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    184 views20 pages

    STAR HEALTH - Senior Citizens Red Carpet Health Insurance Policy PDF

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    Anonymous User

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    © All Rights Reserved
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    STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED haan mma POM ap. 2 Teno Please check whether the details given by you about the insured persons in the proposal form (Copy enclosed) are incorporated correctly in the policy schedule. Hf you find any discrepancy, please inform us within 15 days from the date of receipt of the policy, faling which the detallsrelatingto the person/s covered would be taken as correc. So.lso the coverage detalls may also be gone through and in the absence of any communication from you within 15 days from the receipt ofthis policy it would be construed that the policy isuedis correct andthe claims if any arise under the policy willbe dealt with based on proposal policy deta STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED Regd, & Corporate Ofc: 1, Now Tank Stoo, VallvarKottam High Road, . Inerance Nungambakkam, Chennai - 600 034. Phone : 44 - 2828 8800 (IN: U6601OTN2005PLC088649 Ema ino@saroathin Webs: wwwtarhealhin IROAI Rog No: 128 Cio me — tly 4 |_ In-patient Treatment- Covers hospitalisation expenses for period more than 2¢ hrs. WANBNC)8(D) ©) neues Antunes Us ester tang anil aT teueiytnreineorhasidnaerdineregeey atl eenenr sR a0 pe | 1) pe watant [2 Potential Eras ado dani Spee w era | © | anata ES we ‘on the sum insure , ®. | Sub-lmits for specific diseases: Refer table Subs fo a under Coverag: a or ay TO TE x 2] Pasrany ten pe pear i engi oer ed 6) 3 | Nenana a 4) cocunas Sy rnw ma ean Suda per ae aoa | yn gon Sian tar ses ewe ae d 3 ee earch nar crc, rahe a ee lo routs sovarinaiyual peice trtednetdeesy medal mer (9,98, 40 tea cnatasoeaee ir ot arg RST ADS aaa \watae Sasori re Feed Uta Sr. lo Sepa, Cad Ei ve major | 7.) Counter Pulsaton Therapy and related therapies, Chetation therapy, Deep Brain Stmulaton, Hyperbaric 32) Exclusions Oxygen Therapy, Rotational Field Quantum Magnelic Resonance Therapy, Photodynamic therapy and 7 heb anes te 8 Wrenn a 9.] Naturopathy Treatment x16) vo | fallen aps sora aos ed app apa apo THO 40 ora i1.] Treatment outside India 6) Th cn gw aor ul Pa a ply daa or opi Senior Czen Re Carpet Heath insurance Poy nique le: \ROANLHLTISHAIPIVINI TONGS 20920 Star Health and Allied Insurance Co, Lt, Clause na. of me Description the paiy Dieses caacied dug the fal 0 daa om te cormanceient da of he polgy { i (cot application renewal ofr azidens) i walng “mnths for spec ines Ging he et 2 years Yama conmancorert dae oa pole - ra applicabe subsequent renenal) 38) Pre exiting diseases: wating paid of 2 months y Pajet Cashes of embursemen of covered exenaes up othe speed init TRIB) co 50% foal Preisng cans and 20% oral oer airs 45) sharing [Room Rent Exceeding ofthe um insured or Rs A000 per day 1) Renewal [___ng reeves opayen of erewa reno ttre ba ede Contos | ___ Gee pro of 30 days or renewing the poigy Th Be event of oy wihrawnmadfd with evades andlor premium wih por approval othe 410) Competent autorty Enhancent of som nse atthe eof renewal Renewal ‘Heath Cnskup Renal Beets Benefits: Cumaatve Bonus Heath Check up Not vite “au.,| __ Poleyean be canosied on grounds of msepresentaon, fad, non dadosure of male acl as decared Canceaton] in propsalfrm at ete of cam, cr on-co-aperaon by he sured parson, bysendngtheinsed | (1) 4 