AROGYA SANJEEVANI POLICY
STAR HEALTH & ALLIED INSURANCE CO. LTD.
A simple policy loaded with essential benefits
SHAHLIP22027V032122
STRICTLY FOR INTERNAL TRAINING PURPOSE ONLY
BENEFITS
Hospitalization No-Claim Bonus
Pre & Post-hospitalization AYUSH
Daycare Coverage
Daycare Coverage Modern Treatments
Daycare Coverage
Cataract
Road Ambulance Instalment
Road Premium
Ambulance
Road Ambulance
Air Ambulance
Rural Discount
3
COVERAGE ABOUT THE POLICY SUM INURED
OPTIONS (in LAKHS)
Who Can Avail? Policy Term 0.50 1 1.50 2
1 year 2.50 3 3.50 4
Adults: 18 years to 65 years
Dependent children: Continuity
4.50 5 5.50 6
3 months to 25 years Lifetime renewal 6.50 7 7.50 8
Policy Type: Individual & Instalment Facility
8.50 9 9.50 10
Floater Quarterly, Half-yearly, Yearly
• Family means Self, Spouse,
Dependent children, Parents,
Parents-in-law
Note: Dependent children can be
covered along with parent/s
4
HOSPITALIZATION
EXPENSES ON HOSPITALIZATION FOR A MINIMUM PERIOD OF 24 HOURS COVERED
Cashless Reimbursement
Network Hospitals Non-Network Hospitals
5
HOSPITALIZATION
CONNECTED TREATMENT EXPENSES
Professional Fee Medical Services Medicines
Surgeon Anesthesia Drugs
Consultant Blood Cost of pacemaker
Anesthetist Oxygen
Specialist OT charges
ICU charges
6
ROOM RENT ICU
Sum Insured (Rs) Room Rent (Per day) Sum Insured (Rs) ICU (Per day)
50000 1000
50000 2500
1 Lakh 2000
1 Lakh 5000
1.5 Lakh 3000
2 Lakh 4000 1.5 Lakh 7500
2.5 Lakh & above 5000 2 Lakh & above 10000
Definition_Associat
ed Medical Expenses.doc
Note: Expenses on hospitalization considered in proportion to eligible room rent 7
PRE & POST- DAYCARE CATARACT
HOSPITALIZATION
Covered up to 25% of sum insured
or Rs 40,000, whichever is lower,
per eye in a policy year
All daycare procedures are covered
Per eye in a
Sum Insured
30 60 policy year
(Rs)
Days Days (Rs)
50000 12500
1 Lakh 25000
1.5 Lakh 37500
2 Lakh & above 40000
8
ROAD NO-CLAIM BONUS AYUSH
AMBULANCE
Medical expenses incurred for
Rs 2000 per hospitalization 5% each claim-free policy year,
in-patient treatment under
subject to maximum of 50%
Ayurveda, Yoga, Naturopathy,
Unani, Siddha and Homeopathy
NCB Definition.doc
Coverage up to the limit of sum
insured
Naturopathy.doc
9
MODERN TREATMENTS PREMIUM PAYMENT OPTIONS
Limits per
List of Procedures policy period Grace period of 15 days allowed for
Uterine Artery Embolization and HIFU (High-intensity
focused ultrasound) instalment premium
Balloon Sinuplasty During such grace period, coverage will not
Deep-brain stimulation
Oral chemotherapy Up to 50% of be available
Immunotherapy - Monoclonal antibody to be given as the sum
injection insured ln case of instalment premium due not
lntravitreal injections received within the grace period, the policy
Robotic surgeries
Stereotactic radio surgeries
will get cancelled
Bronchial Thermoplasty ln the event of a claim, all subsequent
Vaporisation of the prostrate (Green laser treatment or
holmium laser treatment) premium instalments shall immediately
IONM - (Intraoperative Neuro-Monitoring) become due and payable
Stem-cell therapy: Hematopoietic stem cells for bone
marrow transplant for hematological conditions to be
covered Grace Period.doc
10
CO-PAY TAX BENEFITS PRE-MEDICAL
SCREENING
5% of co-pay for all claims Insured is eligible for relief Persons above 50 years of age will have
under Section 80D of the to undergo pre-acceptance health
Income Tax Act when premium screening at the company's nominated
Definition_Copaym
ent.doc is paid by any mode other centres.
