Family Health Optima Insurance

Family Health Optima

When a family member is ill, it is a traumatic time for the rest of the family. Star Health provides Family Health Optima to protect all members of a family from financial setbacks in the event of a serious illness. The coverage is applicable equally to all members of the family.

Family Health Optima Benefits

• Hospitalization Cover: This would protect the insured person for in-patient hospitalization expenses for a minimum of 24 hours. These expenses include room boarding expenses to a maximum of Rs.1500 per day in Class A cities, Rs.750/- in Class B cities or Rs.500/- in other locations
• Nursing expenses
• Surgeon's fees, Consultant's fees, Anesthetist and Specialist fees
• Cost of blood, oxygen, diagnostic expenses, cost of pace makers etc
• Cost of medicines and drugs
• Emergency ambulance charges for transporting the covered patient to the hospital up-to a sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period

Additional Benefits

• The sum insured floats among the family members insured. In other words there is no need to take insurance for each member separately for separate sum insured
• Thus there is considerable premium saving

Family Includes

• Family would mean proposer, spouse, dependent children upto 25 years and those who are economically dependent on their parents

Pre - and Post Hospitalization cover

• Pre-hospitalization Medical expenses up-to 30 days prior to the date of admission or post-hospitalization calculated at 7% of the hospitalization expenses (excluding room rent) subject to a maximum of Rs.5000 is payable

Discount

• A discount of 10% on Premium is allowed on renewal of the policy if there is no claim in the immediately preceding year of the policy. This discount is not cumulative

How much to pay?

• If you are above 50 years of age and are interested in buying this policy, Contact Branch Heat +91 94421 57522 Star Health Office or Call us at Phone No. +91 99946 12916, +91 90430 32916, +91 93631 18365 or SMS us at 090922 77712.

A: Adult C: Children upto 25 yrs. NA: Not Available
Year is Age of senior most family member.

Sum Insured : Rs. 1,00,000

5 Months - 45 Yrs 46 Yrs- 50 Yrs 2A 1765 NA 1A + 1C 1515 NA 1A + 2C 1640 NA 1A + 3C 1785 NA 2A + 1C 1890 NA 2A + 2C 2025 NA 2A + 3C 2165 NA

Sum Insured : Rs. 2,00,000

5 Months - 35 Yrs 36 Yrs- 45 Yrs 46 Yrs- 50 Yrs 2A 2890 3140 5535 1A + 1C 2715 3005 5265 1A + 2C 2835 3075 5410 1A + 3C 3085 3415 5715 2A + 1C 3295 3555 5925 2A + 2C 3455 3675 6450 2A + 3C 3625 4060 6795

Sum Insured : Rs. 3,00,000

5 Months - 35 Yrs 36 Yrs- 45 Yrs 46 Yrs- 50 Yrs 2A 3985 4360 7605 1A + 1C 3710 3940 6930 1A + 2C 3825 4110 7160 1A + 3C 4125 4440 7630 2A + 1C 4190 4830 7865 2A + 2C 4310 5110 8400 2A + 3C 4615 5320 8710

Sum Insured : Rs. 4,00,000

5 Months - 35 Yrs 36 Yrs- 45 Yrs 46 Yrs- 50 Yrs 2A 5195 5565 10510 1A + 1C 4750 5070 9660 1A + 2C 4910 5250 10150 1A + 3C 5365 5725 10980 2A + 1C 5295 5775 11270 2A + 2C 5645 6240 11870 2A + 3C 6025 6540 12585

Sum Insured : Rs. 5,00,000

5 Months - 35 Yrs 36 Yrs- 45 Yrs 46 Yrs- 50 Yrs 2A 5920 6525 12010 1A + 1C 5370 5955 11550 1A + 2C 5630 6285 11865 1A + 3C 6035 6770 12390 2A + 1C 6345 7045 12815 2A + 2C 6875 7675 13210 2A + 3C 7260 8195 13860

IT Benefit

• Premium paid by cheque [Payable A/c pay at STAR HEATLH AND ALLIED INSURANCE COMPANY LIMITED] is eligible upto Rs.15000/- for relief under Section 80-D of the Income Tax Act (Rs. 20,000 for senior citizens)

Claim Procedure

• Call 24 hour help-line for assistance
• Inform ID number for easy reference
• For planned hospitalization, please inform 48 hours prior to admission to the hospital
• For emergency hospitalization, information to be given within 24 hours after hospitalization
• Cashless facility can be availed at all network hospitals
• For treatment in non-network hospitals, reimbursement of expenses will be effected on submission of all medical documents

