Presentation on Star Shri Family Care

1. Presentation on Star Shri Family Care

2. Coverages Section 1 Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accident For the entire family on floater basis Section 2 Pure Term Life cover

3. Age Limits • Entry age – 18 years to 50 years (as per last birth day) • Renewals upto 60 years

4. Important condition • An individual can be covered under one policy only. Multiple policies should not be issued.

5. Section 1 Health cover Offered by Star Health and Allied Insurance Company Limited

6. 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.

7. 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 and Secunderabad) • Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Coimbatore , Surat, Meerut 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) Star Health and Allied Insurance Co. Ltd.

8. Allowable Expenses (Contd.) • Nursing charges • 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 upto maximum of Rs 1,500/- per policy period Star Health and Allied Insurance Co. Ltd.

9. Allowable Expenses (Contd.) • 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/- Star Health and Allied Insurance Co. Ltd.

10. Day Care Treatment Minimum of 24 hours Hospitalization is not necessary for the following • Dialysis, • Chemotherapy, • Radiotherapy, • Cataract surgery, • Dental Surgery, • Lithotripsy (Kidney stone removal), • Tonsillectomy, • Cutting and Draining of Abscess, • Liver Aspiration, • Pleural Effusion Aspiration, • Colonoscopy, • Sclerotheraphy, The above treatment shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

11. Sub limits Star Health and Allied Insurance Co. Ltd.

12. Sum Insured The following Sum Insured options are available • Rs. 1,00,000/- • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 5,00,000/- Note : Sum Insured under Section 2 (Pure Term Life Cover) shall not exceed Sum Insured under Section 1.

13. Premium Rating under Section 1 Health Section A – Adult C – Children upto 25 yrs Premium figures excluding Service Tax Star Health and Allied Insurance Co. Ltd.

14. Premium Rating under Section 1 Health Section Premium figures excluding Service Tax A – Adult C – Children upto 25 yrs Star Health and Allied Insurance Co. Ltd.

15. Premium Rating under Section 1 Health Section A – Adult C – Children upto 25 yrs Premium figures excluding Service Tax Star Health and Allied Insurance Co. Ltd.

16. Premium Rating under Section 1 Health Section A – Adult C – Children upto 25 yrs Premium figures excluding Service Tax Star Health and Allied Insurance Co. Ltd.

17. Relief under Section 80 D • The premium paid under health section (Section 1) is eligible for Relief under Section 80 D of the Income Tax Act. • The premium may be paid by any mode of payment other than cash. • For calculating the above limit Premium paid inclusive of Service Tax has to be taken.

18. Exclusions • Pre Existing Diseases during the first 48 months • Any Disease contracted during first 30 days. However, accidents are covered from day 1. • First Year Exclusions (The following diseases are not covered during the first year of policy) • Benign prostate hypertrophy • Hernia, Hydrocele, Fistula in Anus, Piles • Sinusitis • congenital internal disease/defect • Renal stone and Gall stone removal • First Two Years Exclusions (The following diseases are not covered during the first two years of policy) • Cataract • hysterectomy following menorrhia or fibromyoma • Knee Replacement Surgery • Joint Replacement Surgery • Prolapse of intervertibral • Vericose veins/ulcers

19. Exclusions (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. However, dental treatment due to accident is covered. • 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

20. Exclusions (Contd.) • Naturopathy Treatment • Expenses incurred on Lasik Laser or Refractive Error Correction treatment • Hospital registration charges, record charges, telephone charges and such other similar charges. • Expenses incurred on Non Allopathic Treatment.

21. 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

22. 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 Note : It is always advisable to ask the Insured to undergo treatment in Network hospital and use cashless facility.

23. Section 2 Pure Term Life cover Offered by Shriram Life Insurance Company Limited

24. Coverages • Provides for lumpsum (Sum Assured) in the event of death of the policyholder during the term of the contract. • Suicide covered from second year onwards. • Only earning member who is also the proposer will be provided cover under this section.