than cash
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PREMIUM ILLUSTRATION 1 PREMIUM ILLUSTRATION 2
INDIVIDUAL FLOATER
Parent Premium
Sum Insured: Rs 5 Lakh Family size 2A+1P+3C Age Each parent
Family Size: 6 Persons 2A: Self & Spouse Up to 60 10260
Self Age: 46 and spouse age 35 Self age: 45 years
61-70 15340
1 parent/in-law : age 62 years Spouse age: 35 years
Above 70 25925
3 Children, all aged below 25 years 1 parent to be covered: 62 years
All children aged below 25 years Child Premium
Individual Premium Chart Age up to 25 years
Sample
1st Child 2000
Age 1A Floater Premium Chart Sample
2nd Child 1800
3months to 35 4170 Age 2A
Self 7590 Up to 35 6,255
36-45 5420 3rd Child & beyond 1620
Spouse 4170 36-45 8,130
46-50 7590
Parent 1 aged 62 16675 46-50 11,385 For Self & Spouse 8130
51-55 9865
51-55 14,800 Children (First Child 2000+ second child
56-60 12825 5420
Children 3 (Rs. 4,170 x 3) 12510 56-60 19,240 1800 + Third Child 1620)
61-65 16675
61-65 25,010 Parent aged 62 15340
Premium excluding GST 40945
66-70 21675 66-70 32,515
Add GST 7370 Total Premium 28890
71-75 28180 71-75 42,270
76-80 36635 Total Premium payable including Add GST @ 18% 5200
48315 76-80 54,950
GST Total Premium Payable 34090
Above 80 47620 Above 80 71,435
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TELECONSULTATION 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
[email protected] 13
BENEFIT ILLUSTRATION
14
RURAL DISCOUNT WAITING PERIOD
20% discount of premium for rural Initial Waiting Period For 30 days
(Code Excl 03) (Other than
policyholders accidents)
Specified Diseases 24 months/36
(Code Excl 02) months
Pre-existing Diseases
(Code Excl 01) 36 months
Rural Discount.doc
15
SPECIFIED DISEASES - FIRST 2-YEAR EXCLUSIONS
(24 MONTHS)
Benign ENT disorders Tympanoplasty
Tonsillectomy Hysterectomy
Adenoidectomy Benign prostate hypertrophy
Mastoidectomy Cataract and age-related eye ailments
Note: For complete list, please refer to the 16
policy
SPECIFIED DISEASES - FIRST 2-YEAR SPECIFIED DISEASES - FIRST 3-YEAR
EXCLUSIONS ( 24 MONTHS) EXCLUSIONS (36 MONTHS)
Gout and rheumatism Treatment for joint replacement,
unless arising from accidents
Hernia of all types
Age-related osteoarthritis &
osteoporosis
Hydrocele
Non-infective arthritis
Note: For complete list, please refer to the 17
policy
PERMANENT EXCLUSIONS
Investigation & evaluation,
Hazardous or adventure sports
gout and rheumatism
Rest cure, rehabilitation and respite care Breach of law
Obesity/Weight control Unproven Treatments
Change-of-gender treatments Sterility and infertility
Cosmetic
Cosmetic or plastic surgery surgery
or Plastic Maternity expenses
Misrepresentation Note: For complete list, please refer to the 18
of records.doc policy
CLAIM PROCEDURE
DOCUMENTS REQUIRED FOR REIMBURSEMENT CLAIMS
S.No Type of Claim Prescribed Time Limit
Reimbursement of hospitalization,
1 daycare and pre-hospitalization Within 30 days of date of discharge from
expenses hospital
Reimbursement of
2 post-hospitalization Within 15 days from completion of
post-hospitalization treatment
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CLAIM PROCEDURE
Obtain the
On admission in the
pre-authorization form from
Call the 24-hour helpline hospital, produce the ID
Inform the ID number for the hospital helpdesk,
for assistance - 1800 425 card issued by the
easy reference complete the patient
2255/1800 102 4477 company at the hospital
information and re-submit
helpdesk
to the hospital helpdesk
Once all the details are The treating doctor will
furnished, the company will The company will process
In case of emergency complete the
process the request as per the request and call for
hospitalization, hospitalisation/treatment
the terms and conditions as additional
information to be given information and the hospital
well as the exclusions documents/clarifications
within 24 hours will fill up expected cost of
therein and either approve if the information
after hospitalization treatment. This form is
or reject the request based furnished is inadequate
submitted to the company.
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 20
