrexia of unknown origin for less than 10 days,
Tonsillitis and Upper Respiratory Tract infection inlcuding
Laryngitis and Pharingitis, Arthritis, Gout and Rheumatism.
Aug-15
11

Coverage
j. Limit for medical consultation as Outpatient Benefit : upto
Rs.300/- per consultation and upto the following annual
limits.
Aug-15
12
Sum Insured (Rs.) Limit per policy
period (Rs.)
5,00,000 1,200
7,50,000 1,500
10,00,000 2,100
15,00,000 2,400
20,00,000 3,000
25,00,000 3,300

Coverage
Section 2 – Delivery and New Born
a. Expenses for delivery includes (for both Normal and
Caesarean).
b. Pre and Post Natal expenses covered within the
maternity limits.
c. Covered up to maximum 2 deliveries in the life time of
the insured, subject to policy in force.
d. Vaccination expenses up to Rs.1000/- for the new born
baby until the new born baby completes one year and
is added in the policy on renewal.
Aug-15
13

Coverage
Section 2 – Delivery and New Born (Contd..)
e. Waiting Period
• 36 months from the date of commencement of policy
subject to continuous renewal.
• 24 months gap between the coverage of the first delivery
and second delivery.
• Cover is available only when both Self and Spouse are
covered.
Aug-15
14

Coverage
Section 2 – Delivery and New Born (Contd..)
Aug-15
15
Sum Insured
(Rs.)
Normal
Delivery (Rs.)
Caesarean
(Rs.)
Limit of
Company’s
Liability for
New Born
(Rs.)
5,00,000 10,000 15,000 50,000
7,50,000 20,000 40,000 1,00,000
10,00,000 25,000 40,000 1,00,000
15,00,000 25,000 40,000 1,00,000
20,00,000 25,000 40,000 1,00,000
25,00,000 25,000 40,000 1,00,000

Coverage
• Section 3 – Outpatient Dental and Opthalmic
Treatment
a. Available after every block of 3 years.
Aug-15
16
Sum Insured (Rs.) Limit for Out Patient and
Opthalmic Treatments
(upto Rs.)
5,00,000 5,000
7,50,000 5,000
10,00,000 10,000
15,00,000 10,000
20,00,000 10,000
25,00,000 10,000

Coverage
Section 4 – Hospital Cash
a. Maximum 7 days per occurrence.
b. Excess : 24 hours
c. Maximum 120 days during the policy period.
Aug-15
17
Sum Insured (Rs.) Limit of Company’s Liability
per day (Rs.)
5,00,000 500
7,50,000 750
10,00,000 750
15,00,000 1000
20,00,000 1000
25,00,000 1000

Coverage
Section 5 – Health Checkup
a. After every block of 3 claim free years
b. Policy must be in force
Aug-15
18
Sum Insured (Rs.) Limit of Company’s Liability
per day (Rs.)
5,00,000 5,000
7,50,000 7,500
10,00,000 7,500
15,00,000 12,000
20,00,000 12,000
25,00,000 12,000

Coverage
Section 6 – Bariatric surgery
a. Maximum benefit : Rs.2,50,000/- including Pre
and Post Hospitalisation
b. Waiting Period 36 months
c. Applicable for persons above 18 years at the time of
surgery.
d. Subject to BMI more than 40 or more than 35 with Co-
Morbidity (e.g., Diabetes, High BP) and traditional
methods do not help.
e. Opinion by two qualified surgeons.
f. Only on cashless basis.
g. Part of sum insured under Section I.
Aug-15
19

Coverage
Section 7 – Accidental Dealth and Permanent
Total Disablement
a. Cover for the chosen one person
b. Dependant children cannot be chosen for this cover.
c. Maximum age 70 years.
d. Sum insured equal to Section I sum insured.
Aug-15
20

Coverage
Section 8 – Option for Second Opinion
a. Second opinion from a Doctor in Company’s network.
b. Opinion based upon the medical records only.
c. No physical examination of the patient.
d. Opinion for medical reasons only and not for medico-
legal purposes.
e. No liability on the part of Star for any errors or
omissions.
f. Does not affect No Claim Bonus.
Aug-15
21

Automatic Restoration of Sum
Insured
a. Limit : 100% of the sum insured.
b. Upon the exhaustion of the limit of coverage.
c. Only once during the policy period.
d. For illnesses / diseases unrelated to the illnesses /
diseases for which claim was made earlier.
e. Available under Section 1 (excluding 1G)
Aug-15
22

Bonus
a. For every claim free year.
b. Limit
• For Rs.5 lacs Sum Insured : 50% per year, maximum
100%
• For Sum Insured of above Rs.7.5 Lacs & above : 100%
per year, maximum 100%.
• Calculated on the basic sum insured.
• Available at the time of renewal, (including renewals
made within the grace period)
• Bonus amount cannot exceed the basic sum insured, if
there is a reduction of sum insured at the time of
renewal. Bonus applicable under Section 1
(excluding 1 G)
Aug-15
23

Other Features
a. 405 Day Care procedures.
b. Pre acceptance medical examination for people above
50 years.
c. PED cover after 48 months.
d. First two year exclusions.
e. Waiting period of 30 days (waived if covered earlier
under individual / group policy).
f. First two year exclusions.
g. 10 % co-pay for person above 60 years at entry level as
well as for renewals (under Section 1 only, excluding 1 G)
Aug-15
24

Star Health and Allied Insurance Co. Ltd. CHIAug-15
25
Comparison
Features Existing New
Day Care Procedures 101 405
Medical Consultation as
outpatient (other than
Dental and Opthal)
Not Available Available
Domiciliary
Hospitalisation
Bariatric Surgery Not Available Available
Accidental Death and
PTD
Option for Second
Medical Opinion
Entry Age 05 months 03 months
Air Ambulance Charges Not Available Available
Option for 1 A Not Available Available

Declined Risks
• Cerebrovascular Attack (CVA)
• Cardio Vascular Diseases (CVD)
• Cancer
• Chronic Kidney Diseases
• Parkinson’s Diseases
• Alzheimer’s Disease
• Psycho-somatic Disorders (mentally
challenged)
Aug-15
26

Declined Risks (Contd..)
• Cirrohosis of Liver
• COPD
• Auto immune diseases / Connective tissue disorders
requiring long term steroids and
immunosuppressants
• Patients on long term anti-coagulants therapy
• BMI above 35
• Any other serious illness as per underwriting policy.
Aug-15
27

Star Health and Allied Insurance Co. Ltd. CHIFHO-rev2014/cpu/ver1.4/16 Oct 2014 28
• ALSO WE PROVIDE
• LIFE INSURANCE
• HEALTH INSURANCE
• CHILD FUTURE PLANS
• TAX SAVING & PLANNING
• PAN CARD & PASSPORT
• MOTOR VEHICLE INSURANCE
• IMPORT & EXPORT INSURANCE
• INDIVIDUAL,FAMILY,GROUP &
CORPORATE INSURANCE NEEDS

Thank You
Aug-15
29

Comprehensive nandagopal-9994910202

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