Star Unique Health

1. Star Unique Health

2. Why Unique? • This policy is Unique because it covers Certain Pre-Existing diseases as well as any future ailments – ------- all under one policy Major Features.. • Pre Existing Diseases (other than those for which specific time periods have been mentioned separately) covered after complete of 11 months • The policy provides coverage to HIV positive persons. • Premium payable in installments • No pre acceptance medical examination

3. Coverages.. Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accidental injuries Pre Existing Disease.. • Pre-Existing Disease/ Condition will be covered after 11 months of continuous coverage • Does this mean that any PED is covered after 11 months? • No – only certain diseases that are Pre-Existing

4. Coverage for HIV positive persons • The policy extends coverage to HIV positive persons. • Minimum CD 4 count at entry level should be 350 • Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc) not covered • Expenses for treatment of HIV / AIDS not covered

5. Period of Insurance.. • The policy is for a two year period. • Even renewal will be for a two year period • Advantages are :Customer retentionClaims loading, if applicable will happen only once in two years • However, Sum insured will be available afresh for each year. • For example if a person opts for a SI of Rs. 2 lacs – it means it is 2 lacs for first yr and 2 lacs for the second yr. • However sum insured cannot be cumulated or carried forward

6. Installment Premium.. • The premium can be paid in 2 annual installments. • The grace period of 15 days for benefit of continuity will be available for instalment premium also. However, the expiry date of the policy will not change. • Where a claim is made in the first year itself the premium towards the next installment would be deducted from the claim amount. • The policy would lapse if the installment is not paid on or before the due date.

7. Age Limits.. • Entry age 18 Years to 65 Years • Life long renewals Sum Insured • The following Sum Insured options are available Note : The sum insured is for each year of insurance and cannot be cumulated or carried forward

8. Allowable Expenses.. • Room rent, nursing & boarding charges @ 1% of the sum insured subject to a maximum of Rs. 3000/- per day. • Surgeons, Anesthetist, Consultants and Specialists fees • Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc • Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation up to a maximum of Rs 1,500/- per policy period • Pre-hospitalization expenses incurred for a period of 30 days prior to the date of hospitalization • Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs. 5,000/-

9. Day Care Treatment.. Minimum of 24 hours Hospitalization is not necessary for the following • Dialysis • Chemotherapy • Radiotherapy • Cataract surgery • Dental Surgery following accident • Lithotripsy • Tonsillectomy • Treatment of Fracture/Dislocation • Incision and Draining of Abscess • Liver Aspiration • Pleural Effusion Aspiration • Colonoscopy • Sclerotheraphy • Tympanoplasty • Chalazion

10. Day-Care.. • The above treatments shall be taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

11. Sub Limits.. Note : Admissible claims for angiogram would be limited to Rs. 8000/- provided it is followed by a cardiac surgery.

12. Premium ….. approach • We have introduced a dual pricing concept - Delhi, Faridabad, Gurgaon, Mumbai, Bangalore, Ahmedabad will have a slightly higher premium • Rest of India will have comparatively lower premium

13. Annual Installment Premium Applicable for offices in Ahmedabad, Bangalore, Mumbai (including Thane) and New Delhi (including Faridabad, Gurgaon & Noida) Note : Premium figures are excluding Service Tax.

14. Annual Installment Premium Applicable for rest of India Note : Premium figures are excluding Service Tax.

15. Exclusions • Pre-Existing Disease/ Condition within 11 months of commencement of this insurance • Any Disease contracted during first 30 days • First Year Exclusions • Deviated Nasal Septum • Benign Prostate Hypertrophy • Nasal Polyps • Hernia • Hydrocele • Congenital Internal diseases/defects • Fistula in anus, Piles, Sinusitis, and related disorders • Post trauma non union / mal union • Cholecystectomy and Renal Calculi /Gall bladder calculi are not payable. If these diseases (other than congenital internal disease /defects) are Pre-Existing at the time of proposal they are payable after 24 months of continuous coverage with the Company.

16. Exclusions (Contd.) • First Two Years Exclusions • Cataract, • Hysterectomy (abdominal and Vaginal), • Dysfunctional Uterine Bleeding (DUB) • Fibroid Uterus • Prolapsed Uterus • Myomectomy • Cystectomy • Treatment of Internal Derangement of Knee (other than caused by an accident) • Treatment for Joints (other than caused by an accident) • other Arthroscopic Surgeries

17. Exclusions (Contd.) • First Two Years Exclusions (Contd.) • 1. Inter-Vertebral Disc Prolapse (other than caused by accident) • 2. Degenerative Vertebral and Disc diseases • 3. Varicose veins and Varicose ulcers • 4. Thyroiditis • 5. Treatment of Goitre • 6. Tympnoplasty • 7. Mastoidectomy Glaucoma • are not payable irrespective of whether they are Pre-Existing or not.

18. Exclusions (Contd.) • First Four Years Exclusions • Stapedectomy • Bone marrow transplant • Cirrhosis of liver with or without portal Hypertension • Hepatitis • Loss of vision partial / total including Retinopathy • Retinal Detachment • Macular degeneration and Papil Oedema • all types of Cancer • Nephropathy and Chronic Kidney diseases • Implant Removal The above shall not be payable during the first four years only if these are Pre Existing at the commencement of this insurance

19. Exclusions (Contd.) Other Benefits • 30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims • Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs. 25000/- for each year of insurance • Benefits under Section 80-D of the IT Act • Cashless Service without involvement of TPA • Direct Tie up with hospitals on an All India Basis