Star Health Assure Insurance Policy

UIN: SHAHLIP23017V012223

Strictly for Internal Training Purpose only Star Health Assure_version 1.0_April_22
 BENEFITS

Hospitalization
Hospitalization Health Checkup
Domiciliary Hospitalization Health Checkup
Assisted Reproduction Treatment

Pre
Pre &
& Post-hospitalization
Post-hospitalization Hospitalization expenses for
Organ Donor
No-claim Expenses
Bonus No-claim
treatmentBonus
of New Born Baby

Daycare
Daycaretreatments
Coverage Outpatient Consultation
Treatment for Chronic Severe
Health Checkup Assure Outpatient Consultation
Refractory Asthma

Road Ambulance
Coverage for Non-medical Items Home Care treatment Compassionate Travel

Emergency Road Ambulance Hospital Cash Benefit

Delivery Expenses Hospital Cash
Repatriation of Benefit
Mortal Remains

Treatment in Valuable Service

Air Ambulance In Utero Fetal Surgery/ Intervention Lo

Providers network
SeS Optional Cover to choos e deductible

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 BENEFITS

Shared accommodation
Hospitalization Rehabilitation
Hospitalizationand Pain Management

AYUSH
Pre Treatment
& Post-hospitalization Star
Pre Wellness Program
& Post-hospitalization

Second Medical
Daycare Opinion
Coverage Optional
Daycare cover to choose deductible
Coverage

Road Ambulance
Coverage for Modern Treatment

Cumulative Bonus

Automatic Restoration of Sum Insured

SharedSh

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 COVERAGE ABOUT THE POLICY SUM INURED
▪ Policy Term OPTIONS (in LAKHS)
Individual Floater 1 year/2 years/3 years
▪ Continuity
91 days to Adults: 18 years
Lifetime renewal
maximum 75 to 75 years
years ▪ Pre Medical Screening
Dependent
children: 16 days
For those who declare adverse
to 18 years medical history, company may
subject them to undergo pre-
▪ Maximum family size policy medical check-up. 100%
6A + 3C (6 Adults = Self + Spouse + Parents cost of such medical examination
+ Parents-in-law) is borne by the company
5 10 15 20 25 50 75 100 200
and ▪ Instalment Facility :
Family size can be 9 Adults, if children Quarterly, Half-yearly
covered under floater sum insured are
above 18 years of age
Note: In case of dependent children, at the time of renewal
when they complete 18 years of age, such children will be
considered as Adult and he/she can continue under floater sum
insured till he/she gets married
Note: Rs 75 Lakhs, Rs 1 Cr and Rs 2 Cr Sum Insured will be
In Individual policy : Note: Installment facility is not available for long term available for persons aged up to 65 years only.
Good Health declaration, Pediatrician Opinion and the proposal (2 year and 3 year) policies. 4
should routed through our Central Medical Underwriting Team This is applicable only at the time of inception of this policy
 ZONE BASED PRICING MID TERM INCLUSION
▪ Available on payment of proportionate premium for
Newly Wedded spouse, New born baby and Legally
Zone A Zone B adopted child
Delhi including Pune including Nashik, ▪ Intimation should be given within 45 days from the date
Faridabad, Gurgaon, Trivandrum, Ernakulam, of marriage or date of birth
Ghaziabad and Noida, Chennai, Bengaluru,
Mumbai including Hyderabad, Secunderabad
Thane, Ahmedabad, and Rest of Gujarat Special conditions:
Surat and Vadodara
▪ Waiting periods as stated in the policy will be applicable
from the date of inclusion of such newly wedded spouse,
Zone C new born baby, legally adopted child
▪ Subject to underwriter’s approval

Rest of India

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 HOSPITALIZATION
EXPENSES ON HOSPITALIZATION FOR A MINIMUM PERIOD OF 24 HOURS COVERED

Cashless Reimbursement

Network Hospitals Non-Network Hospitals

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 HOSPITALIZATION
CONNECTED TREATMENT EXPENSES

Professional Fee Medical Services Medicines

▪ Surgeon ▪ Anesthesia ▪ Drugs
▪ Consultants ▪ Blood ▪ Medicines
▪ Anesthetist ▪ Oxygen ▪ Implants and such other
▪ Specialist ▪ OT charges similar items
▪ ICU charges

Note: Associated Medical expenses which vary based on the room occupied by the insured person will be considered in proportion to the room rent stated in the policy schedule7or actuals
whichever is less
 PRE & POST
ROOM INCLUDING BOARDING HOSPITALIZATION
AND NURSING EXPENSES

Sum Insured
Per Day (Rs)
(Lakhs)
Up to 1% of Sum Insured or upto 60 Days 180 Days
5/10/15/20/25/50 Rs.20,000/- per day whichever is
less

