| Section 1 |
Health Insurance Coverage |
| Hospitalization Cover |
Hospitalization cover protects the insured for in patient hospitalization expenses for a minimum period of 24 hrs. These expenses include
- Room rent (Single Standard A/C room), nursing and boarding charges
| Sum Insured (₹) |
Limit per policy period by road ambulance (Upto ₹) |
| 1,00,000 and 2,00,000 |
Rs.2,000/- per day |
| 3,00,000 and 4,00,000 |
Up to Rs.5,000/- |
| 5,00,000 to 25,00,000 |
Single Standard AC Room |
- Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist fees
- Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X-ray, diagnostic imaging modalities, dialysis, chemotherapy, radiotherapy, cost of pacemaker, stent and such other similar expenses.
- With regard to coronary stent, the Company will pay such amount up to the extent of cost of bare metal stent/drug eluting cobalt-chromium stent/drug eluting stainless steel stent. In respect of medicines, Implants and such other similar items, the Company will pay up to the cost of alternate indigenous make.
|
| Cataract Surgery Charges |
| Sum Insured (₹) |
Limit per eye ( in ₹) |
Limit per policy period (in ₹.) |
| 1,00,000 and 2,00,000 |
Up to 12,000/- per eye, per policy period |
| 3,00,000/- |
Up to 25,000/- |
Up to 35,000/- |
| 4,00,000/- |
Up to 30,000/- |
Up to 45,000/- |
| Up to 45,000/- |
Up to 40,000/- |
Up to 60,000/- |
| 10,00,000/- to 25,00,000/- |
Up to 50,000/- |
Up to 75,000/- |
|
| Emergency ambulance charges for transporting the covered patient to the hospital |
Rs. 750/- per hospitalization and overall limit of Rs. 1,500/- per policy period. |
| Emergency Air Ambulance Charges |
In case of Air Ambulance, the limit per policy period is 10% of the Sum Insured. |
| Pre-Hospitalization |
Upto 60 days prior to the date of admission |
| Post-Hospitalization |
Upto 90 days post the discharge from the hospital. |
| Domiciliary Hospitalisation |
Coverage for medical treatment for a period exceeding three days, for an illness/disease/injury, which in the normal course, would require care and treatment at a Hospital but, on the advice of the attending Medical Practitioner, is taken whilst confined at home under any of the following circumstances:
- The condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or
- The patient takes treatment at home on account of non-availability of room in a hospital.
However, this benefit shall not cover Asthma, Bronchitis, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all types of Dysenteries including Gastro-enteritis, Diabetes Mellitus and Insipidus, Epilepsy, Hypertension, Influenza, Cough and Cold, all Psychiatric or Psychosomatic Disorders, Pyrexia of unknown origin for less than 10 days, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Arthritis, Gout and Rheumatism.
Pre-hospitalization and Post-hospitalization expenses are not payable for this benefit.
|
| Organ Donor Expenses |
Organ transplantation where the insured person is the recipient are payable provided the claim for transplantation is payable and subject to the availability of the sum insured. Donor screening expenses and post-donation complications of the donor are not payable. This cover is subject to a limit of 10% of the Sum Insured or ₹.1,00,000/-, whichever is less.
|
| Health Check -Up |
Expenses incurred towards cost of health check-up up to the limits mentioned in the table given below for every claim free year provided the health check-up is done at network hospitals and the policy is in force. Payment under this benefit does not form part of the sum insured and will not impact the Bonus.
| Sum Insured (₹) |
Limit per policy period (₹) |
| 1,00,000/- and 2,00,000/- |
Not Available |
| 3,00,000/- |
Up to 750/- |
| 4,00,000/- |
Up to 1,000/- |
| 5,00,000/- |
Up to 1,500/- |
| 10,00,000/- |
Up to 2,000/- |
| 15,00,000/- |
Up to 2,500/- |
| 20,00,000/- |
Up to 3,000/- |
| 25,00,000/- |
Up to 3,500/ |
|
| Hospitalisation Expenses for treatment of New Born Baby |
The coverage for New Born Baby starts from the 16 day after its birth till the expiry date of the policy and is subject to a limit of 10% of the Sum Insured or ₹50,000, whichever is less, subject to the availability of the sum insured, provided the mother is insured under the policy for a continuous period of 12 months without break. |
| Emergency Domestic Medical Evacuation |
Subject to limits mentioned in the table given below, the Company will reimburse reasonable and necessary expenses incurred towards transportation of the insured person from the hospital where the insured person is currently undergoing treatment to another hospital for further treatment subject to policy terms and conditions:
| Sum Insured (₹) |
Limit per Hospitalisation (Upto ₹) |
| Up to 4,00,000/- |
Up to 5,000/- |
| 5,00,000/- to 15,00,000/- |
Up to 7,500/- |
| 20,00,000/- and 25,00,000/ |
Up to 10,000/- |
|
| Compassionate Visit |
In the event of the insured person being hospitalized for a life threatening emergency at a place away from his usual place of residence as recorded in the policy, the Company will reimburse the transportation expenses by air incurred upto₹5000/- for one immediate family member (other than the travel companion) for travel towards the place where hospital is located, provided the claim for hospitalization is admissible under the policy. |
| Repatriation of Mortal Remains |
Following an admissible claim for hospitalization under the policy, the Company shall reimburse up to Rs.5,000/- per policy period towards the cost of repatriation of mortal remains of the insured person (including the cost of embalming and coffin charges) to the residence of the Insured as recorded in the policy. Payment under this benefit does not form part of the sum insured but will impact the Bonus.
