one more delight from the specialist…. star health proudly presents star family delite insurance...

One more Delight from the Specialist…

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Star Health proudly presents

Star Family Delite Insurance Policy

Star Family Delite is a simple policy for those with a

Budget.

It offers two Sum Insured options on Family Floater Basis

• Rs. 2,00,000/-• Rs. 3,00,000/-

Star Delite Insurance Policy

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Age Eligibility

Entry age 18 years – 65 Years.

Children of above 5 months can be Covered if

Parent is Covered.

Beyond the age of 65 years only renewals are

accepted.

Guaranteed renewal for life time.

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Coverage

• Room rent including Boarding and Nursing expenses upto 1% of the sum insured opted.

• ICU charges upto 1.5% of the sum insured opted.

• Surgeon’s fees Consultant’s fees Anesthetist fees. Cost of blood, oxygen, diagnostic expenses, cost of pace makers, cost of medicines and drugs etc

• Emergency ambulance charges for transporting the insured patient to the hospital up-to a sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period Star Family Delite Insurance

Policy

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Coverage

• Pre-Hospitalization upto 30 days prior to the date of admission

• Post-Hospitalization calculated at 7% of the hospitalization expenses (excluding room rent) subject to a maximum of Rs.5,000/- incurred within 60 days from the date of discharge from the hospital.


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Diseases / conditions

Sum Insured

Rs.2,00,000/-

Sum Insured

Rs.3,00,000/-

Limit of Company’s liability in the

policy period

All Cardiac diseases /ailmentsa. CABG b. PTCA

(The limits mentioned are inclusive of cost of Angiogram)

Rs.110000/-Rs. 70000/-

Rs. 125000/-Rs. 80000/-

Minor surgeries warranting Hospitalization

Rs.12000/- Rs.15000/-

Admissions for medical diseases related to Cardio-Vascular System / Central Nervous System

Rs. 35000/- Rs. 45000/-

Major surgeries (other than what is specifically provided for)

Rs. 35000/- Rs. 45000/-

Oncology (all modes of therapy ) Rs. 70000/- Rs.100000/-

Sub Limits

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Diseases / conditions

Sum Insured

Rs.2,00,000/-

Sum Insured

Rs.3,00,000/-

Limit of Company’s liability in the

policy period

Accidental grievous injuries Rs70000/- Rs100000/-

Joint Replacement Rs70000/- Rs100000/-Renal Transplant SurgeryDialysis - per sitting cost limited to Rs1000/-

Rs70000/-Rs15000/-

Rs100000/-Rs20000/-

Cataract Rs15000/- Rs 20000/-

Treatment for infectious diseases –

(amount per day) Subject to a maximum amount

per hospitalisation

Upto

Rs.3000/-

Rs.9000/-

Upto Rs

4500/-

Rs12000/-

Sub Limits

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Day Care Procedure Limit (Rs.)

Lithotripsy (Kidney stone removal) 15000/-

Tonsillectomy/ Adenoidectomy 12000/-

Incision and drainage of abscess 1500/-

Liver aspiration / Pleural effusion aspiration 2000/-

Sclerotherapy 5000/-

Dialysis, Chemotherapy, Radiotherapy, Dental Surgery following accident are also covered under day-care treatment

Following day-care treatments are covered upto the limits indicated, Subject to waiting period as mentioned in the exclusions.

Day Care Procedures

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•No First Year Exclusions.

•Only First 2 years Exclusions.

•PED – waiting period 48months•Circumcision unless necessitated due to an accident

•Cost of spectacles and contact lens, hearing aids including cochlear implants, walkers, crutches, wheel chairs and such other aids.

•Dental treatment or surgery unless necessitated due to accident and requiring hospitalization.

•Charges for Diagnostic, X-ray or laboratory examinations, expenses on vitamins and tonics not consistent with or incidental to the diagnosis and treatment.

Exclusions

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•All expenses arising out of any condition directly or indirectly caused due to AIDS, however, HIV positive persons would be entitled for expenses incurred for treatment other than for opportunistic infections and for treatment of HIV /AIDS, provided at the time of first commencement of Insurance under this policy their CD4 count is not less than 350.

•Treatment arising from or traceable to pregnancy, miscarriage, abortion or complications of any of these (other than ectopic pregnancy).

•Naturopathy Treatment and Non Allopathic treatment

•Vaccination, Inoculation or change of life or cosmetic or aesthetic treatment of any description, Expenses incurred on Lasik Laser or Refractive Error Correction, expenses incurred on weight control services.

•Expenses incurred on Enhanced External Counter Pulsation therapy and related therapies and Rotational Field Quantum Magnetic Resonance Therapy

Exclusions

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Underwriting

•Acceptance limits :Please follow the existing guidelines

followed for underwriting of Family Health Optima Policy

•Medical screening :• No Pre acceptance Medical Examination

upto the age of 50 years.• For Prospects beyond 50 years - Please

follow the existing guidelines followed for underwriting of Family Health Optima Policy.

• This policy is Portable (Inward and Outward)• Existing guidelines remain unchanged.

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•Portability :


Benefit Illustration

Claim for Cataract Surgery

Sum Insured for 1st Year - Rs. 2,00,000/-Sum Insured for 2nd Year - Rs. 3,00,000/-Sum Insured for 3 rd Year - Rs. 3,00,000/-During 3rd year Insured to go in for Cataract Surgery the limit will be as per limit applicable for Rs. 2,00,000/- Sum Insured i.e. Rs 15000/- (Cataract – Excluded in the First two years) 13


Where the claim ratio for the preceding 2 consecutive years exceeds 100%, premium loading as per the table given below would be applicable.

Average claims ratio of preceding two

consecutive years

Loading on premium

>100-125 % 30%

126-150% 50%

>150% 80%

Claims Loading

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Sum Insured Rs. 2,00,000/-


Family Size

Premium (Rs)

Age (years) For Renewals only5mths-

35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80

1A+1C 2800 3250 5100 5600 6400 9000 11300 14700 19200

1A+2C 3100 3750 5600 6200 7000 9800 12300 16000 20800

1A+3C 3650 4500 6300 7000 7800 11000 13800 18000 23400

2A 3000 3600 5550 6200 7200 10100 12700 16600 21600

2A+1C 3700 4200 6100 7000 8100 11400 14300 18600 24200

2A+2C 4500 5000 6900 7900 9100 12800 16000 20800 27100

Service Tax Extra

Premium Rating

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Family Size

Premium (Rs)

Age (years) For Renewals only5mths-

35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80

1A+1C 3710 3940 5900 6930 8500 11900 14900 19400 25300

1A+2C 3825 4300 6400 7160 9000 12600 15800 20600 26800

1A+3C 4400 5200 7100 7900 10095 14200 17800 23200 30200

2A 3985 4360 6300 7605 10030 14100 17700 23100 30100

2A+1C 4300 4830 6900 7900 10625 14900 18700 24400 31800

2A+2C 4800 5600 7700 9100 11090 15600 19500 25400 33100Additional Child for 2 + 2 C can be included at an additional premium of Rs. 1000/- for all age bands Service Tax Extra

Sum Insured Rs. 3,00,000/-

Premium Rating

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one more delight from the specialist…. star health proudly presents star family delite insurance...

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