This document summarizes the revised Family Health Optima Insurance Plan from Star Health and Allied Insurance Co. Ltd. It offers sum insured options from Rs. 200,000 to Rs. 15,000,000. Key benefits include hospitalization coverage, pre- and post-hospitalization benefits, domiciliary hospitalization coverage, health checkups, no claim bonus, automatic restoration of sum insured, and coverage for newborns from day 16. The plan has eligibility up to age 65 and covers dependents up to age 25.

1. Star Health and Allied Insurance Co. Ltd.
STAR HEALTH
NEW PLAN
Family Health Optima
(Revised)
Best policy for family
(Floater coverage)
S.V.NANDAGOPAL
SALES MANAGER
COIMBATORE
9994910202

2. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Sum Insured Options
Rs.2,00,000/-
Rs.3,00,000/-
Rs.4,00,000/-
Rs.5,00,000/-
Rs.10,00,000/-
Rs.15,00,000/-
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NANDAGOPAL.S.V
9994910202
COIMBATORE

3. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
In the case of renewals, where the existing
sum insured is Rs.1,00,000/-, provision to renew
with the same sum insured is also available.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

4. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Premium Rating
Three Tier Rating
Zone 1
Zone 2
Zone 3
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NANDAGOPAL.S.V
9994910202
COIMBATORE

5. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Classification of Zones
Zone 1 : Delhi including National Capital Region, Mumbai
including Thane and the State of Gujarat
Zone 2 : Bangalore, Chennai, Coimbatore, Pune and State
of Kerala
Zone 3 : Rest of India excluding areas falling under Zone 1
and Zone 2
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NANDAGOPAL.S.V
9994910202
COIMBATORE

6. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Classification of Cities (for claims) into three
Class A
Class B
Other locations
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NANDAGOPAL.S.V
9994910202
COIMBATORE

7. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Classification of Cities (contd)
Class A cities : Ahmedabad, Bangalore, Chennai, Hyderabad
including Secunderabad, Kolkata, Mumbai including Thane,
Pune, New Delhi including Noida, Gurgaon, Ghaziabad and
Faridabad (otherwise called as National Capital Region)
……
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NANDAGOPAL.S.V
9994910202
COIMBATORE

8. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Classification of Cities (contd)
Class B cities : Allahabad, Amritsar, Agra, Baroda, Coimbatore,
Cochin, Goa, Indore, Jalandhar, Jodhpur, Kanpur, Kota, Ludhiana,
Mohali, Meerut, Nagpur, Pakhola, Rajkot, Surat, Udaipur,
Varanasi, Vizag, Vijayawada and all State capitals other than
those falling under Class A.
Other locations : Rest of India not falling under Class A & Class B
above ……
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NANDAGOPAL.S.V
9994910202
COIMBATORE

9. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Classification of Cities (contd)
- In the event of claims the limit of liability for room rent will
be as per the Zone for which the premium was paid –
irrespective of place of treatment.
- Expenses relating to hospitalisation will be considered in
proportion to the room rent stated in the policy.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

10. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Benefits
- Hospitalisation Expenses for Accidents / Diseases
/ illnesses
- Pre & Post Hospitalisation
- Domiciliary Hospitalisation (New)
- Cost of Health Check up
- No claim Bonus …..
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NANDAGOPAL.S.V
9994910202
COIMBATORE

11. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Benefits (contd)
- Recharge (New)
- Restore
- Cover for child from day 16 ( New)
- Donor Expenses (New)
- 405 Day Care Procedures
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NANDAGOPAL.S.V
9994910202
COIMBATORE

12. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Hospitalisation Benefits
- Covering Surgeon, Anesthetist, Medical Practitioner,
Consultants, Specialist fees.
- Anesthesia, blood, operation theatre charges, surgical
appliances, medicines and drugs, diagnostic materials
and X-ray, diagnostic imaging modalities, dialysis,
chemotherapy, radiotherapy, cost of pacemaker, stent,
similar expenses, with regard to coronary stenting, the
Company will pay such amount up to the extent of bare
metal stent / drug eluting cobalt-chromium stent / drug
eluting stainless steel stent.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

13. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Pre & Post Hospitalisation
Pre Hospitalisation : 60 days
Post Hospitalisation : 90 days
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NANDAGOPAL.S.V
9994910202
COIMBATORE

14. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Domiciliary Hospitalisation (New)
Medical treatment for a period exceeding three days,
for an illness / diseases / injury, which in the normal
course, would require care and treatment at a hospital
but, on the advice of the attending Medical
Practitioner, is taken whilst confined at home under any
of the following circumstances :
The condition of the patient is such that he / she is not
in a condition to be removed to a Hospital, or
The patient takes treatment at home on account of
non-availability of room in a hospital.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

15. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Cost of Health Check up
- Up to 1% of average basic Sum Insured subject to a
limit of Rs.5,000/-
- Available after every block of 3 continuous renewals,
- Irrespective of whether a claim is made or not.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

16. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
NO Claim Bonus
- In respect of a claim free year of Insurance.
- Available for the Sum Insured options Rs.3,00,000/-
and above
- 25% of the expiring sum insured in the second year
and additional 10% of the expiring sum insured
during the third year.
…….
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NANDAGOPAL.S.V
9994910202
COIMBATORE

17. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
NO Claim Bonus (contd)
- The maximum allowable bonus shall not exceed 35%
of the expiring sum insured.
- The earned bonus for the sum insured option of
Rs.2,00,000/- will be protected if the policy is
renewed continuously without break. No fresh
bonus will accrue.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

18. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Recharge
On exhaustion of Sum Insured, additional Sum Insured up to
the specified limits, available even for the same disease and
even during the same hospitalization.
• This benefit is available once during the policy period.
Limits of Recharge For Zone-1:
• 25% for Sum Insured options of Rs.3 lacs & Rs.4 lacs.
• 15% for Sum Insured of Rs.5 lacs.
• No recharge for Sum Insured of Rs.10 Lacs & Rs.15 Lacs.
…….
NANDAGOPAL.S.V
9994910202
COIMBATORE
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19. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Recharge (contd)
Limits of Recharge For Zone 2 & 3:
• 25% for Sum Insured options of Rs.3 lacs & Rs.4 lacs.
• 30% for Sum Insured of Rs.5 lacs.
• No recharge for Sum Insured of Rs.10 Lacs & Rs.15 Lacs.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

20. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Automatic Restoration of Sum Insured
- Operates immediately on exhaustion of the limit
of coverage.
- Available for sum insured options of
Rs.3,00,000/- and above only.
- Up to 100% of basic Sum Insured
…….
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NANDAGOPAL.S.V
9994910202
COIMBATORE

21. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Automatic Restoration of Sum Insured (contd)
- can be utilized only for illness / disease unrelated
to the illness / diseases for which claim/s was /
were made
- The unutilized restored sum insured cannot be
carried forward
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NANDAGOPAL.S.V
9994910202
COIMBATORE

22. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Free cover for child from day 16
-Free cover for new born baby delivered during the
policy period after 16 days from the date of birth till the
expiry of the policy period subject to a limit of 10% of Sum
Insured or Rs.50,000/- whichever is less (subject to other
terms and conditions of the policy).
- Intimation about the New Born to be given and policy to
be endorsed to include the baby (Nil Endt.)
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NANDAGOPAL.S.V
9994910202
COIMBATORE

23. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Donor Expenses
Organ removal expenses as in-patient only. Over all
limit is 10% of Sum Insured or Rs.1 lakh, whichever
is less. Pre & Post hospitalization expenses for the
Donor are excluded.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

24. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Age Limits
Entry Age : 18 to 65 years
Dependant Children from day 16 (even when
delivery has happened prior to the commencement
of the policy period) up to the age of 25 can be
covered when one of the parents are covered.
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NANDAGOPAL.S.V
9994910202
COIMBATORE

25. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Room Rent Limits
Sum Insured Class A Cities Class B Cities Other Locations
Up to
Rs.4,00,000/-
(Irrespective of
Zones)
2% of the sum
insured subject to
a maximum of
Rs.5000/- per day
1% of the sum
insured subject to
a maximum of
Rs.3000/- per day
1% of the sum
insured subject to
a maximum of
Rs.2000/- per day
Rs.5,00,000/-
Single Standard A/c room for Zone-1 & Rs.7,500/- for
Zone-2 & 3
Rs.10,00,000/- &
Rs.15,00,000/-
Single Standard A/c room for Zone-1 & Rs.10,000/- for
Zone 2 & 3.
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26. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Sublimits for Cataract
Amount in Rs.
Sum Insured For Single Eye Surgery For the policy term
Up to 2 Lacs 12,000 12,000
3 to 5 Lacs 20,000 30,000
10 & 15 Lacs 30,000 40,000
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27. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Important Exclusions
- 30 days waiting period
- First Two Year Exclusions
Cataract, Diseases of the Vitreous and Retina,
Glaucoma, diseases of ENT, Mastoidectomy,
Tympanoplasty, Stapedectomy, diseases related to
Thyroid, Prolapse of intervertebral disc (other than
caused by accident), varicose veins and ……
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28. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
First Two Year Exclusions (contd …)
Varicose ulcers, all diseases of prostate, Stricture
Urethra, all obstructive-uropathies,all types of
hernia, varicocele, hydrocele, fistula / fissure in ano,
Hemorrhoids, Pilonidal sinus and fistula, Rectal
Prolapse, stress incontinence and Congenital
Internal disease / defect
b) Gall bladder and ancreatic diseases and all
treatments (conservative, interventional,
laparoscopic and open) related to ……
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29. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
First Two Year Exclusions (contd …)
Hepato-pancreatobiliary including gall bladder and
pancreatic calculi. All types of management for
kidney and genitourinary tract calculi.
c) All treatments (conservative, interventional,
laparoscopic and open) related to all diseases of
uterus, fallopian tubes, cervix and ovaries,
dysfunctional uterine bleeding, pelvic
inflammatory diseases, benign breast diseases.
……
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30. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
First Two Year Exclusions (contd …)
d) Conservative, operative treatment and all types
of intervention for diseases related to tendon,
ligament, fascia, bones and joint other than
caused by accident
e) Degenerative disc and vertebral diseases
including replacement of bones and joints and
degenerative diseases of the musculo-skeletal
system
…… 30

31. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
First Two Year Exclusions (contd …)
f) Subcutaneous benign lumps, sebaceous cyst,
dermoid cyst, lipoma, neurofibroma,
fibroadenoma, ganlion and similary pathology.
g) Any transplant and related surgery
This waiting period shall not however apply in the
case of the Insured person/s having been covered
under any Individual health insurance scheme
with any of the Indian Insurer for a continuous
period of preceding 24 months without any break
….. 31

32. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
First Two Year Exclusions (contd …)
The claim for such illnesses/diseases/disabilities
contracted/suffered if admitted will be processed
as per the sum insured of the immediately
preceding 24 months policy only. Where there is
a change in the sum insured in the second
continuous policy year the lower of the sum
insured will apply.
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33. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Please Note
In respect of renewals, the list of diseases which are
under First Year Exclusion under the expiring policy
- which have become part of first two year
exclusions now, will, however, we covered in the
first renewal / second year of the policy from the
first inception.
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34. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
Other Important Features
- Life long renewals.
- Ambulance charges Rs.750/- per hospitalisation
and overall limit of Rs.1500/- per policy period.
- Co-Payment : The policy is subject to co-payment
of 20% of each and every claim amount for
fresh as well as renewal policies for insured
persons whose age at the time of entry is
above 60 years.
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35. Star Health and Allied Insurance Co. Ltd.
Revised Family Health Optima Insurance Plan
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NANDAGOPAL.S.V
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