days note without refund of preium [LEGAL ISLA) NOTE Th rtormadon mtb adn conus wh prod rhe and poy daca ae of any col xine {ots nown Customer oman re adh ply acum ms an conons mara n ply acon sha rv Senor Cizns Red Carat Heath insranea Poy nique le: \ROANLHLTISHAIPIVINI TONGS 20120 Star Health and Allied Insurance Co, Lt, Poly Wordings vn ReGd & Carport Ofc, Now Tank Steet, Vln Koln High Road, urge, Chae - 690034 | STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED 2 UROETCHOSFLCOAE EnalefoBetesth Nabe wwattashin ROW Rep Net ae aura oe ea Lael (ong \Unsue l: RDAINL-HLTISHAIPIVIVH24 The proposal and declaration given by he proposer and ther document i any sal be the basis ofthis Contract and is desma tobe incorporated herein Inconsideraion othe premium pid, subjectothe terms, condor exclusions and deitons contained herein he Company agrees as unde: Thal ing the pti stated in the Sched the insured person shal conract any ease or sll rom any ness or sustain body jury trough sccdent and if such seas, nese o ny shall rogue the insued Persons, upon the adie ofa duly Qualified Physcanadcal Specs Madical Practitioner or of uly Qualifed Surgeon incur Hosptazationexponsos for medica surgical eatment alan Nursing Homa Hospital. Inaiaas.an inpatient. th Company wi pay the Insured Parsons the amount of such expenses a ar reasonably and necesariyincured uptothe limitsinacatesbutnotoxceedng he sum nsuredn aggregate nany one period siaedinte schedulehect, tees ‘A. Room, Boarding and nursing expenses as provided bythe Hospital / Nursing Home at 1% ofthe sum insured subject oa rbaximum of Fs 60004 parday B._[CUcrargesupto 2% ofthe sum sured per day. (C. Surgoor, Anaesthas, Medical Practlone, Consular, Specials Foes subjct fo @ maximum of 25% of the sum insured por hospialsaton 1. Anaesthesia, Blood, Oxygen, Operaon There charges, Surgical Applances, Medicines and Orgs, Dagnosic Males and X-ay Dials, Chomothorapy, Rattheray, cot of Pacamaker and similar expanses subject @ maximum of 6% of ho sum insured per hosptalsaten With regard to coronary stnng the company witpay such amount upto he extent of cost of bare metal send elting cobalt crorium senarug ung tanless telson Emergency ambulance charges up-oa sum o Re 60-perhosstasalon and Rs. 1200-per ply period fr ransporaton ofthe insures person by privat ambulance sevice when thi speeded for medical easonsn go to hosptal for retment provided such hosplalsaton claim's admsiblo under hePoly. F. Asam equivalent to 7% ofthe hospitalization expenses cured comprising of Nursing Charges, Surgeon! Consulant fees, Diagnostic charges, Medicines and drugs enly subject o @ maximum of Re 5,000 per eccuttence towards post heepakaton medical expenses whereverteconmendedby the attending Metical Practioner Expenses on Medical Consulaton as a Out Patient incuredina NetacrkHospaluptothelinits mentioned th tbl gen limitof®s.200)-per consulation. Payantunder bs beneftwilnetreduc th sumnsuredandis payable ni when he poly in fre, low wih ‘Suminsured(Ra) Limitperpotcyperiod(Rs.) 700,000 NotAvalable 2.00000 3.00000 | ooo 490000, 200 500.000 1000 7.50,000 "200 1o,00,000 ‘400 Note: Expenses on Hosptization fr minimum poi of 24 hours ae admissible. Howevar hie i it wl ot aly fr Diss, Chemotherapy, Radiotherapy, Cataract sugey, Dena Suge Litotipy[Kitney stone removal) Tnsiecomy, Cuting and Draining of Abscess, Live Aspiration, PuzalEfusonAspaton, Colonoscopy, Slrtheraphyakenin the Hosplal Nursing Home and the Insuredisschagedonthe sa day. Senior Czen Re Carpet Heath insurance Poy nique le: \ROANLHLTISHAIPIVINI TONGS 3ot20 Star Health and