Maximum Star Package Rates

S.No Procedure Name Duration Of Sharing Occupancy/

Stay Single Room A/C General Ward
Single Room Non A/C
E.N.T
Mastoidectomy + Tympanoplasty
1 3
- Including Meatoplasty
2 Fess Bilateral 2
Tympanoplasty
3 2
- All Types of Tympanoplasty Including Canaloplasty
4 Septoplasty 2
Septoplasty with Turbinoplasty for Inferior & Middle
5 2
Turbinates
6 Tonsillectomy 2
7 Tonsillectomy & Adenoidectomy 3
8 Tonsillectomy & Adenoidectomy with Grommet 3
9 Adenoidectomy 2
10 Adenoidectomy with Grommet 2
Uvulopalatopharyngoplasty (UPPP) for Obstructive sleep
11 2
apnea
12 Microlaryngeal excision of Nodule/Polyp/Cysts 1
13 Stapedectomy 2
GENERAL SURGERY
14 Minor amputation 2 to 3
15 Major amputation 5 to 7
16 Guillotine amputation 5
17 Revision of amputation stump 5
18 Open - Appendicectomy 3 to 5
19 Open - Appendicectomy - Pediatric 3 to 5
20 Laparoscopic - Appendicectomy 3 to 4
21 Laparoscopic - Appendicectomy - Pediatric 3 to 4
22 Open - Cholecystectomy 5 to 6
23 Open - Cholecystectomy - Pediatric 5 to 6
24 Laparoscopic - Cholecystectomy 4
25 Laparoscopic - Cholecystectomy - Pediatric 4
26 Circumcision 1
27 Fissurectomy with Sphincterotomy 3 to 4
28 Fistulectomy - Low 3 to 4
29 Fistulectomy - Low - With Laser - Excluding Cost of Laser 3 to 4
30 Fistulectomy - High 3 to 4
31 Fistulectomy - High - With Laser - Excluding Cost of Laser 3 to 4
32 Haemorrhoidectomy - Routine 3 to 4
33 Stapler Haemorrhoidectomy - Excluding Cost of Stapler 3 to 4
34 Herniorraphy - Inguinal - Unilateral 3 to 4

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 Maximum Star Package Rates
S.No Procedure Name Duration Of Sharing Occupancy/
Stay Single Room A/C General Ward
Single Room Non A/C
35 Hernioplasty - Inguinal - Excluding Cost of Mesh 3 to 4
36 Hernioplasty - Femoral - Excluding Cost of Mesh 3 to 4
37 Hernioplasty - Umblical - Excluding Cost of Mesh 3 to 4
Hernioplasty - Femoral - Bilateral
38 4 to 5
- Excluding Cost of Mesh
Hernioplasty - Inguinal - Bilateral
39 4 to 5
- Excluding Cost of Mesh
40 Hernioplasty - Incisional - Excluding Cost of Mesh 4 to 5
Laparoscopic Hernioplasty - Inguinal - Unilateral
41 3 to 4
- Excluding Cost of Mesh
Laparoscopic Hernioplasty - Inguinal - Bilateral
42 3 to 4
- Excluding Cost of Mesh
Laparoscopic Hernioplasty - Umblical
43 3 to 4
- Excluding Cost of Mesh
Laparoscopic Hernioplasty - Incisional
44 4 to 5
- Excluding Cost of Mesh
Emergency Laparotomy (Open / Laparoscopy)
45 5 to 7
- Closure Of Gastro Intestinal perforation
Emergency Laparotomy (Open / Laparoscopy)
46 5 to 7
- Intestinal ByPass
Emergency Laparotomy (Open / Laparoscopy)
47 5 to 7
-Resection and Anastomosis
Elective Laparotomy (Open / Laparoscopy)
48 3
- Lymph Node Biopsy
Elective Laparotomy (Open / Laparoscopy)
49 3
- Intestinal ByPass
Elective Laparotomy (Open / Laparoscopy)
50 3
- Resection and Anastomosis
Lymph Node Biopsy (Cervical / Axillary / Inguinal)
51 3
- Under GA
52 Lipoma - Under GA 2 to 3
53 Perianal Abcess 2 to 3
54 Pilonidal Sinus 2 to 3
55 Modified Radical Mastectomy 5 to 7
56 Simple Mastectomy 4 to 5
57 Breast Lumpectomy - Under GA 1 to 3
58 Thyroidectomy - any type 5 to 7
Surgery for varicose veins saphenofemoral ligation and
59 5 to 7
stripping / sclerotherapy - Unilateral
Varicose veins - Radiofrequency ablation, endovenous laser
60 3 to 5
treatment - Excluding Cost of Laser
OBSTETRICS & GYNECOLOGY
61 Hysterectomy - Abdominal - With or Without BSO 5 to 7
Hysterectomy - Abdominal
62 5 to 7
- With or Without BSO - Laparoscopic

