Star Group

Novel Coronavirus (nCoV) (COVID19) Insurance Policy

Policy No: C/DEL/161219/01/2020-21/000181

Issuing Office Code: 161219

Issuing Office Name: Branch Office - Shalimar bagh
Address: E-27, 1st Floor Hauz Khas New Delhi- 110016
Email Id: Shalimarbagh.bo@starhealth.in

Period Of Insurance: From 14 August 2020 00:00 Hrs To Midnight Of 13 September 2021 23:59 Hrs

Fulfiller Code: SH36518

Risk Coverage Details

Sum Insured: INR 3,00,000/- per family
Uniqui d: SHAHLGP21003V012021
Policy Schedule

Family Floater Basis - Employee, Spouse, Children and

Parents Only (As covered in firm’s Health Insurance
Policy for FY20)
Family Definition
Age Limit: 18 years to 80 years for Self, Spouse and
Parents.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd

Place : Shalimar bagh

Date : 03/09/2020
 Star Health Contacts
Matrix Name Mobile No. Email
Primary Contact Rohit Sharma 7042533994 mhl.claims@starhealth.in
1st Point of Escalation Nishtha Arora 7827886733 Nishtha.Arora@starhealth.in
2nd Point of Escalation Mansi Kher 9899347471 mansikaher@starhealth.in

Matrix Name CUG / Mobile No. Email

Rashmi Sharma 9650884676 Rashmi2.sharma@in.ey.com
Primary Contact Sumedha Kalan 9818764457 Sumedha1.Kala@in.ey.com
Roohan Nijjar 9953537890 Roohan.Nijjar@in.ey.com
1st Point of Escalation Sachin Kathpal 9871389761 sachin.kathpal@in.ey.com
2nd Point of Escalation Latesh Arora 9818033004 Latesh.Arora@in.ey.com
rd
3 Point of Escalation Anand Parab 9820507010 anand.parab@in.ey.com
 Special Conditions

Waiting Period Initial Waiting period of 15 days from commencement date of policy.

Intimation Period Intimation to be sent within 24 Hrs of Hospitalization.

Room, boarding, nursing expenses as provided by the Hospital / Nursing
Home at single standard Ac room per day for normal and ICU at Actuals.
Expenses relating to the hospitalization will be considered in proportion to
the room rent stated in the policy.

Treatment in our network hospitals only, However , in the case of Medical

Room Rent limits including
Emergencies & Accidents treatment can be taken in other Hospitals. In all
Boarding, Nursing Charges etc.
cases immediate intimation shall be given to our Call Center within 24
Hours of Hospitalization.

Medical Practitioner, Consultants, Specialist Fees, Oxygen, ICU Charges,

Ambulance Expenses limits:
Pre & Post Hospitalisation limits:
Coverage:
Addition/Deletion of Employees
medicines and drugs, diagnostic materials and X-ray, diagnostic imaging
modalities and similar expenses are allowed as per Hospitalization package.
Emergency ambulance charges up-to a sum of Rs.750/- per
hospitalisation and overall limit of Rs.1500/- per policy period for
transportation of the insured person by private ambulance service when this
is needed for medical reasons to go to hospital for treatment provided such
hospitalisation claim is admissible as per the Policy.
Relevant Pre-Hospitalization medical expenses incurred for a period not
exceeding 30 days prior to the date of hospitalization, for the disease/illness,
injury sustained following an admissible claim under the policy.
Post–Hospitalization expenses incurred up to 60 days after discharge from
the hospital.
If the insured person shall contract and is diagnosed with Novel Coronavirus
(nCoV) (COVID19) at first instance after inception of policy and requiring
Hospitalization in India, then the Company will pay Hospitalization expenses
incurred up to sum insured on Indemnity basis.
After the inception of the Policy, NO mid-term inclusion of any employee or
dependents will be allowed.
The coverage under the policy in respect of the insured persons will cease
once they cease to be an employee/ member of the Insured or on the expiry
of the policy, whichever is earlier.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Shalimar bagh

Date : 03/09/2020
 Claims will be settled by in-house claims team.