75/100/200 No limit (Any room)

Note: Associated Medical expenses which vary based on the room occupied by the
insured person will be considered in proportion to the room rent stated in the 8
policy schedule or actuals whichever is less
 DAYCARE COVERAGE FOR EMERGENCY ROAD
NON MEDICAL AMBULANCE
ITEMS (CONSUMABLES)
▪ Subject to an admissible hospitalization
All daycare treatments are covered If there is an admissible claim under claim
inpatient / day care the policy, then Items ▪ For transportation of the insured person
as per List I will become payable by private ambulance service to go to
hospital when this is needed for medical
reasons
or
▪ For transportation of the insured person
by private ambulance service from one
hospital to another hospital for better
medical treatment
or
▪ For transportation of the insured person
from the hospital where treatment is
taken to their place of residence (if it is in
same city) provided the requirement of
an ambulance to the residence is
certified by the medical practitioner.
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 AIR AMBULANCE DOMICILIARY
HOSPITALIZATION ORGAN DONOR
▪ Insured Person(s) is/are eligible for
reimbursement of expenses incurred ▪ Coverage for medical treatment ▪ In patient hospitalization expenses
towards the cost of air ambulance (Including AYUSH) for a period incurred for organ transplantation from
exceeding three days, for an the Donor to the Recipient Insured
▪ Covered up to 10% of sum insured per illness/disease/injury, which in the Person are payable provided the claim
policy year normal course, would require care for transplantation is payable.
and treatment at a Hospital but,
▪ It is for emergency care of the insured on the advice of the attending ▪ In addition, the expenses incurred by
person which requires immediate and Medical Practitioner, is taken the Donor, (if any) for the
rapid ambulance transportation to the whilst confined at home under complications that necessitate a Redo
hospital / medical centre that ground any of the following Surgery / ICU admission will be
transportation cannot provided circumstances covered.
▪ The condition of the patient is
▪ Necessary medical treatment not being such that he/she is not in a ▪ Coverage limit under this benefit is
available at the location where the condition to be removed to a over and above the Limit of Coverage
Insured Person is situated at the time of Hospital, and upto the Sum Insured.
Emergency or
▪ The patient takes treatment at ▪ Additional sum insured can be utilized
▪ It is prescribed by a Medical home on account of non- by the Donor and not by the Insured
Practitioner and is Medically Necessary availability of room in a hospital
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▪ The insured person is in India and the
 HEALTH CUMULATIVE
CHECK UP ASSURE BONUS
Payable for each policy year (Irrespective of claim)
25% of sum insured for each claim free year and
Sum Insured Limit Up to (Rs) maximum up to 100% of the sum insured
(Rs) Lakhs Individual (Rs) Floater (Rs)
5 1500 2500

10 2000 5000

15 4000 8000

20 5000 10000

25 5000 10000

50 5000 10000

75 8000 15000

100 8000 15000

200 8000 15000 11

 HOME CARE TREATMENT
▪ Payable up to 10% of the sum insured subject to maximum of
List of conditions covered under Home Care Treatment
Rs 5 Lakhs in a policy year
▪ For treatment availed by the Insured Person at home, only for the ▪ Fever and Infectious diseases which can be managed
as Inpatient
specified conditions, which in normal course would require care and ▪ Uncomplicated Urinary tract infections but needing
treatment at a hospital but is actually taken at home provided that: Parenteral Antibiotics
▪ Asthma and COPD -Mild Exacerbations needing Home
▪ The Medical practitioner advises the Insured person to undergo Nebulization
treatment at home ▪ Acute Gastritis/Gastroenteritis
▪ I.V. Chemotherapy [Where advised by the doctor]
▪ There is a continuous active line of treatment with monitoring of ▪ Palliative Cancer care requiring medical assistance
the health status by a medical practitioner for each day through the ▪ Acute Vertigo
▪ Diabetic foot and Cellulitis
duration of the home care treatment ▪ IVDP [Cervical and Lumbar disc diseases]
▪ Daily monitoring chart including records of treatment administered ▪ Major Surgeries/Arthroplasties needing IV Antibiotics
Post Discharge
duly signed by the treating doctor is maintained ▪ Care for Brain and Spinal Injury Cases Post Discharge
▪ Insured can avail ''Home Care Treatment'' service on cashless / ▪ Post CVA Care at Home after Discharge
▪ Chronic Severe Refractory Asthma (by Advanced
reimbursement basis, if availed from the list of our Network service Medicine)
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providers given in our website ''www.starhealth.in''
 ASSISTED REPRODUCTION TREATMENT
▪ Waiting period : 2 years from the date of first inception of this
policy
▪ Company will pay for one Assisted Reproduction Treatment
cycle in a policy year.
▪ In- patient treatment is not mandatory Sum Insured Limit of Liability in a
(Rs) policy year (Rs)
Special Exclusions
5 1 Lakh
▪ Pre and Post treatment expenses
▪ Sub-fertility services that are deemed to be unproven, 10/15/20/25 2 Lakhs
experimental or investigational
▪ Reversal of voluntary sterilization 50/75/100/200 4 Lakhs
▪ Treatment undergone for second or subsequent pregnancies
except where the child from the first delivery/ previous
deliveries is/are not alive at the time of treatment
▪ Payment for services rendered to a surrogate
▪ Costs associated with cryopreservation and storage of sperm,
eggs and embryos
▪ Selective termination of an embryo.
▪ Services done at unrecognized centre
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 AUTOMATIC RESTORATION OF SUM INSURED
▪ Sum Insured will be restored unlimited number of times and maximum up to 100% each time, which can be
utilized for a subsequent hospitalization.

