HEALTH INSURANCE POLICY FROM STAR HEALTH INSURANCE

1. S.V.NANDAGOPAL
SENIOR SALES MANAGER
STAR HEALTH & ALLIED INSURANCE CO.LTD
THANKS FOR OPPORTUNITY TO SERVE
MOBILE
99949 10202 , 94431 86864 , 83000 20102
www.licnanda.blogspot.com
licnanda@gmail.com , starhealthwithu@gmail.com
வருமுன்னர்க் காவாதான் வாழ்க்கக எரிமுன்னர்
கவத்தூறு ப ாலக் ககடும். திருக்குறள்
WE ARE ONE OF THE LEADING INSURANCE & INVESTMENT
CONSULTANT IN COIMBATORE SINCE 2000

2. Version 1 of March 2014.
STAR HEALTH & ALLIED INSURANCE CO. LTD.,

3. No. of diabetics in India – increasing in leaps and bounds
India
2013-65 million
2035-109 million

4. Diabetes

5. Types of diabetes

6. Some complications of diabetes

7.  Is there anything further that I must
do to fight diabetes?
Yes, Act smart.
Take
STAR DIABETES SAFE
Insurance Cover
How do I deal with diabetes?

8. What is special about Diabetes Safe?
 Diabetes Safe provides relief to diabetic
patients exclusively.
 We will take your stress and help you to live
with diabetes, and take control of your life.

9.  Who can buy?
Type I and Type II diabetics aged between 18 to 65.
 What benefits are offered?
The policy offers TWIN BENEFITS.
It covers all diabetic complications (ignoring the fact it
is a PED).
It provides regular health insurance benefits to the
diabetic insured.
 When does the policy start covering them?
Diabetic complications are covered from “DAY ONE”.
Regular health cover follows the pattern of a Medical
Insurance with 30 days of waiting period, and PEDs
after 48 months.
About the cover…….1

10.  Is not a Medical Screening mandatory for cover to start?
1.Yes, if “Day One” cover is required. THIS IS PLAN A.
2. If you do not want to undergo a Medical, cover is still offered.
But there is a waiting period (WP) and some limitations. THIS IS
PLAN B.
 What are the differences in the “NON_MEDICAL” cover?
 In PLAN B, diabetic complications are covered from 31st day, except
complications like Cardio-vascular diseases, Renal-diseases, Eye diseases and foot-
ulcer complications which are covered from 16th month only.
 There is sub-limit on benefits available for treatment of CARDIO-VASCULAR
diseases.
 Regular health cover follows the pattern of a Medical Insurance with 30 days of
WP, and PED after 48 months.
About the cover…..2

11.  What are the sub-limits for Cardio-vascular system in PLAN B?
 How about Room rent limits?
1. Under both plans, room rents are same.
2. For (Section 1) hospitalizations of diabetic complications, it is cost
of a ‘SINGLE STANDARD A/C’ room.
3. For (Section 2) hospitalizations – Regular Medical cover - it is
1.5% of SI subject to a max of Rs8,500.
About the cover…..3
Sum Insured
(Rs in Lakhs) 3 4 5 10
Corresponding
Limits
(Rs in Lakhs)
2 2.5 3 4

12.  What are the EXTRA FEATURES in the policy?
 AUTO RESTORATION
 100% of SI.
 One time facility.
 Facility NOT AVAILABLE FOR FLOATER option.
 COST OF ARTIFICIAL LIMBS.
 Up to 10% of SI for AMPUTATIONS ADMITTED AS A
CLAIM.
 ‘400 +’ day care procedures listed.
About the cover…..4

13.  Screening required only for PLAN A (Day 1 cover for diabetic complications)
 TMT
 ECHO
 X-Ray Chest
 USG whole Abdomen
 Micro-albuminurea
 Serum Creatinine
 Urine Routine
 General Clinical Examination
 Company designated centers
 Cost borne by Company for accepted cases
 50% of costs recovered for rejected cases (Deemed 50% cost: Rs2000).
About MEDICAL SCREENING

