Star Health Mediclassic Individual Insurance Policy

Introduction

It covers hospitalization expenses incurred in daily life due to diseases and illness or accidental injuries thus taking care of uncertainties.

Eligibility:

• Minimum age: 5 months and maximum: 65 years at the time of entry. Children can be covered only along with parents.
• The sum insured under this insurance is per individual member covered.

Who Can Take This Insurance?      

Policy Benefits:

• Hospitalisation Cover: Hospitalisation expenses are covered for a minimum of 24 hours (room rent, nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs).
• Ambulance charges for emergency transportation to hospital as per specified limits.
• Pre-Hospitalization expenses up to 30 days prior to admission in the hospital.
• Post-hospitalisation paid as lump-sum up to 60 days from the date of discharge; payment not exceeding 7% of hospitalization expenses; maximum of 5000 INR.
• 101 Day-care treatments covered.
• Non-Allopathic Treatments: Covered up-to specified limits.
• Pre-Existing Diseases / Illness:   Are covered after 48 months of continuous Insurance without break with any Indian Insurance Company.

Add-on covers (subject to payment of additional premium)

• Patient Care: Available for above 60 years (attendant charges after discharge from hospital for maximum 5 days per hospitalisation and 14 days per policy period).
• Hospital Cash: Hospital cash benefit for each completed day of hospitalization.

Policy details:

Term of one year but if a premium of two years is paid in advance then a discount of 5% is allowed on total premium.

Automatic Restoration of Sum Insured( not applicable for Family Package ): In the event of a claim, during the currency of the policy, if the entire sum insured is exhausted and the policy has not expired then the automatic restoration of Sum Insured will operate and the sum insured will be restored to the original amount i.e. 200% only once. This restored sum insured can be utilized, during the remaining policy period, for any other illness / diseases unrelated to the ones for which claim/s has /have been made.

Bonus:

For every claim year bonus is equal to 5% of the basic sum subject to a maximum of 25% (only for family package plan).

Pre- Acceptance medical screening: Persons above 50 years will be required to undergo pre-acceptance medical screening at the Company nominated centres. Cost of screening is currently borne by the company.

Family Package:

• Available for persons between 5 months to 45 years. The sum insured is distributed equally among insured family members and calculated on the policy sum insured.

Optional Benefit of New Born Baby cover available under this Plan: Sum Insured : 10% of the mother's sum insured. Premium: 10% of the policy premium.

Health Check-up benefits: Cost of Health Check-up once after a block of every four claim-free years. This benefit is available for sum insured of Rs.2, 00,000/- and above only for a maximum of 5000 INR and payable on renewal.

HIV Persons Coverage:  This policy can be taken by HIV positive persons. But the CD 4 count at the time of entry should be above 350 (proof to be produced). However, hospitalization for any opportunistic infections is not covered.

Premium Chart:

*The above rates may vary. Please check the policy wordings for more details.

Free look period: To review terms and conditions by the insurer and making way for a judicious decision a period of 15 days after policy comes into effect is allowed. Within this period the insurer may also ask for cancellation.

Exclusions:

• Pre Existing diseases as mentioned.
• Disease that creeps into the insured during the first 30 days of the policy period. Also expenses of defined and related diseases as mentioned would not be borne during the first two years of continuous operation of insurance.
• Dental treatment or surgery (excluding accidental damages).
• Injury due to nuclear weapons and war or breach of law on an intentional basis.
• Expenses on Vitamins and tonics not part of the treatment schedule.
• Hospital registration and admission charges, record and telephone charges.

Cancellation Policy:

Misrepresentation, fraud, moral hazard or non-cooperation on behalf of the insured might lead to cancellation of policy making way for appropriate refund.