▪ The restoration will trigger immediately upon partial/ full utilization of the sum insured, which can be utilized for a
subsequent hospitalization.

▪ On partial utilization of the Sum Insured, it will be restored up to extent of utilization.

▪ On full utilization of the Sum Insured, it will be restored to 100%

▪ Used for all claims including for modern treatment, but for a subsequent hospitalization

▪ Maximum payable amount for a single claim under restoration benefit shall not more than the sum insured

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 UNLIMITED RESTORATION - ILLUSTRATION
Insured 1 Insured 2
Sum Insured (Rs) 10 Lakhs 10 Lakhs
No Claim Bonus (NCB) 0 5 Lakhs
15 Lakhs(Sum Insured 10 Lakhs + NCB 5
Total Available amount 10 Lakhs
Lakhs)
1st Claim 5 Lakhs 5 Lakhs
Claim paid amount 5 Lakhs 5 Lakhs
1st Claim
Will the restoration kick in? Yes, Why – Since there
5 Lakhs (Restored Sum Insured) 5 Lakhs (Restored Sum Insured)
is partial utilization of Sum Insured.
15 Lakhs (Restored Sum Insured 5 Lakhs +
10 Lakhs (Restored Sum Insured 5 Lakhs +
Available amount for next claim Balance Sum Insured 5 Lakhs + NCB 5
Balance Sum Insured 5 Lakhs)
Lakhs)
2nd Claim (For Same / different illness) 15 Lakhs 15 Lakhs
Claim paid amount 10 Lakhs 15 Lakhs
2nd Claim
Will the restoration kick in?Yes, Why – Since there
10 Lakhs (Restored Sum Insured) 10 Lakhs (Restored Sum Insured)
is full utilization of Sum Insured.

10 Lakhs (Sum Insured is Restored up to 10 Lakhs (Sum Insured is Restored up to

Available amount for next claim
100%) 100%)
3rd Claim(For Same / different illness) 11 Lakhs 11 Lakhs
3rd Claim Claim paid amount 10 Lakhs 10 Lakhs
Will the restoration kick in? Yes, Why – Since there
10 Lakhs (Restored Sum Insured) 10 Lakhs (Restored Sum Insured) 15
is full utilization of Sum Insured
 DELIVERY EXPENSES IN UTERO FETAL
SURGERY/INTERVENTION
▪ Expenses for a Delivery including Delivery ▪ Waiting period: 2 years from the date of inception of
Sum
by Caesarean section (including pre-natal Per this policy
Insured
and postnatal expenses) up-to 10% of the Policy Types of in utero-surgeries covered
(Rs)
Sum Insured Year ▪ Open Fetal Surgery and FetendoFetal Surgery
Lakhs
▪ Fetal Image-Guided Surgery (FIGS-IT)
5 50,000 ▪ EXIT procedure
▪ Waiting period: 2 years from the date of TYPE OF
first commencement of Star Health Assure DESCRIPTION SURGERIES
10 1 Lakh INTERVENTION
Insurance policy and its continuous CPAM – Lobectomy
1.50 SCT – Resection
renewal 15
Lakhs MMC – Repair
OPEN SURGERY Hysterotomy Cervical Teratoma – Resection EXIT