14.  Floater option available. Self & spouse*
(*both diabetic)
 No exit age. Above 65 only renewals.
 Sum Insured – 4 options.
Rs.3/4 /5 /10 Lakhs.
 Donor expenses for kidney transplant covered within SI
limits.
 Dialysis expenses limited to Rs 1000 per sitting up to a
period of 24 months covered
Other features

15.  Cancer
 Cirrhotic Liver
 Central Nervous system disorders
 Parkinson’s
 Alzheimer’s
 Stroke-related
 COPD
Declined risks – 5 Cs

16. Compare Plan A and Plan B
(Revised) Diabetes Safe Insurance
Comparison between
Plan A Plan B
Medical Screening mandatory. No Medical Screening required.
Cover from DAY 1 for diabetic
complications.
Cover from DAY 31 for diabetic
complications (except Cardio-vascular/
Renal/Eye/Foot-ulcer).
All diabetic complications
covered from Day 1.
Complications involving Cardio-vascular
/Renal /Eye/Foot-Ulcer covered from 16th
month only.
No sub-limit restrictions.
Sub-limits for cardio-vascular
complications.
Premium lower. Premium higher.
One Medical Screening for any
entry
NO MEDICAL screening EVEN for fresh
entry aged >50

17.  Weight /obesity control and such other related treatment
 Metabolic/genetic/endocrine disorders
 Stem cell therapy and related treatments
 Expenses on therapies like:
 High Intensity Focused Ultra sound therapy
 Balloon sinoplasty
 EECP
 Deep brain stimulation
 Hyperbaric oxygen therapy
 Rotational Field Quantum Magnetic Resonance therapy ……
 similar therapies
 Other than Allopathic treatments (including Naturopathy)
 Experimental /unproven therapies.
 Change of sex/cosmetic treatment etc.
 All other regular exclusions like charges purely for diagnostics/cost of
aids/Lasik surgery/Convalescense/ HIV/Pregnancy or Infertility-related etc
Principal exclusions: Section 1 (Diabetic complications)

18.  PED till 48 months
 First 30 days.
 Circumcision/inoculation/vaccination (other than rabies)
 Dental treatment (accidents excepted)
 All exclusions listed in Section 1
 Other hospital expenses in excess of what is proportionate to
eligible room rent limits
 20% of package charges* wherever incurred so.
*Charges will be adjusted in proportion to room rent limits first.
 First 2-year exclusions listed (explained in following slide)
Principal exclusions: Section 2 (Regular health cover)

19.  Treatment in First 2-years
 Eye: Cataract/Retinal detachment/glaucoma
 Ear-Nose-Throat: Diseases of ENT including stapedectomey
 Thyroid
 PIVD (Accident excepted)
 Varicose veins/ulcers
 Varicocoel/Hydrocoele
 BPH (Prostate)
 Hernia of all types
 Fissure/Fisrtula/Hemorrhoids
 Urethral strictures
 Congenital Internal disease/defect
 All types of treatment for Calculus in liver/gall/pancreas /kidney and genitourinary tract
 All treatments affecting female reproductive system
 All treatments relating to tendon/ligament/bones and joint
 Degenerative diseases of Musculo-skeletal system
 Subcutaneous benign lumps, Sebacious/dermoid cysts/ lipoma/neurofibroma and lumps/cysts of
similar pathology.
 Any transplant or related surgery
Principal exclusions: Section 2 (Regular health cover)

20.  Free-look period
 Portability
 Renewal
 Cancellation.
Regulatory compliance in terms of

21.  Migration matrix
Switching to Diabetes Safe
(Revised) Diabetes Safe Insurance
Migration plan for existing policy holders
Existing Diabetes Safe Revised Diabetes Safe
Policy in the second year
Cover from day 1. No medical screening required.
Both Sec 1 and Sec 2 covers available.
One year waiting period for the 2- year exclusions to go.
PED waiting period – three years.
Policy in the third year
Cover from day 1. No medical screening required.
Both Sec 1 and Sec 2 covers available.
No 2-year exclusions.
PED waiting period – two years.
Policy in the fourth year
Cover from day 1. No medical screening required.
Both Sec 1 and Sec 2 covers available.
No 2-year exclusions.
PED waiting period – one year.

