Presentation on Star Unique Health Insurance Policy

1. Presentation on Star Unique Health Insurance Policy

2. Why Unique?? • This policy is Unique because it covers Certain Pre-Existing diseases as well as any future ailments – ------- all under one policy

3. Major Features • Pre Existing Diseases (other than those for which specific time periods have been mentioned separately) covered after complete of 11 months • The policy provides coverage to HIV positive persons. • Premium payable in installments • No pre acceptance medical examination

4. Coverages Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accidental injuries

5. Pre Existing Disease • Pre-Existing Disease/ Condition will be covered after 11 months of continuous coverage • Does this mean that any PED is covered after 11 months? • No – only certain diseases that are Pre-Existing

6. Coverage for HIV positive persons • The policy extends coverage to HIV positive persons. • Minimum CD 4 count at entry level should be 350 • Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not covered • Expenses for treatment of HIV / AIDS not covered

7. Period of Insurance • The policy is for a two year period. • Even renewal will be for a two year period • Advantages are :Customer retentionClaims loading, if applicable will happen only once in two years • However, Sum insured will be available afresh for each year. • For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for first yr and 2 lacs for the second yr. • However sum insured cannot be cumulated or carried forward

8. Installment Premium • The premium can be paid in 2 annual installments. • The grace period of 15 days for benefit of continuity will be available for instalment premium also. However, the expiry date of the policy will not change. • Where a claim is made in the first year itself the premium towards the next installment would be deducted from the claim amount. • The policy would lapse if the installment is not paid on or before the due date.

9. What is a Hospital? • Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which Either • 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.

10. Age Limits • Entry age 18 Years to 65 Years • Policies can be renewed up to 70 years • Beyond 70 yrs the insured person would be eligible to move to any other health insurance policy that the Company offers

11. Sum Insured • The following Sum Insured options are available Note : The sum insured is for each year of insurance and cannot be cumulated or carried forward

12. Allowable Expenses • Room rent, nursing & boarding charges @ 1% of the sum insured subject to a maximum of Rs. 3000/- per day. • Surgeons, Anesthetist, Consultants and Specialists fees • 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 up to a maximum of Rs 1,500/- per policy period

13. Allowable Expenses (Contd.) • Pre-hospitalization expenses incurred for a period of 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/-

14. Day Care Treatment Minimum of 24 hours Hospitalization is not necessary for the following • Dialysis • Chemotherapy • Radiotherapy • Cataract surgery • Dental Surgery following accident • Lithotripsy • Tonsillectomy • Treatment of Fracture/Dislocation • Incision and Draining of Abscess • Liver Aspiration • Pleural Effusion Aspiration • Colonoscopy • Sclerotheraphy • Tympanoplasty • Chalazion

15. Day-Care……… • The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

16. Sub Limits Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.

17. Premium ….. approach • We have introduced a dual pricing concept - Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Ahmedabad will have a slightly higher premium • Rest of India will have comparatively lower premium

18. Annual Installment Premium Applicable for offices in Ahmedabad, Bangalore, Mumbai (including Thane) and New Delhi (includingFaridabad, Gurgaon & Noida) Note : Premium figures are excluding Service Tax.

19. Annual Installment Premium Applicable for rest of India Note : Premium figures are excluding Service Tax.

20. Exclusions • Pre-Existing Disease/ Condition within 11 months of commencement of this insurance • Any Disease contracted during first 30 days

21. Exclusions (Contd.) • First Year Exclusions • Deviated Nasal Septum • Benign Prostate Hypertrophy • Nasal Polyps • Hernia • Hydrocele • Congenital Internal diseases/defects • Fistula in anus, Piles, Sinusitis, and related disorders • Post trauma non union / mal union • Cholecystectomy and Renal Calculi /Gall bladder calculi are not payable. If these diseases (other than congenital internal disease /defects) are Pre-Existing at the time of proposal they are payable after 24 months of continuous coverage with the Company.