▪ There is no waiting period for subsequent 20 2 Lakhs Tracheal occlusion

Neck tumors
2.50 CDH (EXIT to ECMO)
deliveries 25
Lakhs Balloon Occlusion of Trachea (for CDH)
Laser Ablation of Vessels (for TTTs)
▪ Both self and spouse are covered under 50 5 Lakhs FETENDO Fetoscopic Surgery Cord Ligation/Division
Cystoscopic Ablation Valves (Urinary Obstruction)
this policy for a continuous period of 2 Amniotic Bands Release
7.50
years under Individual or floater sum 75 Amnioreduction/Infusion
Lakhs Fetal Blood Sampling
insured. FIGS
Fetal Image
RFA Anomalous Twins
100 10 Lakhs Guided Surgery
Vesico/Pleuro Amniotic Shunts
Balloon Dilation Aortic Stenosis
▪ Pre-hospitalisation and Post 200 20 Lakhs CHAOS
Hospitalization expenses are not applicable EXIT procedure
Planned
Specialized
Removal of the CDH Tracheal Occlusion Balloon
Pulmonary Sequestration
Delivery 16
CCAM
 IN UTERO FETAL HOSPITALIZATION EXPENSES FOR
SURGERY/INTERVENTION TREATMENT OF NEW BORN BABY
▪ Expenses incurred in a hospital/ nursing home on treatment of
List of procedures covered the New born for any disease, illness (including any congenital
disorders) or accidental injuries are covered from Day 1 of its
▪ Amniotic band syndrome birth till the expiry date of the policy
▪ Bronchopulmonary sequestration of the lung
▪ Congenital cystic adenomatoid malformation (CCAM) Special conditions applicable for this section:
of the lung ▪ Available only if delivery expenses claim is paid under this policy
▪ Congenital diaphragmatic hernia (CDH) or if mother is covered under this policy for a continuous period
▪ Congenital high airway obstruction syndrome (CHAOS) of 1 year without break
▪ Fetalanemia ▪ Intimation about the birth of the New Born should be given to
▪ Lower urinary tract obstruction (LUTO) the company and the coverage will be given to the New Born
▪ Mediastinalteratoma from the first day of its birth
▪ Neck mass ▪ Initial waiting period, PED and specified disease waiting period
▪ Sacrococcygealteratoma (SCT) and Exclusion no.20 (Code-Excl 20)* as stated under this policy
▪ Spina bifida (myelomeningocele) shall not apply for the New Born baby cover
▪ Twin reversed arterial perfusion (TRAP) sequence ▪ In the subsequent years, the New Born Baby will be covered up
▪ Twin-twin transfusion syndrome (TTTS) to the Sum Insured (without any underwriting and the entry age
criteria), if the policy holder opts the coverage for New Born and
pays the premium.
▪ Enhancement of sum insured is subject to underwriters approval
Exclusion no.20 (Code-Excl 20)* : Congenital External Condition / Defects / Anomalies (except to
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the extent covered under coverage hospitalization expenses for treatment of New Born Baby
HOSPITALIZATION EXPENSES FOR TREATMENT FOR CHRONIC
TREATMENT OF NEW BORN BABY SEVERE REFRACTORY ASTHMA
Sum Insured Limit per policy ▪ Payable up to 10% of sum insured not exceeding Rs.5 lakhs
Lakhs (Rs) year (Rs) per policy period

5/10/15/20/25 2 Lakhs ▪ In-patient hospitalization / Day Care treatment / Home

Care Treatment/ Out-patient treatment expenses incurred
50/75/100/200 4 Lakhs for treatment of Chronic Severe Refractory Asthma
by Advanced Medicine

▪ Covered if recommended by the treating Medical

practitioner (Pulmonologist)

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 COMPASSIONATE TREATMENT IN
REPATRIATION OF
TRAVEL VALUABLE SERVICE
MORTAL REMAINS
PROVIDERS NETWORK
▪ In the event of the insured person ▪ Following an admissible claim ▪ 1% of Sum Insured subject to a maximum of
being hospitalized for a life for hospitalization under the Rs.5,000/- per policy period is payable as
threatening emergency at a place policy lump sum
away from his usual place of
residence as recorded in the policy ▪ Company shall reimburse up Note:
▪ Payable only if there is an admissible claim for
to Rs.15,000/- in a policy year hospitalization under the policy.
▪ Company will reimburse the
transportation expenses by air ▪ Payable towards the cost of ▪ Covered if a hospital is a part of the Valuable service
incurred upto Rs.10,000/- for one repatriation of mortal remains provider network list as on date of admission
immediate family member (other of the insured person ▪ Payment under this benefit does not form part of the sum
than the travel companion) (including the cost of insured
embalming and coffin charges)
▪ For travel towards the place where ▪ The Company shall not be responsible for the quality of
to the residence of the Insured the treatment in the Valuable Service Providers Network.
hospital is located, provided the as recorded in the policy
claim for hospitalization is
admissible under the policy