Allied Insurance Co, Lt, Polley Wordings The amountpayabe respectotthefollowingvestmentisupothelimtmenionesthee-against Lhotisy (dn ston removal) -R.20 000 Tonsiletomy-Re7 Ccutingand Orang ofAbscess-Re 1,500 LiverAspatin- R200 Poul fusionAspraton-Rs.2, Calonoscony-Rs 2 Scloroneraphy-Rs 5.0004 Not 1. Chemotherapy Raciterapy salam pate sb-imtsforestmertot cancer as mentonadbslow, 2, Dias shalt partofb subs frteatmento Renal omplcatons as mantaned bow Proviesthewaveroftheminemum prod 24hurshospatsationlimtedtothe abovenatdeatmens ol. Theexpensespayeblein during the entire poly paiadinrespectottefollowing Sseaseslcondtnsis ied thearountmentioned there agains Sum Insured Rs. | 1,00,000/- | 2,00,000/- | 3,00,000/-| 4,00,000/- | 5,00,0001- | 7,50,000/- | 10,00,000/ Particulars Limit of Company's Liability Rs. Cataract +5000 | 15000 | 18.000 | 20,000- | 21,5007 | 23,000 | 25,0000 Corebro- vascular Accident 75,0001- | 150,0001- | 200.0001. | 225,0001- | 275,000/- | 300,0001- | 360,0001- Cardiovascular Diseases 75,000!- | 150,000'- | 200,000/- | 226,0001- | 275,000/- | 300,0001- | 360,000 Cancer 75000 | 150,000'- ] 200,000/- | 226,0001- | 275,000/- | 300,0001- | 360,000 Treatment for Breakage of Bones | 75,000/- | 150,000/- | 200,000). | 225,000/- | 275,0001- | 300,0001- | 360,000). Renal Complications] 75,000/- | 150,000 | 200,000 | 225,000. | 275,000. | 300,0001- | 360,000. ‘Allother major surgeries 60,000 | 120,000 60,0001. | 200,000 | 226,0001- | 260,0001- | 275,0001- Note: Company’ aby respect ofl clams admted during the period of ns Schedule. hal io exceed the Sum insured por person meaned inthe Exponsesrelatingtotshospalizatonwilbecon /Accldent/Aceidentalmsans a suden, unforeseen andinvlunar even causedby extemal, vsibleand violent means, ‘Any on llness mans continous pod filles adil includes relapse wihin 45 days om hada oft consult wh the HosptalNusing Hore whore teatrentmayhave beentaken Cashiess Service means a eit extended by he insur: tothe insured where the payments, of the cost of treatment undergons bythe insured in accordance withthe polcy lems and conditions, re directv madetothe eter providery the insurer the extentpre-auhorization approved Company nars Sts Haath andAsedneance Company Lintad Condition Precedentmesnsthe poly r conn upon michthsinsure Ebi ode hepolcyis condos upon Congentlinteralmsans congenital anomaly hich’ snotnthe sible andaccessibl parts othe body Congenital Extemalmsans congenital ramaty whch sinishe and accessblopars othe body CCo-payment i @ cost shaing requitement under a health insurance poly that provides tat he ins Senior Czen Re Carpet Heath insurance Poy nique le: \ROANLHLTISHAIPIVINI TONGS 40120 Star Health and Allied Insurance Co, Ltd. Polley Wordings missle deim amount co-payment dos notreduce the sum insured. Contributions essenally height ofan insurer ‘o cal upon oer insures abe tothe same insured to share the cost ofan inden ism ona ‘aleableproporionof sum nsurd. Tis cause shallot apply lo ary Beef ofeedonfredbenettbass, Day Care Centre means any nstuton etashed for day care eatment fies and/or ora moda setup within hospital and wich has boon ogitered wth thelacalauhortes, wherever appicable andis under the supenison ofa Rogitard and Qualfd Medical Practone and mut omy wihall minimum tera as unde: as qualfed pursing staftundertseesoymont has qualfed mesial practtonerisin charge; has afl equppedoperaton hate ofits own where surialprocedues are caradou !anans daly records ofpatants andvllmakethate acessboto he surance company's authored personal Dental Treatment means a teatment cored out bya dental