STAR HEALTH INSURANCE COIMBATORE
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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.
STAR HEALTH INSURANCE COIMBATORE
- 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/- 2 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. 3 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 4 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 5 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 6 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) …… 7 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 …… 8 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. 9 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 ….. 10 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 11 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. 12 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 13 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. 14 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. 15 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. ……. 16 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. 17 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 18
- 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. 19 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 ……. 20 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 21 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.) 22 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. 23 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. 24 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. 25
- 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 26
- 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 …… 27
- 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 …… 28
- 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. …… 29
- 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. 32
- 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. 33
- 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. 34
- 35. Star Health and Allied Insurance Co. Ltd. Revised Family Health Optima Insurance Plan 35 FOR ALL KIND OF INSURANCE NEEDS CALL US THANKS WITH REGARDS NANDAGOPAL.S.V WELLWISHER PROFESSSIONAL INSURANCE AND INVESTMENT CONSULTANAT