Note: FOR THE LIST OF VALUABLE SERVICE PROVIDERS NETWORK PLEASE

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VISIT OUR COMPANY WEBSITE www.starhealth.in
 SHARED AYUSH TREATMENT SECOND MEDICAL
ACCOMMODATION OPINION
▪ Can obtain a Second Medical Opinion from a
Doctor in the Company’s network of Medical
▪ If the insured person occupies, a ▪ Medical expenses for Inpatient Practitioners.
shared accommodation during Hospitalization incurred on
in-patient hospitalization, then treatment under Ayurveda, ▪ All the medical records provided by the Insured
amount of Rs.1,000/- per day will Unani, Sidha and Homeopathy Person will be submitted to the Doctor chosen by
be payable for each continuous systems of medicinesin a him/her online and the medical opinion will be
and completed period of 24 hours AYUSH Hospital is payable up made available directly to the Insured by the
of stay in such shared to the sum insured. Doctor.
accommodation.
Note: ▪ All medical records should be forwarded to the
Note: ▪ Yoga and Naturopathy systems mail-id e_medicalopinion@starhealth.in.or
▪ Payable only if there is an of treatments are excluded through Post/Courier.
admissible claim for hospitalization
under the policy
Special Conditions:-
▪ Specifically requested for by the Insured Person
▪ This will not be applicable where
▪ This opinion is given based only on the medical
the sanction is on package rates
records submitted without examining the patient
▪ The second opinion should be only for medical
▪ Insured stay in Intensive Care Unit
reasons and not for medico-legal purposes
or High Dependency Units / wards
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will not be counted for this
 MODERN TREATMENT REHABILITATION AND
The following procedures will be covered (wherever medically
PAIN MANAGEMENT
indicated) either as in patient or as part of day care treatment in a ▪ Covered up to the sub-limit (or) maximum up to 20%
hospital upto sum insured (including pre and post hositalization of the sum insured whichever is less, per policy year
expenses) during the policy period
Uterine artery Embolization and HIFU Rehabilitation
Balloon Sinuplasty ▪ If availed at authorized centres as an In-patient/Out-
Deep Brain Stimulation patient, and if there is an admissible claim for In-
Oral Chemotheraphy patient hospitalization for an injury, disease or illness
specified below
Immunotheraphy- Monoclonal
Antibody to be given as injection
▪ Poly Trauma
▪ Head injury
Intra Vitreal injections
▪ Diseases of the spine
Robotic surgeries ▪ Stroke
Stereotactic radio surgeries ▪ Treatment can be taken only at the Authorized centres
Bronchical Thermoplasty, Vaporisation of the prostate mentioned in the website – www.starhealth.in
(Green laser treatment or holmium laser treatment)
IONM-(Intra Operative Neuro Monitoring
Stem cell therapy
Hematopoietic stem cells for bone marrow transplant for
haematological conditions

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 REHABILITATION AND PAIN MANAGEMENT
Name of the covered pain management
Sub-limits (Per Policy Period)
treatment Name of the covered pain management
(Rs) Sub-limits (Per Policy Period) (Rs)
treatment

Sum Insured (Lakhs)

Sum Insured (Lakhs) 5/10/15/20 25 & above 5/10/15/20 25 & above

Lumbar and cervical medial branch block with Gasserian ganglion ablation for Trigeminal
RF ablation for lumbar and cervical facet joint 65,000 75,000 65,000 75,000
neuralgia
arthritis
Intercostal nerve ablation for post
Caudal epidural injection for Discogenic pain 40,000 50,000 thoracotomy pain and Thoracic malignancy 65,000 75,000
pain

Lumbar and cervical selective nerve root Coeliac plexus ablation for upper
50,000 60,000 65,000 75,000
block for Lumbar and Cervical radicular pain gastrointestinal malignancies pain

Caudal Neuroplasty for Failed back spine Superior hypogastric plexus ablation for lower
85,000 1,00,000 65,000 75,000
surgery Gastro intestinal malignancies pain