pracitonerincuing examinations, lings (where appropriate), crowns, exactions ané suger excutingany foro cosmaisugeryimpans Day Care treatment nsans medical eatment andlor surjcal procedure whichis undertaken under General or Local Anestesainahospialay cro conteinlesstan 4 hrsbocaus of technological advancement and which wouldhavechervseequredahospalzation of ore than2¢ours reatmentnormaly lakenonanout-ptent basisisnotincuded nthe copect this definton Diagnosis mearsDiagosishy aejstord medical practitioner, supported crea adlogcal and histological histo pathological andlaboralay ‘evidence and also surgical evidence wherever applicable, aoceplable tothe Company Disclosure to information norms moans the poy shal bo vid anal premium plé hereon shal be fered tothe Company, nthe event of mis- ‘epreselaton, mis dscripionornon disosue of any mall act Grace Period means te specfed period ofimeimmedaey folowing premium due dat during which the payment canbe made to renew or continue ‘he policy nore wihoutlos ofcontiruilybenefts such as waiingperodand coverage of pre-existing diseases, Coverageis ot avaiable forthe peri lorwbichnopremiumisreceved HosptalNursing Home means any institution estabishad for in paint care and day care eatment of lness andor injuries and which has been regjtered asa hospital wih te ocalauhores under te Civica Estabishments (Rgisrabon and Regulator) Act, 200 or under the enactments speciieunderthe Schedule of Secton Sf hess Actorcompbes wihal minimum citer asunder 4. Hasqualiodnursing sta underis ompaymertround th cock . Hasatieasiinpatientbeds in ownshaving popuitonolesthan10,00000and ales! Sinpatlonbedsinal other places ©. Hasquited mesial practtonrsinchargroundthe dock, 4. Hasafulyeqippedoneraton thet ofits ownwhere surgical procedures are caridout ©. Mainline diy ecorsofpatens and makestheseaccesieltheinsurance company auborzedpersenn Hospitalization means atissonina hospital fr aminimum period o 24in patent care consecutive hous excepto specified proceduestreatment ‘here suchachissoncoulbetorapeadotlss than? consecutve hours. less means sickness ora disease or pathological condton eading the Impatmentof natal phylgical incon whichmanestsisl during the oc period and requresmedicalretment Injury means accent physical bdilyharm excusing lessor seas solely and rely causedby extemal vent andvisble and evident means whichis verldandcerted by aMedica Prectiionr InsuredPerson neansthenamelsofpersonls showninte schedule ofthe Poy. In-Patient mens an Insured Person whois edited to Hospital and stays there fra mirimum pared of 24 hour forthe sole purpose of recsving treatment, Intensive Care Unit means an iden secon, ward or wing of hosp whichis under the constant supension ofa deeated medica practioner), an which s special equipped forthe contnucus montorng and teatment of patients who arein acca condton, requir Ite suppor faces and wherethelevelofcare and supersionis considerably mor sophisticated andinersiv han nheordnaryandoher wads. Major Surgery means Irtestnalebstucton acute subacute cron, ile Pancreat surgery, Gast Intestinal surgeries, TotalKnee Replacement Serio Cinzens Re Carpet Heath insurance Potiey Unquo le: ROANLHLTISHAIPVIVI TAGS 50120 Star Health and Allied Insurance Co, Lt, Polley Wordings ‘surgery, Toa Hip Replacementsurgery, thermo surges oon, Hem-Ortwo Pasty suger, Sugorieson Prosate, Surgery elatedto Genito rary Trac ‘Medical Advise means any consukaonor advice tom aMadicalPractonerincludng tha issue of en presrpion or epeatpresciton, Medical expenses moans those expenses thal an Insured Person has nacessaly and