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STAR SUPER SURPLUS. Case I. Dinesh Agrawal*, Age 44 years, male, resident of Mumbai, physically fit, till hospitalized due to hypertension. Treated for Ventricular Tachycardia, Cardiovascular Disorder. Treatment cost 6 lac29 thousand Health Insurance policy holder, SI – 2 lac. *Name changed.
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Case I Dinesh Agrawal*, Age 44 years, male, resident of Mumbai, physically fit, till hospitalized due to hypertension. Treated for Ventricular Tachycardia, Cardiovascular Disorder. Treatment cost 6 lac29 thousand Health Insurance policy holder, SI – 2 lac *Name changed
Case II Yogesh Thakkar*, Age 46 years, Male, resident of Gandhinagar, Gujarat, fond of eating, complained of loss of sense of taste Treated for Tongue Cancer, Oncology Treatment cost Rs 7 lac 9 thousand Health Insurance policy holder with SI – 4 lac *Name changed
Case III Manjunath*, Age 31 years, Male, Resident of Chennai, Tamil Nadu, software engineer, sudden chest pain, hospitalized. Treated for Recent anterior wall myocardial infarction, a Cardiovascular Disorder. Treatment cost Rs 3 lac 95 thousand Covered under GMC through employer - SI – 1.5 lac *Name changed
Case IV Rajesh Chatwal*, Age 24 years, Male, resident of New Delhi, bike lover, rammed into a stationary lorry in a dark lane at a speed of 60 km/ph. Accidental Injury - Compound type III B - left leg & right leg with bimalleolar - right ankle. Fracture shaft humerus left side. Treatment cost 19 lac81 thousand Covered in Health Insurance with parents, SI – 3 lac *Name changed
Case V Vidya S*, Age 32 years, female, resident of New Delhi, music lover, hospitalized due to infection, Reason of death - MDR TB, Fulminant Hepatic failure DIC, Severe lactic acidosis ( refractory ) ARF (anuric), Severe Leukemoid reaction Treatment cost 8 lac 22 thousand Covered under a family floater policy - SI – 5 lac *Name changed
What would one do in such a scenario, where the claim amount is very high, even though a basic health insurance policy exist? Option 1 – Usually, borrow money from friends and relatives. Will they oblige??? Option 2 – Should take a higher sum insured at the beginning itself.The premium will be as high as 15000/-. Will it be affordable??? And condition of pre-acceptance medical tests will increase cost and effort. Option 3 – Take a Critical Illness insurance policy, but it will be restricted to only a few diseases and will not cover accidental hospitalization expenses. Or
Take STAR SUPER SURPLUS
USPs • It’s a unique top-up cover. • Sum Insured 7lac, and 10lac. • Individual as well as family floater options available • No pre-acceptance medical tests required till 60years of age. • Very affordable premium • Pre-existing diseases covered after 3 years of policy • Renewable upto 75 years Comparison with any health policy
Exclusions • Pre-existing diseases/injuries • Disease contracted during first 30 days of policy • Joint replacement surgery • (except due to accidents – waiting 2 years waiting period) • War, invasion, acts of foreign enemies. • Circumcision, Cosmetic or aesthetic treatments • Any form of plastic surgery • The cost of spectacles, contact lenses, hearing aids, crutches, artificial limbs, dentures, artificial teeth and all other external appliances • Dental treatment. • Convalescence, general debility or weakness • *For detailed list of exclusions please refer policy wordings
Deductible - means the amount stated in the schedule which shall be borne by the insured in respect of each and every hospitalization claim incurred in the policy period. • The company’s liability to make any payment for each and every claim under the policy is in excess of the deductible. • Each and every hospitalization would be considered as a separate claim. For ex. If a claim arises for 7 lac, deductible is 3 lac, 4 lac is payable under Super Surplus.
Entry Age under the policy • The primary member or the proposer can cover Self, Spouse, and 3 Children • The premium calculated is flat for any age.
Premium Rating INDIVIDUAL Premium Rating FLOATER 2 ADULT + 2 CHILD
Guidelines • Family would consist of self, spouse and children .For parents a separate policy needs to be taken • No midterm additions are allowed • Change in plan from a lower to higher deductible is allowed ,but a change in plan from higher to lower deductible is not allowed • Deductible would apply afresh on every claim in a policy period .In case of our own renewals deductible would apply afresh every year
Claim Procedure • The Claim under cashless and reimbursement would be admissible in excess of the deductible limit subject to terms, conditions, exclusions & definitions as per the policy wordings. • The proof of settlement of the deductible amount has to be produced at the time of claim in case of any other existing insurance policy .
Whom to sell? Target 1 – Policy holders with SI less than 5 lac Target 2 –Employees with basic insurance policy provided by employer Target 3 – High Net-worth Individuals Target 4 - Members who do not have any Health policy can also opt for this policy; the expenses up to the deductible limit (per hospitalization) have to be borne by the member on his own . Profiles to look for:
How to pitch? 18% of the urban population suffers from hypertension, which leads to renal failure, stroke and cardio-vascular diseases 30% of the population suffers heart attacks before age 40 66% of deaths today are due to cardio-vascular diseases Almost 3.5 million Indians suffer from diabetes Cardio-vascular diseases (CVDs) like heart disease and stroke are the main causes of death and disability
How to pitch? • Cost of hospitalization is increasing every year @ around 12% • Even if you have a basic medical insurance policy it will be inadequate after a while. Buying another policy will increase premium and contribution clause will be applicable. • Super Surplus will help in high claims when your basic policy gets exhausted. • Super Surplus comes at very affordable rates. • Available on Individual and family floater basis and renewable till 75 years