Star Health and Allied Insurance Co. Ltd. Presentation on Medi Premier Presentation on MEDI PREMIER.

Star Health and Allied Insurance Co. Ltd.

Presentation on Medi Premier

Presentation on

MEDI PREMIER



Policy Sections

Section I - Regular Hospitalisation Benefits

Section II - Payment of lump-sum compensation for their continuation of treatment of specified Major Illnesses



Age Limits

26 Years – 75 Years

Acceptance subject to medical screening for persons above 50 years



Section I



Coverages

Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accident



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.



Allowable Expenses

Room rent & boarding charges @ 2% of the sum insured up-to a maximum of Rs. 4,000/- per day

Boarding and Nursing charges

Surgeons, Anesthetist, Consultants and Specialists fees

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



Allowable Expenses (Contd.)

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/-



Day Care Treatment Expenses 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.



Sub limits

Name of the Ailment / Surgery / Procedure

Sub Limit

Cataract surgery 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. 7,500/-

Cutting and Draining of Abscess Rs. 1,500/-

Liver Aspiration Rs. 2,000/-

Pleural Effusion Aspiration Rs. 2,000/-

Colonoscopy Rs. 2,000/-

Sclerotheraphy Rs. 5,000/-



Section II



Coverages

Payment of Lump Sum compensation for the following Major Illnesses

• Stroke

• Renal Failure

• Cancer



Allowable Expenses

Lump Sum Compensation under Section II in addition to payment of hospitalization under Section I.



Conditions

The Major Illness experienced should be the first incidence of that major illness.

Such hospitalisation expenses would be paid only till the date of diagnosis of the major illness.

On entitlement for payment of lump-sum under this section, all further benefits under the policy shall cease and policy automatically gets terminated.



Conditions (contd.)

Only one lump sum payment will be made during the lifetime of the insured, irrespective of the number of major illness suffered by the insured/number of policies.

The signs or symptoms of the Major Illness experienced by the Insured Person after 90 days following the date of policy commencement.

The insured must survive beyond 30 successive days from such date of detection of major illness, to be eligible for a claim.



Common Features

Under both Sections



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

Maximum Sum Insured - Rs. 4,00,000/-

The following Sum Insured options are available

• Rs. 1,00,000/-• Rs. 1,50,000/-• Rs. 2,00,000/-• Rs. 2,50,000/-• Rs. 3,00,000/-• Rs. 3,50,000/-• Rs. 4,00,000/-



Rating

Age Sum Insured (Rs.)1 Lakh 1.5 Lacs 2 Lacs 2.5 Lacs 3 Lacs 3.5 Lacs 4 Lacs

26 Yrs to 35 Yrs 1488 2231 2950 3544 4200 4794 5375

36 Yrs to 45 Yrs 1700 2525 3275 4000 4650 5325 5800

46 Yrs to 55 Yrs 3107 4390 5807 7102 7870 9438 10992

56 Yrs to 65 Yrs 4104 5856 6800 9252 10300 12848 14101

66 Yrs to 70 Yrs 5723 8481 11041 13557 15983 18380 20626

71 Yrs to 75 Yrs 6133 9175 12010 14811 17556 20236 22802

Benefit Under Section II is restricted to 50% of the Sum Insured under Section I subject to a maximum of Rs. 2 lacs.



Other Benefits

Benefits under Section 80-D of the IT Act

Cashless Service without intervention of TPA

Direct Tie up with hospitals on an All India Basis

24 X 7 In-House Call center

Toll Free Telephone line assistance

Full knowledge based website to offer medical information, including Health Tips

Health Check-up benefits

Frequent health meets to disseminate info on the health related topics


Presentation on Medi PremierExclusions

Pre Existing DiseasesAny Disease contracted during first 30 days under Section I and 90 days under Section II

First 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.)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.)

Hospital registration charges, record charges, telephone charges and such other similar charges.

Non Allopathic shall be restricted to 25% of the sum insured subject to a maximum of Rs. 25,000/- for the entire policy period.



Options not available under Medi Premier As against Medi Classic the following optins are not

available under Medi Premier

• No Claim Discount

• Hospital Cash

• Patient Care

• Family Package Cover

• Group Policy

• Age limits is restricted to 26 to 75 years as against 5 months to 80 years.



Attractiveness of this policy

Lump Sum payment for critical illness in addition to hospitalization expenses

Policy will be in force even after exhausting the full Sum Insured under Section I till the expiry of the policy



Claim 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 Hospital

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



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 Doctor

Bills 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

Claim Procedure (Contd.)



Thank You

Star Health and Allied Insurance Co. Ltd. Presentation on Medi Premier Presentation on MEDI PREMIER.

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Transcript of Star Health and Allied Insurance Co. Ltd. Presentation on Medi Premier Presentation on MEDI PREMIER.