This document describes the Star Health Criticare Plus health insurance plan offered by Star Health and Allied Insurance Company. It provides coverage for hospitalization expenses under Section I and lump sum payouts for major illnesses under Section II. Key features include coverage for individuals aged 3-65 years, sum insured options from Rs. 200,000 to Rs. 10,00,000, and coverage for hospitalization, pre and post hospitalization expenses, day care procedures, and critical illnesses. Waiting periods and sub-limits apply for certain procedures and illnesses.

1. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
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
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2. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING

3. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Policy sections..
 Section I - Regular Hospitalisation Benefits
 Section II - Payment of lump-sum compensation for specified Major
Illnesses
 3 Years – 65 Years, Children from 3 yrs to 18yrs can be covered along with
at least one parent
 Acceptance subject to medical screening for persons above 50 years
Age Limits..

4. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 Hospitalization Expenses incurred as an inpatient for
 Sickness/Illness/Diseases
 Accident
Coverages..
Medical Examination..
1. For persons with adverse medical history and
2. For persons with age above 50 (Any SI).
3. For SI above 2 lacs even if the person is below the age of 50 yrs.
Section -I

5. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 Room, boarding & nursing charges @ 2% of the sum insured up-to a
maximum of Rs. 4,000/- per day.
 Surgeons, Anesthetist, Consultants and Specialists fees.
 Operation Theatre charges, drugs and medicines diagnostic materials, cost
of pace maker etc.
 Emergency Ambulance - Rs 750/- per hospitalisation upto maximum of Rs
1,500/- per policy period.
 Pre-hospitalization expenses incurred for a period of 30 days prior to the
date of hospitalization.
 Post hospitalization expenses on a lump-sum basis @ 7% of the actual
hospitalization expenses (excluding room rent and hospital registration
charges), subject to a maximum of Rs 5,000/-
Allowable Expenses…

6. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Family discount..
 5% for upto 2 members, 10% for more than 2 members.
Non Allopathic Treatment :
Admission beyond 24 hrs must.
Only Reimbursement basis.
Maximum of Rs. 25,000/- for the entire policy period.

7. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Expenses on Hospitalization for minimum period of 24 hours are admissible.
However, this time limit will not apply for the following procedures
 Cataract
 Lithotripsy (Kidney stone removal)
 Tonsillectomy
 Cutting and draining of peripheral abscess
 Cutting and draining of sub-cutaneous abscess-
 Liver Aspiration
 Pleural Effusion Aspiration
 Sclerotheraphy
 Dialysis, Chemotherapy, Radiotherapy and Dental owing to Accidents
Day Care Treatment..

8. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Day Care Procedure Sub limit
CATARACT
Rs. 20,000/- in respect of one eye and
Rs. 30,000/- in the entire policy period
Lithotripsy (Kidney stone removal) Rs. 20,000/-
Tonsillectomy Rs. 15,000/-
Cutting and Draining of Peripheral
Abscess
Rs. 2,500/-
Cutting and Draining of Sub-Cutaneous
Abscess Rs.4,000/-
Liver Aspiration Rs. 2,000/-
Pleural Effusion Aspiration Rs. 2,000/-
Sclerotheraphy Rs. 5,000/-
Sub limits

9. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Waiting period for Section I
 Waiting period for Health Cover: 30 days
 Accidental : Day 1 cover
 Pre Existing Disease covered after 4 years.
 First and First two year Exclusions same like Family
Health Optima.

10. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Sec II : Lumpsum payout
• What happens when the insured is diagnosed with
Critical Illness?....
On diagnosis, there will be a Lump Sum
Compensation under Section 2 + Payment of
Hospitalization under Section 1 up to the date of
diagnosis of Major Illness.
(Waiting period : 90 days.)

11. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Coverages.. Section -II
 First Diagnosis of Cancer, Chronic Kidney Disease, Brain
Tumour,
 Undergoing first time - Major Organ Transplant, Occurrence
for the first time of the following medical events:
 Cerebro-Vascular Stroke causing Hemiplegia,
 Acute Myocardial Infarction resulting in Left
Ventricular Ejection Fraction of < 25%
 Established irreversible Coma,
 Established irreversible Paraplegia,
 Established irreversible Quadriplegia

12. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
Policy year June 2012 to June 2013 SI 5 LACS
Sec I : 5 lacs &
Sec II : 5 lacs
Total 10 lacs )
Claim for Cancer in December
2012
SI 5 lacs paid Sec II Closed
Hospitalisation expenses till the
date of diagnosis of Critical Illness
Rs.30k Paid from Sec I
Criticare Plus to continue either till
June 2013 or till the SI of
4,70,000(under SEC I) is
exhausted, whichever happens
first..
Criticare plus cannot be renewed
further. Renewal can be done
either in Medi Classic or Health
gain.
Critical illness
for which claim
has been
already paid will
remain a
permanent
exclusion

13. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 The Major Illness experienced should be the first incidence of that
major illness.
 Hospitalisation expenses would be paid only till the date of
diagnosis of the major illness.
 Only one lump sum benefit will be payable irrespective of
 No. of policies issued to the insured
 No. of major illness suffered by the insured
 Waiting period of 90 days from the date of issuance of policy (for
section 2 benefits)
Conditions..

14. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 Minimum Sum Insured - Rs. 2,00,000/-
 Maximum Sum Insured - Rs. 10,00,000/-
 The following Sum Insured options are available
 Rs. 2,00,000/-
 Rs. 3,00,000/-
 Rs. 4,00,000/-
 Rs. 5,00,000/-
 RS. 10,00,000/-
Sum Insured..

15. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 Sum Insured restricted to Rs.200000/-
 30% COPAY Will be applicable
 Following Sub-limits will apply.
Disease
Company’s liability
(maximum)
Cerebro vascular accident / cardio
vascular disease/cancer and breakage of
bones, renal complications.
150000
All other major surgeries 120000
Persons above 60 yrs at Entry..

16. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING
 Survival period of 30 days after occurrence of major disease not
applicable
 Higher limit for Tonsillectomy.
 Maximum sum insured Rs.1000000/-
 Family Discount available of 5% up to 2 members and 10% for
more than two members
 Covers both Hospitalisation benefit and Lumpsum payout.
 Covers Non Allopathic Treatment
Sales Pitch……

17. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARINGFHO-rev2014/cpu/ver1.4/16 Oct 2014 17
• 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 &
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18. STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
PERSONAL & CARING