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 Maximum Star Package Rates
S.No Procedure Name Duration Of Sharing Occupancy/
Stay Single Room A/C General Ward
Single Room Non A/C
Hysterectomy - Vaginal
63 5 to 7
- With or Without Pelvic Floor Repair
Hysterectomy - LAVH
64 5 to 7
- With or Without Pelvic Floor Repair
65 D & C with Hysteroscopy 2 to 3
66 Open - Ruptured Ectopic Pregnancy 3 to 4
67 Laparoscopic - Ruptured Ectopic Pregnancy 3 to 4
68 Open - Wertheims 7 to 9
69 Laparoscopic - Wertheims 7 to 9
70 Open - Myomectomy 5 to 7
71 Laparoscopic - Myomectomy 5 to 7
ORTHOPAEDICS
ACL / PCL / MCL Reconstruction
72 5
- Excluding Cost of Implant
73 Menisectomy 5
74 Carpal Tunnel Release 3 to 5
75 Closed Reduction-Dislocation - Minor 2 to 3
76 Closed Reduction-Dislocation - Major 3 to 4
77 Implant Removal - Minor ( Except K-Wire) 1
78 Implant Removal - Major 2
79 K Wire Removal 0
80 Open Reduction - Dislocation - Minor 3 to 4
81 Open Reduction - Dislocation - Major 4 to 5
82 ORIF of Fracture - K Wire - Including Cost of Implant 2
83 ORIF of Fracture - Plating - Excluding Cost of Implant 5 to 7
84 Nailing - Interlocking - Excluding Cost of Implant 5 to 7
85 Fracture Neck of Femur - Excluding Cost of Implant 5 to 7
86 Laminectomy / Discectomy 5 to 7
Spinal Fusion
87 5 to 7
- Where Implant is not going to be used
Spinal Fusion - Where Implant is going to be used
88 5 to 7
- Excluding Cost of Implant
89 Closed Reduction of Fracture Under GA for Major Joints 3 to 4
90 Reduction of Dislocation in GA for Major Joints 3
91 Hemiarthroplasty - Excluding Cost of Implant 5 to 7
92 Total Knee Replacement - Excluding Cost of Implant 5 to 7
93 Total Hip Replacement - Excluding Cost of Implant 5 to 7
94 Dynamic hip screw - Excluding Cost of Implant 5 to 7
UROLOGY & NEPHROLOGY
95 A V Fistula For Dialysis 3 to 5