Exclusions

• Expenses incurred for treatment of any illness/ disease/ condition, which is pre-existing at the time of commencement of insurance
• Any expenses incurred for treatment of illness/ disease/ sickness contracted by the Insured Person during the first 30 days from the commencement of the policy
• First Year exclusions – Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone / Renal Stone removal / treatment
• Two Years Exclusions – Hysterectomy for Menorrhagia or Fibromyoma, Cataract, Knee Replacement Surgery (other than caused by an accident),Joint Replacement Surgery(other than caused by an accident), Prolapsed Intervertebral Disc(other than caused by an accident), Varicose veins / ulcers
• Naturopathy treatment
• Expenses, which are purely diagnostic in nature with no positive existence of any disease
• Expenses those are mainly cosmetic in nature
• Expenses incurred for treatment of diseases/illness/accidental injuries by systems of medicines other than Allopathic
• Expenses incurred for treatment of congenital disease/defects/anomalies
• For a detailed list of exclusions please refer policy conditions

Eligibility

• Any person aged between 5 months and 60 years residing in India, can take this insurance

How to buy this insurance?

• Please Contact Us through our Help Line 099946 12916, 93628 54443 / SMS / Marketing & Sales Manager

Star Health Corporate Solutions

Corporate Solutions

Star Health & Allied Insurance Company is India's first & only exclusive health insurance company. We offer customized solutions to meet your Company's requirements.

Why should you choose Star Health Insurance to manage your employee health insurance portfolio?

Large Hospital Network

• STAR Health has a large number of network hospitals across the country offering CASHLESS treatment to its members. We have negotiated discounted tariff for healthcare services at the identified network of Hospitals and Nursing Homes wherever possible. Additions to the network are done on a regular basis by our dedicated networking team.

Experienced Personnel

• All our Managers have prior experience in implementing and servicing large Health insurance schemes. They are very well versed with the claim processes. This will ensure a smooth & effortless transition.

In-house Claims Processing

• STAR Health has its own medical officers and technical staff to handle the network provider claims as well as the reimbursement claims. Our experienced staff will adjudicate the claims in a speedy manner and reduce turn around time. This also means that your employees will have a single point of contact - No more depending on any Third Party for claims related issues or ID cards.

Cost Containment through Case Management and Medical Audit

• At Star Health we understand that inflated & fraudulent hospitals bills are a major cause of concern for corporates. To prevent these, expert case managers monitor the health status of the member and control any unnecessary tests and investigations, medicines or malpractices on part of the hospitals. The medical audit conducted periodically on hospitals will help in ascertaining the quality and cost of care provided by the network hospitals.

Medical services offered by in-house doctors

• Medical Authorization
• Medical Case Management
• Medical Outcome Audit
• Medical Scrutiny
• Random Inspection at Network Hospital
• Record Verification at Network Hospitals
• Rationalization of Tariffs at Network Hospitals

24x7 Doctor on Call

STAR Health offers round the clock General Practitioner advice and medical counseling to its insured members. All that your employees have to do is call our toll free helpline number.

24x7 Call Centre

STAR Health's 24x7 in-house call centre is accessible through a nation wide toll free number - 1800 425 2255. Your employees can call the call centre for assistance in information on:

• Network hospitals
• Support services in an Emergency
• Coverage eligibility
• Claims- documentation support, query handling
• Claims settlement status
• General information on health insurance plan

Help Desk

STAR Health can place a dedicated, 5 days a week, client-service executive for conducting Help Desk services inside the premises of your company. The client service executive at the help desk will provide seamless and prompt delivery of the following services:

• Attending to the queries of the employees and HR Dept.
• Assist HR in endorsement follow-up of any addition, deletion.
• Attending to the queries of your employees at the network hospitals at the time of hospitalization
• Attending to the members during emergency cases like providing Ambulance services etc.
• Hastening the process of pre-authorization during emergencies.
• Follow up with the enrolment and claims management team, to provide responses in record time
• Conducting employee orientation and induction programs on the health policy. Periodicity to be decided upon mutual discussion.
• Information on network of diagnostic centers, hospitals and nursing homes
• Protocols of reimbursement in case of in-patient services availed outside the network hospital.
• Collection of the claim documents from the members for non-network claims
• Generation of documentation checklist, recording the deficiencies in the checklist, communicating deficiencies to the members and recovery of the deficient documents from the members.

Comprehensive Report on Utilization

The following reports will be generated location wise and will be forwarded to the Corporate on a periodic basis.

• Claim intimation received report
• Authorization issued
• Actual claim received with breakup of network hospital claims (CASHLESS) and member reimbursement claims
• Settlement status of the claims
• Medical statistics
• Utilizations report: Employee Vs Dependant, Age ,Hospitalization bill break-up (under service heads)
• Details of claim rejections
• Report on grievances if any
• Periodic updating on the network hospitals

Other Value Added Services

Health Camps:

We can arrange for annual health camp for employees only, conducted by our in house doctors, at your Premises as per the convenience of the employees and HR Dept

The scope of the Health camp can be:

1. One General Medical Examination per location
2. One Eye Camp per location
3. One Dental check-up per location

Mediclassic Star Health Individual Insurance

Medi-Classic Individual Policy

Health insurance is one of those products that people always wish they had the foresight to take. Just like you prepare for every important financial milestone, it is essential that you plan for protecting your health – because ill-health can have huge financial implications as well and you need to protect yourself from all eventualities.