actualy inoue for medicalreaenton account oflinassor Accident on the adie ofa Medical Practione, slong as these reno more tan would have been payable the Insured Personhad not been insured ‘anno moran oherhosptalsordocorsin the samelocasty wouldhavecargedorthe sama medicalireabret Medically Necessary moans any ratrent, lets, medication or slay in hospital or part ofa stay ina hospi which is requced fr the modal rmanagerant of the iess or jury ered bythe Insured must nl exceed the lve of are necessary to provide safe, adequate and appropri ‘medica caein scope, duration orintnsty -nusthave been prescribed by a Medica Practoner-mustconfamtothe professional standards widely ‘aozeptdininemationalmedca racic ory hemedca community inna ‘Medical Practitioners a person who hos valid regstaton fom the Medial Counl fan Sat or Mekal Cou of int Coun fr Indian Medicine ofr Homeopathy stu bythe Gvernmentaf nda ora Stale Goverment ands tharaby ented oprate medicine wiv sure andisactingwihintne scope antjusdcionofcance. "Network Hospital means l such hospas rather providers thatthe Company have mutually agreed wi, to provid saves tke cashless accesso poleyelders, Thelitsavalable wih the Company andsubjecttoamendmentromtmeto tie. "Non Network Hospital moans any hospital other oo shatisnotpartofthe network Notitcation af elaimis the process of nltyng claim tothe insurer by spectying ths inlines as welas he adress lelephonerumbertowhichit shouldbe noted. (ut patient treatments nein hich te Insured vss a cinichositl or associated fc ikea consutaton rom for agnos's andtreatmentbased ontheadvice of amedal practone: Theinswedis not adnitedasa day car orn-patont, Pre-Esatng Disease means any Condon, iment or jy read for wich the insured person had signs sya, andr was lagnosed, andr recived medica adc veatentwitin 48 montspriottotheinsuredpersons frst poliy wih any Ian insure ton PostHospitalization: means medica expenesincured immediatly arth insured parson is schargedtrom the hospital provided 4. Suchmedica expersosareincuredforte sare condon for whchtheinsuredpasor'shorpalzatonwasequrdand 8. Theinpatonthosialzation clam or suc hospitalizations admissible by tensurance company Portability means tan‘ by anindvdual heath insurance policyholder (nung amily cove ofthe cet ganas boundexclusionsiheshechoosestoswch moreinsurertoanohe, for proiting conditions andtine ‘Qualified Nurse means apersanwho held valid reisaton fromthe Nursing Cound ota othe Nursing Counc any statin india, Reasonable and Customary charges. means tho charges for sonvioes or suppls, which are tho slandar charges forthe spec provder and consstertwth the prvaiingchargesin the geographical areaforidencalorsimiarsenics, akingintoaccounthenatueothelnessinjuryinvohved Renewaldeines the esen which heconract insurance canbe renewed on mutual consent wih provision of tae pera forteatingthe renewal continuous forte purpase ofall wating periods Room Rentmeans the aroun charged the hospital occupancy ofa bed onper day (24hrs) basis an shalinclude associated mesicalexpenses, ‘Sum Insured means he Sum nsuredoplad or andor which he promium spi ‘Surgry/Surgeal Operation means manual andor opraive proved (5) required orteatment oan ness onary coecton of defomies and ote, agnosisand cure of diseases, eof seringr prolongation fife, perfrmedina hospital day cae cenby amesicalpractioner UnprovenlExperimental treatment Tratres treatment experimental orunproven, oot ‘The Company stall ot be iat to make any payments under tis pole n respect of any expenses wha o ver ncured by th insured person in connection orinespectt: luting