25. Policy Term • 60 Years less age at entry

26. Sum Insured The following Sum Insured options are available • Rs. 1,00,000/- • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 5,00,000/- Note : Sum Insured under Section 2 (Pure Term Life Cover) shall not exceed Sum Insured under Section 1.

27. Premium Rating under Section 2 Life Section With Standard Age Proof : Premium figures excluding Service Tax

28. Standard Age Proof • School Certificate • College Certificate • Employer Certificate • Passport (issued after  01/04/1986) • Driving License (issued after18/04/1993) • PAN card • Birth Certificate/Municipal birth certificate/certified extract from municipal or other records made at the time of birth

29. Premium Rating under Section 2 Life Section With Non Standard Age Proof : Premium figures excluding Service Tax

30. Non Standard Age Proof • Ration Card • Voter ID Card • E.S.I.S Card • Domicile certificate in which the date of birth is mentioned • Baptism certificate • Certified extract from the birth register maintained by the village panchayat stating the date of birth. This extract to be on letter head of the village panchayat with signature of the sarpanch along with the seal. • Marriage certificate of Christians issued by a Roman Catholic Church. • Life Insurance policy from any insurer.

31. Note : In case of difficulty in getting standard age proof, the best practice would be to charge premium as per non standard age proof.

32. Relief under Section 80 C • The premium paid under this section is eligible for Relief under Section 80 C of the Income Tax Act. • For calculating the above limit Premium paid inclusive of Service Tax has to be taken.

33. Important Conditions

34. Waiting Period • 90 days. Only accidental death is covered from day 1. • Only accidental death benefits are covered during the first three months of the contract. In this period, no death benefit is payable in case of death due to other causes. After the expiry of this period, death due to all causes (subject to mandatory exclusions) are payable.

35. Exclusions • Suicide or self inflicted injury, whether the life assured is medically sane or insane, during the first year. • War, terrorism, invasion, act of foreign enemy, hostilities, civil war, martial law, rebellion, revolution, insurrection, military or usurper power, riot or civil commotion. War means any war whether declared or not. • Taking part in any act of a criminal nature, an assault, an illegal activity or any breach of law.

36. Exclusions (Contd.) • Treatment for injury or illness caused by avocations / activities such as hunting, mountaineering, steeple-chasing, professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, deliberate exposure to exceptional danger. • Radioactive contamination due to nuclear accident. • Participation in aviation other than as a fare-paying passenger in an aircraft that is authorized by the relevant regulations to carry such passengers between established aerodromes.

37. Common features under both sections

38. Free Look Period • If the policyholder is not satisfied with the ‘Terms and conditions’ of the policy, the policy can be returned to the Company within 15 days from the date of receipt of the policy. However, the company reserves the right to deduct medical examination fees, cancellation fee ,stamp duty charges for issue of the policy and proportionate risk premium for the period concerned. • If cancellation happens after Free Look Period, Section 1 premium will be refunded on short term basis subject to no claim under the policy. There will be no refund under Section 2. • Free Look period is applicable only during the first year of cover.

39. Days of grace • A grace period of 15 days will be allowed for payment of premiums under both sections. • However, under Section 1 only continuity benefits with regard to Waiting period and PED will be provided. Cover will not be available during the break in period. • Whereas, under Section 2 If death occurs within the break in period but before the payment of the premium then due, the policy shall be valid and the claim if admitted will be paid after deducting the said premium as also the unpaid premiums falling due before the next policy anniversary. If the premium is not paid before the grace period, the policy lapses.

40. Star/Shriram Advantages • No Third Party Administrator direct in-house claims settlement. • Faster & hassle-free claim settlement. • Cashless hospitalization. • Network of more than 4600 hospitals across India. • Free expert medical consultation over phone. • 24 x 7 Toll Free Helpline. • Information on health through free health magazine. • The global expertise of one of the biggest Life Insurer.

41. Operational Instructions • All cheques should be collected in favour of M/s. Star Health and Allied Insurance Company Limited. • The list of Star Offices where the proposals have to be submitted will be intimated after mapping of Shriram Agents to Star Offices.

42. Declined Risks Please avoid granting cover to any person suffering from the following ailments • Heart • Cancer • Renal

43. Thank You