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| Treatment in Preferred Network Hospitals. |
In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, the Company may suggest an appropriate hospital from the network for treatment. Where the insured accepts the same and undergoes treatment in the suggested hospital, an amount calculated at 1% of Basic Sum Insured subject to a maximum of ₹5,000/- per policy period is payable as lump sum.
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| Shared Accommodation |
If the Insured person occupies, a shared accommodation during in-patient hospitalization, then amount as per table given below will be payable for each continuous and completed period of 24 hours of stay in such shared accommodation.
| Sum Insured (₹) |
Limit per Day (Upto ₹) |
| 1,00,000/- and 2,00,000 |
Not Payable |
| 3,00,000/- to 15,00,000/- |
Up to 800/- per day |
| 20,00,000/- and 25,00,000/ |
Up to 1,000/- per day |
|
| AYUSH Treatment |
Expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in a Government Hospital or in any institute recognized by the government and/or accredited by the Quality Council of India/National Accreditation Board on Health is payable up to the limits given below:
| Sum Insured (₹) |
Limit per Policy Period (Upto ₹) |
| 1,00,000/-to 4,00,000 |
Up to 10,000/- per day |
| 5,00,000/- to 15,00,000/- |
Up to 15,000/- per day |
| 20,00,000/- and 25,00,000/ |
Up to 20,000/- per day |
|
| Second Opinion |
The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company's network of Medical Practitioners. All the medical records provided by the Insured Person will be submitted to the Doctor chosen by him/her online and the medical opinion will be made available directly to the Insured by the Doctor. To utilize this benefit, all medical records should be forwarded to the mail-id e_medicalopinion@starhealth.in. |
| Assisted Reproduction Treatment |
The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility subject to:
- A waiting period of 36 months from the date of first inception of this policy with the Company for the insured person. The maximum liability of the Company for such treatment shall be limited to ₹1,00,000/- for Sum Insured of ₹5,00,000/- and ₹2,00,000/- for Sum Insured of ₹10,00,000/- and above for every block of 36 months and payable on renewal
- For the purpose of claiming under this benefit, in- patient treatment is not mandatory.
- Automatic Restoration of Basic Sum Insured, Recharge Benefit shall not be applicable for this benefit
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| Automatic Restoration of Basic Sum Insured |
There shall be automatic restoration of the Basic Sum Insured immediately upon exhaustion of the limit of coverage, which has been defined, during the policy period.
Such Automatic Restoration is available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one.
|
| Recharge Benefit |
If the limit of coverage under the policy is exhausted/ exceeded during the policy period, additional indemnity up to the limits stated in the table given below would be provided once for the remaining policy period. Such additional indemnity can be utilized even for the same hospitalization or for the treatment of diseases / illness / injury / for which claim was paid / payable under the policy. The unutilized Recharge amount cannot be carried forward.
| Sum Insured (₹) |
Limit (Upto ₹) |
| 1,00,000/-and2,00,000 |
Not available |
| 3,00,000/- |
Up to 75,000/- |
| 4,00,000/ |
Up to 1,00,000/- |
| 5,00,000 to 25,00,000 |
Upto 1,50,000/- |
|
| Upto 1,50,000/- |
If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of ₹5,00,000/- and subject to the policy terms and conditions.
|
| Bonus |
In respect of a claim free year of Insurance, for the Basic Sum Insured options ₹.3,00,000/- and above, the insured would be entitled to benefit of bonus of 25% of the expiring Basic Sum Insured in the second year and additional 10% of the expiring Basic sum Insured for the subsequent years. The maximum allowable bonus shall not exceed 100%.
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| Section 2 |
Life Insurance Coverage |
| Life Cover |
This plan provides for lump sum in the event of death of the Primary Life Insured during the term of the plan and ensures that your loved ones are taken care of, even in your absence
|
| Sum Assured |
₹3 lacs to ₹15 lacs (@ intervals of ₹1 lac)
|
| Maturity / Survival / Surrender / Loan Benefit |
Maturity / Survival / Surrender / Loan Benefit
|
| Medicals Requirement |
No Medicals till insured is 50 years of age
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