22.  Migration matrix
Regulatory compliance in terms of … (cont’d)
(Revised) Diabetes Safe Insurance
Migration plan for existing policy holders
Policy in the fifth year of renewal or
any year beyond 5th year.
Cover from day 1.
No medical screening required.
Both Sec 1 and Sec 2 covers available.
No PED applies.
SI 0.50/1/2/3Lakhs Fit onto Rs 3Lakhs.
SI 4/5 lakhs May be fitted onto respective levels.
Higher SI options in the migrated
policy.
Can be accepted without Medical screening, if no
claims. If there were claims, requests will be
evaluated and decided.
Policies from which migration is
allowed
Comprehensive/Health Gain/FHO/Medi-classic

23. Compare with Apollo Energy
UNMATCHED FEATURES in STAR DIABETES SAFE compared to Apollo Energy
Sr no. Feature Diabetes Safe Energy
1 Sale of Policy PA N-INDIA
Restricted to major cities. For
other centres, application has to
be done and cover at the
discretion of Insurer.
2
Type of
diabetes
covered
Both Type 1Diabetes and Type 2 Diabetes Type 2 ONLY
3
Policy cover
options
Both Individual and Family Floater options Only Individual option
4 Plan options
Plans with or without Pre-acceptance medical
screening available.
NO Such Options. Policy
available only after Medical
Screening.
5 Plans
Plan A with medical screening.
Plan B without medicals ALSO
AVAILABLE.
Silver and Gold.
ONLY with medicals.
GOLD with additional benefit of
wellness programme, but at a
HIGHER COST.
6 Coverage from
Day 1for Plan A (with medical tests) Day 1 COVER
Plan B (without medical tests) COVER STARTS
on Day 31(15 months WP for some listed
conditions).
No such option (No cover
without medicals).
7
Auto restore
facility
Available - 100% restored NO FACILITY of SI ‘Restore’.

24. Compare with Apollo Energy
Sr no. Feature Diabetes Safe Energy
8
Day care
procedures
Expanded day care procedures – 400+ listed
procedures
144 procedures
9 Dialysis benefit Up to 24 months - with Rs1000 per sitting.
Not spelt out. Benefit will end
with policy period.
10
Artificial limbs
facility
Yes, upto 10% of SI. Excluded
11
Premium
advantage
Premium advantage ranging from Rs. 1000 to
13000 (STA R Plan A with medical screening
compared)
Premium higher than STAR
12
Premium
loading
No loading
Option to load premium upto
150% kept with Insurer for
adverse risk profiles.
The downsides (Compared with Silver Plan without Wellness Programme which can be compared
with our product):
PED:
PED waiting period for Non-Diabetic complications is 48 months while it is 36 months in
Energy.
Room
caps:
Room rent limits in our policy RR for diab hosp (Std single A/C & Lower of either 1.5% of SI
or 8.5K for diabetic & non-diabetic treatments). Apollo does not have room caps.
Benefit
limits:
No sum insured caps for treatment, while we have caps in Cataract, and Cardio claims.
Effective claim value limited to 40% to 67% of SI.
Option
for 2
lakhs:
Sum insured options start from Rs 3 lakhs (3/4/5/10L). Apollo starts at 2 lakhs (2/3/5/10L)
Comparison prepared by Training dept on 28 feb 2013_cpu

33. FHO-rev2014/cpu/ver1.4/16 Oct 201433
 ALSO WE PROVIDE
 LIFE INSURANCE
 HEALTH INSURANCE
 CHILD FUTURE PLANS
 TAX SAVING & PLANNING
 PAN CARD & PASSPORT
 MOTOR VEHICLE INSURANCE
 IMPORT & EXPORT
INSURANCE
 INDIVIDUAL,FAMILY,GROUP &
CORPORATE INSURANCE
NEEDS