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Comprehensive Health Insurance Plan

This document summarizes the coverage provided by the Star Comprehensive Revised health insurance plan, which includes: 1. Hospitalization coverage (Section 1) for individuals ages 3 months to 65 years with sum insured options from Rs. 5 lacs to Rs. 25 lacs. It also covers pre- and post-hospitalization expenses, day care procedures, domiciliary hospitalization, and ambulance charges. 2. Maternity and child coverage (Section 2) including normal delivery, caesarean section, and coverage for newborn children with certain benefit limits. 3. Outpatient dental and ophthalmic treatment coverage (Section 3) with certain limits provided every 3 years.

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820 views2 pages

Comprehensive Health Insurance Plan

This document summarizes the coverage provided by the Star Comprehensive Revised health insurance plan, which includes: 1. Hospitalization coverage (Section 1) for individuals ages 3 months to 65 years with sum insured options from Rs. 5 lacs to Rs. 25 lacs. It also covers pre- and post-hospitalization expenses, day care procedures, domiciliary hospitalization, and ambulance charges. 2. Maternity and child coverage (Section 2) including normal delivery, caesarean section, and coverage for newborn children with certain benefit limits. 3. Outpatient dental and ophthalmic treatment coverage (Section 3) with certain limits provided every 3 years.

Uploaded by

vinujohnpanicker
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
  • Hospitalization: Details the hospitalization cover, including room options, post and pre-hospitalization coverage, and exclusions.
  • Options: Describes the options related to who can buy the plan and pre-existing medical conditions coverage, including senior citizen policies.
  • Additional Cover: Provides information about additional benefits such as newborn baby cover, major illness coverage, and waiting periods.
  • Automatic Restoration: Discusses automatic restoration of sum insured after hospitalization claims.
  • Optional Benefits: Explains optional benefits available for policyholders, including personal accident cover and second medical opinion.

STAR COMPREHENSIVE REVISED

AGE AT ENTRY 3 Months To 65 Years


WHO CAN BUY INDIVIDUAL / FAMILY FLOATER
RENEWAL Life Long
PRE-MEDICAL
Age 51 years & Above for All Sum Insured at Company's cost
TEST
SI OPTIONS 5L, 7.5L, 10L, 15L, 20L, 25L
Consultation OP in Network Hosp
Hospitalization Single Standard A/C ROOM
every year

Pre H-30 Days & Post H-60 Days


Pre & Post Hospitalization 5L - 1200
without sub limits

Day Care Procedures 405 Day Care without Limits 7.5L - 1500

Domiciliary Hosp 3 Days & above Covered * 10L - 2100


SECTION-1
HOSPITALIZATION
Per policy period Rs.
Ambulance Charges 2000/3000/3500/4000/4500/ 5000 (As 15L - 2400
per SI)
AIR AMBULANCE 10% of SI (For SI 7.5 Lacs & Above 20L - 3000
For SI 5 Lacs 50% on 1st renewal
No Claim Bonus 100% on 2nd renewal. For SI 7.5L & 25L - 3300
above 100% on 1st renewal
Note: Rs. 300 per consultation for regular OPD in network hospitals only

SECTION 2 - Delivery & New Born Baby (Coverage includes congenital internal & external defects also)

Waiting Period: 36 months for the first delivery. Between two deliveries 24 months waiting period is applicable
SECTION-2
MATERNITY &
SUM INSURED Normal Delivery Caesarean
CHILD COVER 5L 10000 15000
7.5 L 20000 40000
10L To 25L 25000 40000
Coverage for New Born Child : 50000 for SI 5 Lacs & 100,000 for 7.5L & above
Vaccination Expenses foe new born child : Upto Rs. 1000/-
SECTION 3 - OP Dental & Ophthalmic Treatment
Waiting period: 36 months. Once in every block of 3 years & other one is regular OPD irrespective of claim
condition

OPD/DENTAL amount
SECTION -3 OPD SUM INSURED payable after every 3 NOTE
DENTAL & years
OPTHALMIC
TREATMENT 5L 5000
Dental: Gingivectomy, Root Canal Braces, Teeth
7.5L 5000 Whitening, Cavity etc.
10L 10000
15L 10000 Ophthalmic: Eye check up, Contact Lenses
20L 10000 & Spectacles etc
25L 10000
SECTION 4 - HOSPITAL CASH BENEFIT
Max 7 Days per hospitalization (Time excess one day) & 120 Days during the policy period
SECTION - 4 SUM INSURED Limits per day
HOSPITAL CASH 5L 500 NOTE: The benefit is provided if there is an admissible claim
7.5L - 10L 750
under SEC-1 only.
15L - 20L 1000
25L 1500
SECTION 5 - HEALTH CHECK UP - After continuous coverage of a block of 3 claim free years
SECTION - 5 SUM INSURED Limits per day
HEALTH CHECK 5L 5000 NOTE: The amount is reimbursed on submission of
UP 7.5L - 10L 7500 prescription, bills, report copies, receipts
15L - 25L 12000
SECTION 6 - BARIATRIC SURGERY On Cashless Basis only
Claim is payable for Bariatric surgeries after 36 months from the inception of the policy & will be a part of SI under
SECTION - 6 - Section-1
BARIACTRIC
SURGERY Maximum Limit for surgery is 2.5Lacs per policy inclusive of Pre & Post Hospitalization, Opinion by 2 qualified surgeons

Age at the time of surgery should be more than 18 years & BMI above 40+
SECTION - 7 SECTION 7 - FREE PA COVER For Age Group 18 to 70 Years
PA COVER PA Cover is provided to one nominated member Proposer OR Spouse (Not for Dependent Children)
Equal to SI for Accidental Death or 11 named
100 % for Death Or Permanent Total Disability
Disabilities
SECTION - 8 SECTION 8 - OPTIONAL BENEFIT FOR SECOND MEDICAL OPINION FROM DOCTOR IN COMPANY'S NETWORK
OPTION FOR This should be specifically requested for by the Insured Person
This opinion is given without examining the patient, based only on the medical records submitted
SECOND MEDICAL
The second opinion should be only for medical reasons and not for medico-legal purposes
OPINION
Utilizing this facility alone will not amount to making a claim & will not affect NCB
AUTOMATIC Available up to 100% for All S.I after exhaustion of Basic SI
RESTORATION
Not allowed for same person same reason
DAY CARE List of 405 Named Day Care Treatments

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