22. Exclusions (Contd.) • First Two Years Exclusions • Cataract, • Hysterectomy (abdominal and Vaginal), • Dysfunctional Uterine Bleeding (DUB) • Fibroid Uterus • Prolapsed Uterus • Myomectomy • Cystectomy • Treatment of Internal Derangement of Knee (other than caused by an accident) • Treatment for Joints (other than caused by an accident) • other Arthroscopic Surgeries

23. Exclusions (Contd.) • First Two Years Exclusions (Contd.) • Inter-Vertebral Disc Prolapse (other than caused by accident) • Degenerative Vertebral and Disc diseases • Varicose veins and Varicose ulcers • Thyroiditis • Treatment of Goitre • Tympnoplasty • Mastoidectomy Glaucoma • are not payable irrespective of whether they are Pre-Existing or not.

24. Exclusions (Contd.) • First Four Years Exclusions • Stapedectomy • Bone marrow transplant • Cirrhosis of liver with or without portal Hypertension • Hepatitis • Loss of vision partial / total including Retinopathy • Retinal Detachment • Macular degeneration and Papill Oedema • all types of Cancer • Nephropathy and Chronic Kidney diseases • Implant Removal The above shall not be payable during the first four years only if these are Pre-Existing at the commencement of this insurance

25. Exclusions (Contd.) • 30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims • War and allied perils including nuclear risks • Circumcision unless necessary for treatment of a disease not excluded hereunder • or as may be necessitated due to an accident, • vaccination or inoculation (except as a post-bite treatment) • change of life or cosmetic or aesthetic treatment of any description, • plastic surgery other than as may be necessitated due to an accident or as a part of any illness. • Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids.

26. Exclusions (Contd.) • Dental treatment or surgery of any kind unless necessitated due to accidental injuries and requiring hospitalization. • Convalescence, general debility, Run-down condition or rest cure, Psychosomatic disorders, Congenital external disease or defects or anomalies, infertility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol. • Treatment for HIV / AIDS and opportunistic infections.

27. Exclusions (Contd.) • Purely diagnostic expenses • Expenses on vitamins and tonics not forming part of treatment • Maternity expenses (other than ectopic pregnancy) • Naturopathy Treatment • Hospital registration charges, admission charges, record charges, telephone charges and such other charges

28. Exclusions (Contd.) • Lasik Laser or Refractive Error Correction treatment • weight control or treatment for obesity  • Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs. 25000/- for each year of insurance.

29. Claim Procedure In case of Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255/044-28263300) • 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

30. Claim Procedure (Contd.) In case of Non Network Hospitals • Immediate intimation to the Call Centre (1800 425 2255 /044-28263300) • 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

31. Other Benefits • Benefits under Section 80-D of the IT Act • Cashless Service without involvement of TPA • Direct Tie up with hospitals on an All India Basis • 24 X 7 In-House Call center (044-2826 3300) • Toll Free Telephone line assistance (1800 425 2255) • Full knowledge based website to offer medical information, including Health Tips. • Information on health through free health magazine

32. Value added services • Consult our Expert Doctor for Free Medical Advice on Toll • Free Number 1800 425 2255 / 1800 102 4477 • Quarterly Health Magazine to all policy holders providing an • insight into health related issues.

33. Target segment Who can be the target segment for selling this insurance? • Persons who are hypertensive • Diabetics with no complications set in as yet • Persons who have undergone CABG

34. Who should be avoided? • Proposals from Cancer patients • Persons with Chronic kidney failure • Persons suffering from Alzhemiers • Persons with Psycho somatic disorders • Stroke affected persons • Paralytic patients

35. Transfer of Policy from Star Health to this policy • Only waiver of 30 days waiting period is allowed. • For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.

36. Transfer of Policy from other Insurers • Only waiver of 30 days waiting period is allowed. This waiver will not be provided even if there is one day gap. • For other things (viz. First year exclusion, First Two years exclusion, PED, etc) it should be treated as a fresh proposal only.

37. Thank You