Stellate ganglion ablation for upper limb CRPS 65,000 75,000 Ganglion impar ablation for perineal cancer
65,000 75,000
pain and coccydynia
Occipital nerve Pulsed RF lesioning for
Migraines,Cluster headache and cervicogenic 65,000 75,000
headaches Cooled RF ablation of genicular nerve for
1,00,000 1,25,000
grade 1 and 2 osteoarthritis knee and hip
Lumbar sympathetic chain RF ablation for
lower limb CRPS, diabetic periphery painful 65,000 75,000 Suprascapular nerve RF ablation for rotator
neuropathy and Ischaemic limb pain cuff partial tear and peri arthritis shoulder 65,000 75,000
pain 22
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 STAR WELLNESS PROGRAM
Maximum number of Wellness
No. Activity Points that can be earned under
Wellness Points each activity in a policy year
▪ This program intends to promote, Earned
Discount in Premium Manage and Track Health
1. a) Online Health Risk Assessment (HRA) 50
200 to 350 4%
incentivize and to reward the Insured 351 to 600 10%
a) Preventive Risk Assessment 200
Affinity to Wellness
601 to 750 14% a) Participating in Walkathon, Marathon,
Persons’ healthy life style through various 2. Cyclothon and similar activities
100
751 to 1000 20%
a) Membership in a health club (for 1 year or 100
wellness activities. more)
3. Stay Active – If the Insured member achieves the 200
▪ The wellness reward points which will be step count target on mobile app
In case of floater policy, the a) Weight Management Program (for the
100
tracked and monitored by the Company. weightage is given below 4. a)
Insured who is Overweight / Obese)
Sharing Insured Fitness Success Story through
Family Size Weightage adoption of Star Wellness Program (for the
▪ Can be utilized to get discount in premium. Insured who is not Overweight / Obese)
50
Self, Spouse 1:1
▪ Will be enabled and administered online Self, Spouse and 1:1:0:0:0
a) Chronic Condition Management Program (for
the Insured who is suffering from Chronic
Dependent 250
Condition/s - Diabetes, Hypertension,
through Star Wellness Platform through Children (up to 18
5.
Cardiovascular Disease or Asthma)
years) a) On Completion of De-Stress & Mind Body
Self, Spouse and 2:2:1:1:1 Healing Program (for the Insured who is not
Star Health customer mobile app “Star Dependent suffering from Chronic Condition/s - Diabetes, 125
Hypertension, Cardiovascular Disease or
Children (aged
Power” and through Star Health Customer above 18 years)
Asthma)
Additional Wellness Services
Star Tele health services
Portal. (digital platform) Medical Concierge Services
Digital Health Vault
▪ Note: Applicable for the Insured person(s) Wellness Content
Note: In case of two year policy, total
number of wellness points earned in two Post-Operative Care
aged 18 years and above only year period will be divided by two. Discounts from Network Providers
 Illustration of Benefits

A 50 year old Individual Suresh and his wife Lakshmi along with their two dependent children (aged below 18 yrs) buy a Star Health Assure Insurance Policy with
Sum Insured 20 Lakhs, let’s understand how they can earn Wellness Points under the Floater Policy. Suresh has declared that he is suffering from Diabetes &
Hypertension. Suresh has declared his Body Mass Index (BMI) as 30 & Lakshmi has declared her BMI as 25 Suresh and Lakshmi enrolled under the Star wellness
program and completed the following wellness activities.
Wellness Points Earned by Wellness Points Earned by
S.No Name of the wellness activity taken up during the policy year
Suresh Lakshmi
1 Completed Online Health Risk Assessment (HRA) 50 50

2 Submitted Health Check-Up Report 200 200

3 Participation in Marathon 100 0

4 Attended to Gym 100 100

5 Achieved 10,000 average number of steps per day during the policy year 200 200

Suresh accepted the Weight management program and reached 27 BMILakshmi accepted
6 100 100
the Weight management program and reached 23 BMI
Suresh Managed Diabetes & Hypertension through Chronic Condition Management
7 250 125
Program; Lakshmi has completed De-stress & Mind Body Healing Program

Total Number of Wellness Points earned 1000 775

No of wellness points based upon weightage - 1:1 500(1000X1/2) 388(775X1/2)

Total Number of Wellness Points earned by Suresh and Lakshmi = 888 (500+388)
Based on the no of Wellness Points earned, Suresh & Lakshmi are eligible to get 20%
discount on renewal premium 24
 CO-PAYMENT OPTIONAL COVER TO CHOOSE
DEDUCTIBLE
▪ If the insured person chooses any of the following deductible, the
▪ 10% of each and every claim amount for
Company will provide a discount on premium
fresh as well as renewal policies for
insured person whose age at the time of Sum Insured Aggregate Discount Offered
Deductible Option
entry is 61 years an above.
Up to Rs 20 Lakhs Rs 50,000 45%

Rs 1,00,000 55%

Above Rs 20 Lakhs Rs 50,000 35%

Rs 1,00,000 50%

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Note: This deductible is applicable for every policy year (on Aggregate basis)
 ILLUSTRATION OF DEDUCTIBLE
If an Insured with Rs 10 Lakhs Sum Insured opted for an aggregate deductible of Rs.50,000 in a year, lets understand how
this deductible will be applied
First Policy Year

Sum Insured Rs 10 Lakhs (Opted Deductible is Rs. 50,000/- )

What does opting a deductible Coverage will start once the Insured incurs single/ multiple claims that add up to the
mean deductible amount in a policy year
1st Claim (Injury due to Accident) Rs. 50,000/- (Not paid by us as it is within Deductible limit)