· Exclusion : If the insured person travels outside India during

the currency of the policy mentioned in the proposal clause
stands waived off.
· Exclusion : If the Insured person has travelled (within or
outside India) within 3 months prior to commencement date
of this insurance, as mentioned in the proposal, the clause
stands waived off.
· Home care treatment, when patient is advised treatment at
home for mild symptoms shall be allowed with the limit of INR
10,000/-per person basis actual expense and not exceeding
Other Conditions: 15 days per policy period. The eligible criteria factoring in
guidelines issued by AIIMS, ICMR, Ministry of Health and
various State Governments arrived at, as under:-

v Patients with Mild symptoms whose COVID19

PCR test positive.
v Advised for home treatment by treating Physician
in his/her letterhead.
v Availability of telemedicine facilities in the hospital
to monitor the home isolation patient.

All other terms and conditions as per Star Group Novel

Coronavirus (nCoV) (COVID19) Insurance Policy Clause.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Shalimar bagh

Date : 03/09/2020
Sector Classification

Urban

The cover for the persons covered earlier under the group policy will be granted only as
per standard retail policies. However, in respect of persons who have been covered
continuously for a period of one year under the group policy with our Company, we shall
waive the 30 days waiting period and First year exclusions. In respect of persons who
have been covered continuously for a period of two years under the group policy with our
Company, we shall waive the 30 days waiting period, First year exclusions and First two-
year exclusions.
In respect of persons who have been continuously covered for a period four years under
the group policy with our Company, we shall grant cover for Pre-Existing diseases also.
Attached to and forming part of Policy No :
Condition precedent: In the event of any claim under the policy or intimation should be given to
the
company immediately, through toll free no: 1800 425 2255 or 1800 102 4477, 044 2826 3300
(chargeable),
or email: support@starhealth.in or fax - 1800 425 5522.
STAR value added unique services: Web enabled service for Policy details and health tips
Inhouse Cashless facility for treatment at network
hospitals across
India.
24*7 customer care center
Free General Physician advice
Warranted that in case of dishonor of premium cheque(s) the Company shall not be liable under
the policy
and the policy shall be void bainitic (from inception).
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as
per forms
attached.

Entered by : SH36516 for Star Health and Allied Insurance Company Ltd.

Place : Shalimar bagh

Date : 03/09/2020
Documents Requirement
Hospital.xlsx

1. Hospital Network List attached & Link enclosed. https://www.starhealth.in/network-hospitals

2. For Cashless benefits:

· You may take your policy number to the network Hospital list is enclosed.
· Please tell TPA desk to send the pre auth documents to the below e-mail ID:
· Cashless.network@starhealth.in
· Cashless.gmc@starhealth.in
· mhl.claims@starhealth.in
· Nishtha.arora@starhealth.in

Pre auth & discharge note will be approved as per the documents sent

3. Required documents for Home Quarantine:

GMC CLAIM
FORM.pdf
We are enclosing the claim form as well, please fill in Part A for the same.

v All prescriptions & Consultations.

v Medicines Bills
v Treating Medical doctor Certificate
v Sanitizers & Gloves.

Further any other reports or testes recommended in proportion to the treatment continued for COVID you
may please submit.

We request you to send all the scan documents as of now to us for further perusal along with Cancelled
cheque of the proposer With Name printed.

4. In case, if you have been Hospitalized then the following documents are required:

· Discharge Note
· All Medicines & Consultations
· Final Bill
· Payment receipt
· Detailed ICP Papers
· All investigation reports.

Further any other additional document might be asked in concurrence to the Medical scrutiny for the
treatment done.

Please send the Physical documents to the below address:

To ,
Nishtha Arora
Star health & allied insurance company Ltd .
E – 27, 1ST FLOOR , HAUZ KHAS, New Delhi - 110016