STAR HEALTH GAIN INSURANCE

1. STAR HEALTH GAIN INSURANCE

2. Major Product Features • Flat premium of only Rs. 14,725/- • Coverage for both inpatient and outpatient treatment • Policy can be given for both individual and family floater basis. • Any unutilised amount under outpatient benefit can be carried forward to the next one year

3. Coverages • Under section – I • Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accidental injuries • Under section – II • Hospitalization Expenses incurred as an outpatient treatment subjects to the limits

4. Family Means • Proposer • Spouse • Dependent Children

5. What is a Hospital ? • Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries • It has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner • or • Should comply with minimum criteria as under • It should have at least 15 inpatient beds (10 in Class ‘C’ Towns). • Fully equipped operation theatre of its own wherever surgical operation is carried out. • Fully qualified nursing staff under its employment round the clock • Fully qualified Doctor(s) should be in charge round the clock.

6. Age Limits • 5 Months – 60 Yrs • Dependent Children can be covered only with any one of their Parents

7. Sum Insured • Minimum Sum Insured - Rs. 1,00,000/- • Maximum Sum Insured - Rs. 5,00,000/- • The following Sum Insured options are available • Rs. 1,00,000/- • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 4,00,000/- • Rs. 5,00,000/-

8. Allowable Expenses • Room rent & boarding charges as follows • Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 4,000/- per day • (Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi & NCR and Secunderabad) • Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day • (Baroda, Indore, Ludhiana, Coimbatore , Cochin and all State Capitals other than those falling under Class A) • Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day • (Other Cities) • Nursing charges • Surgeons, Anesthetist, Consultants and Specialists fees

9. Allowable Expenses (Contd.) • Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc • Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period • Pre-hospitalization expenses incurred 30 days prior to the date of hospitalization • Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs 5,000/-

10. Sub limits

11. Day Care Treatment • Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal), • Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, • taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

12. Limit of Outpatient benefits for individual IP – Inpatient NA – Not Available

13. Limit of Outpatient benefits for family floater A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)

14. Limit of Outpatient benefits for family floater (contd.) A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given

15. Renewal Discount • Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart • It is not Cumulative

16. No Claim Discount for Individual basis

17. No Claim Discount for family floater basis

18. Discount for family floater basis ( Contd. )

19. Other Benefits • Benefits under Section 80-D of the IT Act • Cashless Service without intervention of TPA • Direct Tie up with hospitals on an All India Basis • 24 X 7 In-House Call center • Toll Free Telephone line assistance • Full knowledge based website to offer medical information, including Health Tips. • Health Check-up benefits • Frequent health meets to disseminate info on the health related topics

20. Exclusions (IP Section) • Pre Existing Diseases • Any Disease contracted during first 30 days • First Year Exclusions • Benign prostate hypertrophy • Hernia, Hydrocele, Fistula in Anus, Piles • Sinusitis • Renal stone and Gall stone removal • First Two Years Exclusions • Cataract • hysterectomy following menorrhia or fibromyoma • Knee Replacement Surgery • Joint Replacement Surgery • Prolapse of intervertibral • Vericose veins/ulcers • congenital internal disease/defect

21. Exclusions (IP Section)(Contd.) • Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operations • Circumcision unless necessary for treatment of a disease • Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids • Dental treatment or surgery • Convalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol • Naturopathy Treatment • Expenses incurred on Lasik Laser or Refractive Error Correction treatment

22. Exclusions (IP Section) (Contd.) • Hospital registration charges, record charges, telephone charges and such other similar charges. • Expenses incurred on Non Allopathic Treatment.

23. Claim Procedure • In case of Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255) • The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network Hospital • Based on the intimation a field visit will be done by the Star Doctor • Pre Authorization will be issued to the Hospital • Based on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital

24. Claim Procedure (Contd.) • In case of Non Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255) • Claim form will be sent to the Insured. • Based on the intimation a field visit will be done by the Star Doctor • Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents • Original Discharge Summary • Main Hospital Bill with Break Up • Investigation Reports with X-Ray Film • Medical Bills with Prescriptions

25. How is ‘Star Health Gain’ different from ICICI’s Tax Advantage • ICICI’s Tax Advt OP claim cannot be made after 90 days from the date of the policy- No such restriction in Star Health Gain policy • ICICI Tax Advt allows only ONE OP claim per year - Any number of OP claims allowed in one year under Star Health Gain policy • Residue OP amount can be carried forward to next one year under Star Health Gain policy • OP benefit can be taken even for PED, Maternity, dental, diagnostics under Star Health Gain policy

26. How is different from Mediclassic

27. How is it different from FHO

28. Thanks