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 Maximum Star Package Rates
S.No Procedure Name Duration Of Sharing Occupancy/
Stay Single Room A/C General Ward
Single Room Non A/C
96 TURP 5 to 7
97 Hydrocelectomy Unilateral 2 to 3
98 Hydrocelectomy Bilateral 2 to 3
99 Varicocelectomy 2 to 3
100 PCNL + Stenting 2
101 Mini - Perc + Stenting 2
102 URSL lithotripsy - Including Cost of DJ Stenting 2
103 Lithotripsy - ESWL + Stenting - For 3 Sittings 0
104 Hemo-Dialysis - Per sitting 0
105 Cystoscopy & DJ Stent Insertion 0
106 Cystoscopy & DJ Stent Removal 0
107 Cystoscopy - With Biopsy 1
108 Cystoscopy 1
109 Cystoscopy & TURBT 5
110 Orchidectomy - Unilateral 2 to 3
111 Orchidectomy - Bilateral 2 to 3
112 Pyelolithotomy 5 to 7
113 Open - Nephrectomy 7 to 9
114 Nephrolithotomy 3 to 5
CARDIOLOGY
115 ASD Surgical Closure - Open 7
116 VSD Surgical Closure - Open 7
117 ASD Device Closure - Excluding Cost of Device 7
118 VSD Device Closure - Excluding Cost of Device 7
119 CABG 7 to 10
120 Coronary Angiogram 1
121 Angioplasty - PTCA - Excluding Cost of Stent 3 to 4
122 Renal Angioplasty - Excluding Cost of Stent 4 to 5
123 Vertebral Angioplasty - Excluding Cost of Stent 4 to 5
124 Balloon Valvotomy - Excluding Cost of Balloon 3 to 4
125 Balloon Atrial Septostomy - Excluding Cost of Balloon 3 to 4
126 Mitral Valve Replacement - Excluding Cost of Valve 7 to 10
127 Aortic Valve Replacement - Excluding Cost of Valve 7 to 10
128 Tricuspid Valve Replacement - Excluding Cost of Valve 7 to 10
129 Double Valve Replacement - Excluding Cost of 2 Valves 7 to 10
130 Aorto Aorto Bypass with Graft - Excluding Cost of Graft 7 to 10
131 Aorto Aorto Bypass without Graft 7 to 10
Peripheral Arterial Bypass with Graft
132 6 to 8
- Excluding Cost of Graft

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 Maximum Star Package Rates
S.No Procedure Name Duration Of Sharing Occupancy/
Stay Single Room A/C General Ward
Single Room Non A/C
133 Peripheral Arterial Bypass without Graft 6 to 8
Permanent Pacemaker Implantation
134 7 to 10
- Excluding Cost of Pacemaker

Note Forming Part of Agreement:

1) Where procedure charges are inclusive of implants, etc. – the package charges are maximum payable rates for END to END
Treatment, including Room Rent / Nursing / Operation Theatre charges, Doctor’s / Surgeon’s Charges, Asst. Surgeon, Anaesthetist
charges, relevant investigations, Blood & Blood products, Medicines & Consumables for the specified duration of stay and Implants /
Mesh / Prosthesis wherever applicable.
2) Where package quoted is for procedure charges + cost of implants:-
a) The package charges are maximum payable rates for END to END Treatment, including Room Rent / Nursing / Operation Theatre
Charges, Doctor’s / Surgeon’s Charges, Asst. Surgeon, Anaesthetist Charges, relevant investigations, Blood & Blood Products, Medicines
& Consumables for the specified duration of stay.
b) The actual cost of Mesh, Implants and Prosthesis not otherwise regulated by the NPPA and DPCO will be payable as per current
market rates.
c) Cardiac stents, knee implants now regulated by NPPA and such other products that may be regulated by NPPA from time to time will
be payable as NPPA guidelines.
d) In case of imported drugs the amount payable will be that of the Indian Equivalent of the same as per the DPCO capping.
e) If the customer develops complications during hospitalization payable amount shall be modified provided sufficient documented
proof of the same is submitted as justified.
3) The Hospitals to submit specification, invoice and sticker of the implant / Mesh / Prosthesis, wherever used.
4) Cashless authorization will be as per the Terms and Conditions and Limitations of the policy of insurance, including Sub-limits and Co-
pay.
5) This memorandum of understanding is valid for a period of 3 years from the date of acceptance by both the parties.
6) The service provider to abide strictly to all the Terms & Conditions provided in the MOU and the Package charges agreed upon and
not to charge additional amounts either to Star Health Insurance Company or to its customers, over and above the package charges
entered into between the parties.

For Star Health and Allied Insurance Co. Ltd

Authorised Signatory

For Hospital
Name of the Hospital: __________________________________________________________________________________

Address: _____________________________________________________________________________________________

Through Sri/ Smt.___________________ Sign ____________________________Date______________________________

In presence of Sri/ Smt._______________ Sign_______________________Date___________________________________

Hospital Seal :( Mandatory) _____________________________________________________________________________

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