rug experimental herapy which is not based on established madcap 1 Pra Bxting Dsuases 25 deed inthe poy unl 12canseculve months of continuous coverage ha polcy with an nan insurer. psd, since i pono the fst Senior Czen Re Carpet Heath insurance Poy nique le: \ROANLHLTISHAIPIVINI TONGS Goi20 Star Health and Allied Insurance Co, Ltd. Polley Wordings 2 ‘Any disease contracted by te insured parson during the est 30 days rom the conmencemenl dat of his ploy. This exlson shall nat applyincas of insured person having boon covered under any hea insrance poly (individual or Group Insurance pai wit any of theloian Insurance comgaies fora continuous perodof preceding 12months wtoutabreak. During the fet woyearscf contauous operant bs Snir Citizens Red Carel Hea Insurance Poy any expenses. on 8) Cataract, Gaucoms, Diseases ofthe anteor segment and posteor segment ofthe eyes, Al Diseases related to ENT, Diseases ‘ated lo Toyo Prolapse of orvetbral ds (eter than caused by aciden), Varicose veins ad Varcose ulcers, ll diseases of Proslate,StictureUretva al ypos ot Hema, Varcocele, Hydrocse,Fsua/ Fssurein ao, Honoris, Pina Sins and Fistula, RectalProlapse, Stes Incontinence ané Congenital namal disease dafoc, 1b) Gal badder and Pancreat diseases and al veatmens (conservalve, interventional, laparoscope and open) related to Hepato- pancrelobllay ees inclusing Gall badder and Pancrealc calcu. Al ypes of management fx Kidney and Genito-uinay act call )_Alltreatments (conservative, iterentona laparoscope and oper related to all dseases of Uterus, Fallopian tubes, Cenix and (Ovaries, DystnctonalUlerine bleeding Pave ntammatory diseases, Borign breast diseases. 4) Conservative, operative treatment and allypesofinterventon for diseases reatesto Tendon Ligament Fascia, Bones andjonother thancausedby accent 6} Degeneraive sc and Verbal diseases including replacemant of Bones and Joins and Degenerative diseases of he Musculo- skeltasystom ‘Subcutaneous benign lumps, Sebaceous cyst Dermoideys noma, Newofbroma, Foo adenoma, Gangion ant snla pathology 4) Anytansplantandroatd surgery “This wang perad shall ot however apply in he case ofthe Insured parsons having been covered under any Indivdual heath Insurance scher wth anyoftheleian Insurer fora coninueus peed of receding 24 months wihoulary break. Creumcision except where medically necessary), Ineculaton or Vacsinaton excepto pos-biereament and ormedcaltrstment ther ‘hanfor prevention fcseases) Dentateatment (unless necessitated due tn accidental ues andrequtinghospitaizaton),any fom ofcosreticsurgeryand/orimplants CComvalescenca, General deity, Rur-down canon or rst cu, Nuttonal defloncy states, Peychitc, Mental and behavioural dsorar, Congenital extemal deat or defects ot anomats, Venareal disease and Sexual Tansitod Diseases, tenons ijury anduseofitxicating rags alcoho smokingandtobaco chewing, Injunidiseasedrecty orindkecty caused by orang rm or at-butaba to way, vasen, acto oregn enemy warskecperatons (whether arbedecarederral) Inuryordsease rectly orindacty cavsedby or conte toby nuclear weaponsimaterals “Treatment arising rom or raceable to pregnancy, cidith, miscarriage, aboron or complications of any of hese (ln than ectopic pregnancy), fail planning reatrentandallypescf treatment forinferly andi compicatons hea Expenses incuod on weight conto servos inducing surgical rocadues fr teatment of obesity, matical teatment for woight convo, testmentfor metabolic genet and endocine disorder. ‘Alaxpensesarsing outta condo rect onde caused du or associated wih huranT-

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