Presentation on FAMILY HEALTH OPTIMA

Presentation on Family Health Optima

Presentation onPresentation on

FAMILY HEALTH OPTIMAFAMILY HEALTH OPTIMA


Star Health and Allied Insurance Co. Ltd.

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accident For the entire family on floater basis

CoveragesCoverages

Note: Please avoid the acceptance of the following risk Heart Disease Cancer



Proposer

Spouse

Dependent Children

Family MeansFamily Means



What is a Hospital ?What is a Hospital ?Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries

It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner

orShould comply with minimum criteria as under

• It should have at least 15 inpatient beds (10 in Class ‘C’ Towns).

• Fully equipped operation theatre of its own wherever surgical operation is carried out.

• Fully qualified nursing staff under its employment round the clock

• Fully qualified Doctor(s) should be in charge round the clock.



Age LimitsAge Limits

5 Months – 65 Yrs

Renewal upto 65 Yrs

Dependent Children can be covered only with any one of their Parents



Sum InsuredSum Insured

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/-



Allowable ExpensesAllowable ExpensesRoom rent & boarding charges as follows

• Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 4,000/- per day

(Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi and Secunderabad)

• Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day

(Baroda, Coimbatore and all State Capitals other than those falling under Class A)

• Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day

(Other Cities)

Nursing charges

Surgeons, Anesthetist, Consultants and Specialists fees



Allowable Expenses (Contd.)Allowable Expenses (Contd.)Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc

Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period

Pre-hospitalization expenses incurred 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/-



Name of the Ailment / Surgery / Procedure

Sub Limit

Cataract surgery Rs. 12,000/- in the entire policy period

Sub limits



Day Care TreatmentDay Care TreatmentExpenses on Hospitalization for minimum period of 24 hours

are admissible. However, this time limit will not apply for • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal),• Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is

discharged on the same day.



Sum Insured Rs. 2,00,000/-Age Band 5 Months

– 35 yrs36 yrs – 45 yrs

46 yrs – 55 yrs

56 yrs – 60 yrs

61 yrs – 65 yrs

2A 3778 4087 6789 7776 NA

1A + 1C 3292 3623 6149 7109 NA

1A + 2C 3452 3701 6309 7225 NA

1A + 3C 3701 4076 6646 7688 NA

2A + 1C 4224 4544 7219 8399 NA

2A + 2C 4401 4677 7798 8835 NA

2A + 3C 4588 5101 8179 9342 NA

A – Adult

C – Children upto 25 yrs

Rating (Contd.)Rating (Contd.)S.tax includedS.tax included




– 35 yrs36 yrs – 45 yrs

46 yrs – 55 yrs

56 yrs – 60 yrs

61 yrs – 65 yrs

2A 4395 4809 8388 11063 18450

1A + 1C 4092 4346 7644 10131 NA

1A + 2C 4219 4533 7897 10727 NA

1A + 3C 4550 4897 8416 11135 NA

2A + 1C 4622 5327 8675 11719 NA

2A + 2C 4754 5636 9265 12232 NA

2A + 3C 5090 5868 9607 12966 NAA – Adult






– 35 yrs36 yrs – 45 yrs

46 yrs – 55 yrs

56 yrs – 60 yrs

61 yrs – 65 yrs

2A 5730 6138 11593 14907 22170

1A + 1C 5239 5592 10655 14041 NA

1A + 2C 5416 5791 11195 14571 NA

1A + 3C 5918 6315 12111 15172 NA

2A + 1C 5840 6370 12431 15762 NA

2A + 2C 6226 6883 13093 16424 NA

2A + 3C 6646 7214 13881 17444 NAA – Adult






– 35 yrs36 yrs – 45 yrs

46 yrs – 55 yrs

56 yrs – 60 yrs

61 yrs – 65 yrs

2A 6530 7197 13247 17488 25740

1A + 1C 5923 6568 12740 16793 NA

1A + 2C 6210 6932 13087 17256 NA

1A + 3C 6657 7467 13666 17951 NA

2A + 1C 6999 7771 14135 18475 NA

2A + 2C 7583 8466 14571 19247 NA

2A + 3C 8008 9039 15288 19970 NAA – Adult




Rating (Contd.)Rating (Contd.)


– 35 yrs36 yrs – 45 yrs

46 yrs – 55 yrs

56 yrs – 60 yrs

61 yrs – 65 yrs

2A 9287 9910 16501 20554 NA

1A + 1C 9061 9668 16098 20053 NA

1A + 2C 9194 9811 16341 20356 NA

1A + 3C 9513 10148 16903 21056 NA

2A + 1C 9966 10633 17709 22060 NA

2A + 2C 10418 11118 18514 23058 NA

2A + 3C 10638 11355 18916 23560 NA


S.tax includedS.tax included



Renewal DiscountRenewal Discount

10% Discount on Basic Premium is allowed on renewal for every Claim Free Year

It is not Cumulative



Other BenefitsOther Benefits

Benefits under Section 80-D of the IT ActCashless Service without intervention of TPADirect Tie up with hospitals on an All India Basis24 X 7 In-House Call centerToll Free Telephone line assistanceFull knowledge based website to offer medical information, including Health Tips. Health Check-up benefitsFrequent health meets to disseminate info on the health related topics



ExclusionsExclusionsPre Existing Diseases10% Co-Pay for each and every claim where the entry age is between 60-65Yrs.Any Disease contracted during first 30 daysFirst Year Exclusions

• Benign prostate hypertrophy• Hernia, Hydrocele, Fistula in Anus, Piles• Sinusitis• congenital internal disease/defect• Renal stone and Gall stone removal

First Two Years Exclusions• Cataract• hysterectomy following menorrhia or fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery• Prolapse of intervertibral• Vericose veins/ulcers



Exclusions (Contd.)Exclusions (Contd.)Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operationsCircumcision unless necessary for treatment of a diseaseCost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aidsDental treatment or surgeryConvalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcoholNaturopathy Treatment Expenses incurred on Lasik Laser or Refractive Error Correction treatment



Exclusions (Contd.)Exclusions (Contd.)

Hospital registration charges, record charges, telephone charges and such other similar charges.Expenses incurred on Non Allopathic Treatment.



Claim ProcedureClaim Procedure

In case of Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network HospitalBased on the intimation a field visit will be done by the Star DoctorPre Authorization will be issued to the HospitalBased on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital



Claim Procedure (Contd.)Claim Procedure (Contd.)

In case of Non Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)Claim form will be sent to the Insured.Based on the intimation a field visit will be done by the Star DoctorBills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents

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



Thank You

Documents

Presentation on FAMILY HEALTH OPTIMA