Group Mediclaim

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING


Benefits of your Group Tailor Made Policy


EXPENSES COVERED

Inpatient Hospitalization

Room rent , Boarding and nursing exp.,ICU Charges,Doctors feesDiagnostic chargesNursing charges SurgeonAnesthetistConsultant and Specialist feesBlood OxygenOT charges Surgical AppliancesMedicines and DrugsDiagnostic Materials X ray etc…

COVERAGE SCOPE


IN PATIENT DAY CARE PROCEDURES

An Insured Person who is admitted to Hospital and stays

there for a minimum period of 24 hours for the sole purpose of

receiving treatment.

Means medical treatment which is undertaken in a Hospital/day care

centre in less than 24 hours becauseof technological advancement, and

which would have otherwise required a Hospitalization of

more than 24 hours

MINIMUM DURATION REQUIRED DURING HOSPITALISATION


BENEFITS COVERED : (Example)

Period of Insurance 08/11/2013 to 13/09/2015Grade Sum Insured Rs.5,00,000/-

Family Floater Yes (Employee, Spouse, Children)

Hospitalization in a Non-Network Hospital

Yes( Only Incase of Accident or

Emergency)Hospitalization in a

Network HospitalYes

Pre-Existing Diseases Covered from Day 11 yr & 2 yr Exclusions Waived off

Maternity cover New Born Baby cover

Covered from Day 1Covered from Day 1

Day Care Procedures Yes

Pre & Post Hospitalization30 Days – 60 Days

Yes

*


ROOM RENT,BOARDING AND NURSING Exp.,

Ambulance – Not exceeding Rs.5,000/- if incurred

Room rent - For 5,00,000/- Sum Insured 2% of Sum Insured subject to

Maximum of Rs.5000/- per day

Stay in room other than eligibility -Expenses relating to the hospitalisation will be considered in

proportion to the room rent stated in the policy.

*


PRE & POST HOSPITALISATION EXPENSES

Pre - Hospitalization expenses - 30 days

Post – Hospitalization Expenses - 60 days

*


DAY CARE PROCEDURES :

*

Policy specifies sub-limits to following procedures:

Cataract, Lithotripsy, Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion

Aspiration, Colonoscopy, Sclerotheraphy.


CORPORATE BUFFER

Sum Insured available – Rs.10,00,000/-

Corporate Buffer limit restricted to Individual/Individual Family Sum Insured

Further corporate buffer can be utilized only when there is a left over balance under the basic Sum Insured available only.

Corporate buffer benefit can be utilized only for treatment of major Diseases.

Major Diseases means - Cancer, Chronic Kidney Disease, Brain Tumour, Major Organ Transplant, Cerebro-Vascular Stroke causing Hemiplegia, Acute Myocardial Infarction, Established Irreversible Coma, Established Irreversible Paraplegia & Established Irreversible Quadriplegia.

*


MATERNITY & N EW BORN BABY COVER

For Caesarean Rs.50,000/-

For NormalRs.35,000/-

New Born baby cover From Day One

*


MIDTERM INCLUSION

In Case of Existing EmployeeOnly Newly Married Spouse and

Newborn Child can be added.

In Case of Newly joined Employee

Employee and Dependents can be added.

*


IN THE EVENT OF ANY CLAIM

Note:

• Treatment in our network hospitals only,

• Incase of Medical Emergencies & Accidents treatment

can

be taken in other Hospitals.

• In all cases immediate intimation shall be given to our

call center

*


IN THE EVENT OF ANY CLAIM (cont’d) CONTACT DETAILS

Please inform 24X7 call centre

Toll free : 1800 425 2255 / 1800 102 4477 (or)

044-28263300

Fax 1800 425 55 22

(or)044-28306700

Local Assistance

Cashless Hospitalization

Dr. Chandra Mohan - 9700000544Dr. Nagesh - 9849709522

Land line no: 040-44344801/802(Between 10.00 am to 8.30 pm)

Re-imbursementPavan – 040-44344806

(Between 10.00 am to 5.30 pm)

*


CLAIM PROCEDURE

In case of Network Hospitals

Intimate the hospitalization details immediately to the Call Centre on Toll Free No: 1800 424 2255 / 044 – 2826 3300.

The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital.

Based on the intimation a field visit will be done by the Star Health Doctor.

Pre Authorization will be issued to the Hospital.

Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital.

*


CASH LESS CLAIM PROCESS

Claim Registration – 1800 425 2255

Field visit report

Initial Sanction

Final Bill submission

Rejection

Final Enhancement given

*


CLAIM PROCEDURE (CONT’D)

*

In case of Non-Network Hospitals

Intimate the hospitalization details immediately to the Call Centre on Toll Free No: 1800 424 2255 / 044 – 2826 3300.

Claim form will be sent to the Insured.

Based on the intimation a field visit will be done by the Star Doctor

Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents to concern person at your office, (Please remember to collect following documents from hospital without fail).

• Original Discharge Summary• Main Hospital Bill with Break Up• Investigation Reports with X-Ray Film• Medical Bills with Prescriptions


REIMBURSEMENT CLAIM PROCESS

Field visit report

Claim settlement

Claim Registration -1800 425 2255

Rejection

Submission of Claim Form

*


Claim form must be filled fully and sent to Star Health office along with the following documents in original where ever applicable.. • All columns of Claim form should be filled in properly and signed by the

Customer.• In the Claim form Medical Certificate to be filled in by Treating doctor

with Signature and Stamp.• Discharge summary.• Lab Investigation reports and Bills.• Medical bills with doctor’s prescriptions.• First consultation report.• Case sheet • Policy Bond/Id card.• Any Accident case: Self declaration ; FIR / MLC is mandatory for Motor

& Other Accidents.• X-rays, MRI, CT-Scan, USG Scan films and reports.• Any Fracture Case: Pre and Post Operative X- ray films.• Final break up bills with receipt Nos.

*

REIMBURSEMENT CLAIM PROCESS (CONT’D)



ACCIDENT COVER

Sum Insured per employee - Rs.10,00,000/-

Coverage – Accidental Death , Permanent Total Disability, Permanent Partial Disability,

Temporary Total Disability (Weekly Compensation)

*


Thank You

Documents

Group Mediclaim