Balance Sum Insured Rs. 10 Lakhs

2nd Claim (Dengue fever) Rs. 65,000/- (Payable as the deductible limit of Rs. 50,000/- is already exhausted in the
policy year)
Balance Sum Insured Rs. 9,35,000/-

3rd Claim (bacterial Rs. 55,000/- (Payable as the deductible limit of Rs. 50,000/- is already exhausted in the
gastroenteritis) policy year)

Balance Sum Insured Rs. 8,80,000/-

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 WAITING PERIOD

Initial Waiting Period

For 30 days (Other than Accidents)
(Code Excl 03)
Specified Diseases
2 years
(Code Excl 02)
Applicable for 3 year policy term: 2.5 years
Pre-existing Diseases
Applicable for 1 year and 2 year policy
(Code Excl 01)
term :3 years
Delivery Expenses Cover 2 years

In Utero Fetal Surgery / 2 years

Intervention
Assisted Reproduction
2 years
Treatment

New Born Baby Cover 1 year

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 List of Benefits which are part of sum insured and in addition to sum insured

S No Coverage Forming Part of Sum Insured / In addition to Sum Insured

Room Rent , Boarding, Nursing Expenses, Surgeon, Anesthetist, Medical

Practitioner, Consultants, Specialist Fees, Anesthesia, Blood, Oxygen, Operation
1 theatre charges, ICU charges, Surgical appliances, Medicines and Drugs, Forming Part of Sum Insured
Diagnostic materials and X-ray, Diagnostic imaging modalities, dialysis,
chemotherapy, radiotherapy, cost of pacemaker, stent and similar expenses.
2 All day care treatments Forming Part of Sum Insured
3 Coverage for Non-medical items (Consumables) Forming Part of Sum Insured
4 Emergency Road ambulance Forming Part of Sum Insured
5 Air Ambulance Forming Part of Sum Insured
6 Pre-hospitalization Expenses Forming Part of Sum Insured
7 Post Hospitalization Expenses Forming Part of Sum Insured
8 Domiciliary Hospitalisation Forming Part of Sum Insured
9 Organ Donor Expenses Forming Part of Sum Insured
10 Complications necessitating Redo surgery or ICU admission for the Organ donor In addition to Sum Insured
11 Health Check Up Assure In addition to Sum Insured
12 Home care treatment Forming Part of Sum Insured
13 Delivery Expenses Forming Part of Sum Insured
14 In Utero Fetal Surgery/Intervention Forming Part of Sum Insured
15 Assisted Reproduction Treatment Forming Part of Sum Insured
16 Hospitalisation expenses for Treatment of New Born Baby Forming Part of Sum Insured
17 Compassionate Travel In addition to Sum Insured
18 Repatriation of Mortal Remains In addition to Sum Insured
19 Treatment in Valuable Service Providers Network In addition to Sum Insured
20 Shared Accommodation In addition to Sum Insured
21 AYUSH Treatment Forming Part of Sum Insured
22 Coverage for Modern Treatment Forming Part of Sum Insured
23 Automatic Restoration of Sum Insured In addition to Sum Insured
24 Treatment for Chronic Severe Refractory Asthma Forming Part of Sum Insured
28
25 Rehabilitation and Pain Management Forming Part of Sum Insured
 TELE - CONSULTATION FACILITY
TALK TO STAR IS FREE-OF-COST FACILITY!
FOR OUR CUSTOMERS, AGENTS, SALES MANAGERS AND EMPLOYEES

▪ Provided by our company in the time of need, helping us realize our motto -
PERSONAL & CARING
▪ Unique facility offered by our technology platform
▪ Provided with specialist doctors during the grim period of COVID-19 pandemic
and to avoid visiting hospitals
▪ Consult with specialists in Ophthalmology, Cardiology, Paediatrics, Orthopedics,
Gynaecology, Psychiatry, Diabetology, Dentistry, Neurology and Dermatology
▪ To avail this facility, call 7676905905 or mail to telemedicine@starhealth.in

29
 LONG TERM TAX BENEFITS PREMIUM PAYMENT IN
DISCOUNT INSTALMENT OPTIONS

▪ Insured has option for payment of premium on

▪ Two year policy: 10 % Insured is eligible for relief under
discount on 2 nd year instalment basis ie Quarterly and Half Yearly
Section 80D of the Income Tax Act
premium
▪ Grace period of 7 days allowed
▪ Three year policy: 10% when premium is paid by any mode
discount is available on 2
other than cash ▪ During such grace period, coverage will not be
nd and 3rd year premium
available
▪ ln case of instalment premium due not received
within the grace period, the policy will get
cancelled
▪ ln the event of a claim, all subsequent premium
instalments shall immediately become due and
payable
30
 SPECIFIED DISEASES - FIRST 2 YEARS’
EXCLUSIONS (CODE EXCL 02)

