Family Optima Presentation

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



Proposer

Spouse

Dependent Children upto 25 yrs and those who are economically dependent on their parents.

Proposals from persons above 45 yrs, age proof in the form of DL, Pass Port, Ration Card or School Certificate is required.

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 – 60 Yrs

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



Sum InsuredSum Insured

Minimum Sum Insured - Rs. 1,00,000/-

Maximum Sum Insured - Rs. 5,00,000/-

The following Sum Insured options are available

• Rs. 1,00,000/-• Rs. 2,00,000/-• Rs. 3,00,000/-• Rs. 4,00,000/-• Rs. 5,00,000/-



Allowable ExpensesAllowable ExpensesRoom rent & boarding charges as follows

• Class A Cities – Rs.2000/- subject to Max. Rs.4000/-per day (Ahmedabad , Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai

including Thane, Pune, New Delhi, and Secunderabad)

• Class B Cities – Rs. 1000/- subject to Max. Rs.3000/-per day (Baroda, Coimbatore and all State Capitals other than those

falling under Class A)

• Other Locations – Rs. 1000/- subject to Max. Rs. 1000/-per day

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. 1,00,000/-Age Band 5 Months – 45

yrs46 yrs – 55 yrs 56 yrs – 60 yrs

2A 1765 NA NA

1A + 1C 1515 NA NA

1A + 2C 1640 NA NA

1A + 3C 1785 NA NA

2A + 1C 1890 NA NA

2A + 2C 2025 NA NA

2A + 3C 2165 NA NA

A – Adult

C – Children upto 25 yrs

RatingRating



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

35 yrs36 yrs – 45

yrs46 yrs – 55

yrs56 yrs – 60

yrs

2A 2890 3140 5535 6400

1A + 1C 2715 3005 5265 6120

1A + 2C 2835 3075 5410 6225

1A + 3C 3085 3415 5715 6645

2A + 1C 3295 3555 5925 6965

2A + 2C 3455 3675 6450 7360

2A + 3C 3625 4060 6795 7820

A – Adult


Rating (Contd.)Rating (Contd.)




35 yrs36 yrs – 45

yrs46 yrs – 55

yrs56 yrs – 60

yrs

2A 3985 4360 7605 10030

1A + 1C 3710 3940 6930 9185

1A + 2C 3825 4110 7160 9725

1A + 3C 4125 4440 7630 10095

2A + 1C 4190 4830 7865 10625

2A + 2C 4310 5110 8400 11090

2A + 3C 4615 5320 8710 11755

A – Adult






35 yrs36 yrs – 45

yrs46 yrs – 55

yrs56 yrs – 60

yrs

2A 5195 5565 10510 13515

1A + 1C 4750 5070 9660 12730

1A + 2C 4910 5250 10150 13210

1A + 3C 5365 5725 10980 13755

2A + 1C 5295 5775 11270 14290

2A + 2C 5645 6240 11870 14890

2A + 3C 6025 6540 12585 15815

A – Adult






35 yrs36 yrs – 45

yrs46 yrs – 55

yrs56 yrs – 60

yrs

2A 5920 6525 12010 15855

1A + 1C 5370 5955 11550 15225

1A + 2C 5630 6285 11865 15645

1A + 3C 6035 6770 12390 16275

2A + 1C 6345 7045 12815 16750

2A + 2C 6875 7675 13210 17450

2A + 3C 7260 8195 13860 18105

A – Adult





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 Diseases (covers after 4 yrs of continuous renewal with us, without break)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

Health & Medicine

Family Optima Presentation