STAR Health and Allied Insurance service offers STAR Medi Classic policy to provide for reimbursement of hospitalization expenses.

Medi-Classic Benefits

• Hospitalisation cover – In-patient hospitalisation expenses for a minimum of 24 hours. Includes room rent at 2% of Sum Insured subject to a maximum of Rs.4,000/-
• Boarding and Nursing expenses
• Surgeon’s fees, Consultant’s fees, Anesthetist’s fees
• Cost of blood, oxygen, diagnostic expenses, cost of pace-makers
• Cost of medicines and drugs
• Emergency ambulance charges for transporting the insured patient at Rs.750/- per hospitalisation and Rs.1500/-per policy period
• Pre-hospitalisation expenses upto 30 days prior to date of admission in the hospital A lump-sum amount calculated at 7% of the specified hospitalisation expenses payable towards Post-hospitalisation, subject to a maximum of Rs.5000/-

Optional Benefits (on payment of additional premium)

• Hospital Cash – Provides for payment of Rs.500/- for each completed day of hospitalisation subject to a maximum of Rs.1500/- per hospitalisation
• Patient Care – Available with Medi-Gold plan. It pays for the attendant charges after discharge from the hospital upto a maximum of 7 days
• New Born Baby Care – Available with Family Package Plan and provides cover for the new-born baby from birth upto the expiry of the policy period. The sum insured to the new-born is restricted to 10% of the sum insured for the mother under the policy

Special Features

• No Claim Discount ranging from 5% to 25% for every claim free year of insurance (other than Family Package)
• Discount for voluntary deductibles ranging from 2% to 12% (other than Family Package)
• 24 X 7 toll-free call centre.
• Cashless hospitalization in over 3200 network hospitals.

How much to pay (for individuals)

• If you are above 50 years of age and are interested in buying this policy, Contact Branch Heat +91 94421 57522 Star Health Office or Call us at Phone No. +91 99946 12916, +91 90430 32916, +91 93631 18365 or SMS us at 090922 77712.

Sum Insured (in Rs)	5 months - 35 yrs	36 - 45 yrs	46 - 50 yrs	56 - 60 yrs
50000	575	700	1320	NA
100000	1200	1350	2447	3000
150000	1800	2000	3400	4200
200000	2350	2600	4583	5300
250000	2800	3150	5548	7200
300000	3300	3650	6170	8200
350000	3750	4150	7408	10196
400000	4200	4500	8700	11451
500000	4900	5400	10700	13958
1000000	7465	7965	13265	16525

IT Benefit

• Premium paid by Cheque [Payable A/c pay at STAR HEATLH AND ALLIED INSURANCE COMPANY LIMITED] is eligible upto Rs.15000/- for relief under Section 80-D of the Income Tax Act (Rs. 20,000 for senior citizens)

Claim Procedure

• Call 24 hour help-line for assistance
• Inform ID number for easy reference
• For planned hospitalisation, please inform 24 hours prior to admission to the hospital
• For emergency hospitalisation, information to be given within 24 hours after hospitalisation
• Cashless facility can be availed in all network hospitals
• For treatment in non-network hospitals, payment must be made up-front and then reimbursement will be effected on submission of documents

Exclusions

• Expenses incurred for treatment of any illness / disease / condition, which is pre-existing at the time of commencement of insurance
• Any expenses incurred for treatment of illness / disease / sickness contracted by the Insured Person during the first 30 days from the commencement of the policy
• First Year Exclusions – Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone / Renal Stone removal / treatment
• Two Years Exclusions – Hysterectomy, Cataract, Joint Replacement Surgery, Prolapsed Intervertebral Disc, Varicose veins / ulcers
• Naturopathy treatment
• Expenses, which are purely diagnostic in nature with no positive existence of any disease
• Expenses that is cosmetic in nature
• Expenses incurred for treatment by systems of medicines other than Allopathic shall be limited to 25% of Sum Insured, subject to a maximum of Rs.25000/- in the entire policy period

Renewal Features

• Renewal of policy under mutual consent
• Where Claims ratio is 100% for immediately preceding two consecutive years, a loading on the premium may be imposed ranging from 20% to 50%

How to buy this insurance?

• Please Contact Us through our Help Line 099946 12916, 93628 54443 / SMS / Marketing & Sales Manager