Cataract, Diseases of ENT, Diseases related to All types of management for Kidney calculi
thyroid, Benign diseases of the breast and Genitourinary tract calculi

Subcutaneous benign lumps, Sebaceous cyst,

Dermoid cyst, Mucous cyst lip/cheek All types of Hernia

Ligament, Fascia, Bones and Joint Including Desmoid Tumor, Umbilical Granuloma,
Arthroscopy and Arthroplasty Umbilical Sinus, Umbilical Fistula

Vertebral diseases, including replacement of All Diseases of Prostate, Stricture Urethra, all
bones and joints Obstructive Uropathies

Note: For complete list, please refer to the policy

31
 PERMANENT EXCLUSIONS

• Investigation & Evaluation - Code Excl 04

• Rest Cure, rehabilitation (Except to the extent covered • Treatments received in health hydros, nature cure clinics,
under coverage Rehabilitation and Pain Management) spas - Code Excl 13
& respite care - Code - Excl 05 • Dietary supplements and substances that can be
• Obesity/Weight Control - Code Excl 06 purchased without prescription - Code Excl 14

• Change-of-Gender treatments - Code Excl 07 • Refractive Error - Code Excl 15

• Cosmetic or plastic surgery - Code Excl 08 • Unproven Treatments - Code Excl 16
• Hazardous or Adventure sports - Code Excl 09 • Sterility and Infertility (Except to the extent covered under
coverage Assisted Reproduction Treatment) - Code Excl 17

• Breach of law - Code Excl 10 • Maternity- Code -Excl 18

• Excluded Providers - Code Excl 11 • Circumcision (unless necessary for treatment of a disease
• Treatment for alcoholism, drug or substance abuse not excluded under this policy or necessitated due to an
- Code Excl 12 accident) - Code Excl 19

Note: For complete list, please refer to the policy wording

32
 CLAIM PROCEDURE
FOR REIMBURSEMENT CLAIMS

Sl. ▪ Duly completed claim form, and

Type of Claim Prescribed Time Limit
No.
▪ Pre Admission investigations and treatment papers
1 Reimbursement of Claim must be filed within ▪ Discharge Summary from the hospital
hospitalization, 15 days from the date of
daycare and pre- discharge from the ▪ Cash receipts from hospital, chemists
hospitalization hospital ▪ Cash receipts and reports for tests done
expenses
▪ Receipts from doctors, surgeons, anesthetist
Reimbursement of Within 15 days after ▪ Certificate from the attending doctor regarding the diagnosis.
2 post-hospitalization completion of 180 days
expenses from the date of discharge ▪ KYC (Identity proof with Address) of the proposer, where
from hospital
claim liability is above Rs 1 Lakh as per AML Guidelines
Note: Call the 24 hour help-line for assistance - 1800 425 2255 /
1800 102 4477, Senior Citizens may call at 044 40020888

33
 CLAIM PROCEDURE

Call the 24-hour helpline for

Obtain the pre-authorization
assistance -1800 425 On admission in the hospital,
form from the hospital
2255/1800 104 2277 Inform the ID number for produce the ID card issued
helpdesk, complete the patient
Senior Citizens may call at easy reference by the company at the
information and re-submit to
044 40020888 hospital helpdesk
the hospital helpdesk

Once all the details are The company will process The treating doctor will complete
In case of emergency furnished, the company will the request and call for the hospitalization/treatment
hospitalization, information process the request as per the additional information and the hospital will
to be given within 24 hours terms and conditions, as well as documents/clarifications if fill up expected cost of
after hospitalization the exclusions therein, and the information furnished is treatment. This form is
either approve or reject the inadequate submitted to the company
request based on the merits

Cashless facility can be availed only in networked Hospitals. For details of Network Hospitals, the insured may visit www.starhealth.in or contact the nearest branch
34
 PRODUCT USP
❑ Maximum Maximum family size , 6A + 3C (6 Adults = Self + Spouse + Parents + Parents-in-law)

❑ Higher Sum Insured up to Rs 2 Cr (Rs 75 Lakhs, Rs 1 Cr and Rs 2 Cr sum insured is applicable for
persons aged below 65 years)

❑ Automatic Restoration: Sum Insured will be restored unlimited number of times and maximum up
to 100% each time

❑ No categorization for room including boarding and Nursing expenses ( Upto 1% of sum insured or
upto Rs 20,000 per day whichever is less)
❑ Rs 75/100/200 Lakhs Sum Insured no limits for room rent

❑ Optional cover to choose deductible

❑ Home Care treatment

❑ Delivery expenses, treatment of New born baby cover 35

 ONE PAGER, PREMIUM CHART, AML

Star Health Assure_version 1.0_April_22

Strictly for Internal Training Purpose only