STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED

Regd. & Corporate Office : 1, New Tank Street, ValluvarKottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : U66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129

Product Details

STAR GROUP HEALTH INSURANCE POLICY FOR BANK CUSTOMERS

Unique id : SHAHLGP19102V011819

Eligible Persons : Current Account / Savings Account Holders and their family Members

Entry Age : Adults : 18 yrs to 79 yrs. Dependent Children 5 months to 30 yrs. Dependent Children can be covered only if
either of the parents are covered under this Group Policy.

Policy Type : Individual Sum Insured Basis / Floater Sum Insured Basis

Family Size Options for Floater Insured Basis : Self + Spouse / Self + Spouse + 1 Dependent Child / Self + Spouse + 2
Dependent Children
Pre-acceptance Medical Screening : No Pre-acceptance Medical Screening
Coverage :
Eligible Room Category
Sum Insured Rs. Limit Rs.
2,00,000 Up to 2,000/- per day
3,00,000 & 4,00,000 Up to 5,000/- per day
5,00,000 - 25,00,000 Single Standard A/C Room

Expenses relating to hospitalization will be considered in proportion to the eligible room category stated in the policy or actual
whichever is less.
Cataract: Expenses incurred on treatment of Cataract is subject to the limit as per the following table

Sum Insured Rs. Limit per eye Rs. Limit per policy period Rs.
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/-
5,00,000/- & 7,00,000/- Up to 40,000/- Up to 60,000/-
10,00,000/- to 25,00,000/- Up to 50,000/- Up to 75,000/-

Pre hospitalization expenses up to 60 days prior to date of admission

Post hospitalization expenses up to 90 days after date of discharge
Road Ambulance expenses up to Rs.750 per hospitalization & maximum of Rs.1500 during entire period of insurance
Automatic Restoration of Sum Insured: There shall be automatic restoration of the Sum Insured immediately upon
exhaustion of the Sum Insured, which has been defined, during the policy period upto 25% of the Sum Insured.
Restoration will operate only after the exhaustion of the sum insured.
It is made clear that such restored Sum Insured can be utilized only for illness / disease unrelated to the illness /
diseases for which claim/s was / were made. The unutilized restored sum insured cannot be carried forward.
Note: Automatic Restoration of Basic Sum Insured is available only for sum insured options of Rs.3,00,000/- and
above. Not applicable for Sum Insured of Rs.2,00,000/-.
Day Care Procedures : All day care procedures covered
 STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
Regd. & Corporate Office : 1, New Tank Street, ValluvarKottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : U66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129

Organ Donor Expenses for 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 Rs.1 lakh whichever is
less.
AYUSH Treatment: In-patient Hospitalization 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:
Note: Payment under this benefit forms part of the sum insured.

Sum Insured Rs. Limit per policy period Rs.

Up to 4,00,000/- Up to 10,000
5,00,000/- to 15,00,000/- Up to 15,000
20,00,000/- and 25,00,000/ Up to 20,000

Cost of Health Checkup: 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 checkup is done at network hospitals and the policy is in force. Payment
under this benefit does not form part of the sum insured. If a claim is made by any of the insured persons, the health
check up benefits will not be available under the policy for the other covered members of the family of that insured
person who has made a claim.
Note : Payment of expenses towards cost of health check up will not prejudice the company's right to deal with a claim in
case of non disclosure of material fact and / or Pre-Existing Diseases in terms of the policy.

Sum Insured (Rs.) Limit Per Policy Period (Rs.)

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/-
7,00,000/- Up to 1,750/-
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/-

Air Ambulance charges up to 10% of the sum insured, provided that

1. It is for life threatening emergency health condition/s of the insured person which requires immediate and rapid ambulance
transportation to the hospital/medical centre that ground transportation cannot provide.
2. Necessary medical treatment not being available at the location where the Insured Person is situated at the time of
Emergency
3. It is prescribed by a Medical Practitioner and is Medically Necessary;
4. The insured person is in India and the treatment is in India only
5. Such Air ambulance should have been duly licensed to operate as such by Competent Authorities of the Government/s.
Note: This benefit is available for sum insured options of Rs.5,00,000/- and above only.
 STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
Regd. & Corporate Office : 1, New Tank Street, ValluvarKottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : U66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129

Exclusions: The Company shall not be liable to make any payments under this policy in respect of any expenses
what so ever incurred by the insured person in connection with or in respect of:
1. Any disease contracted by the insured person during the first 30 days from the commencement date of the
policy.
2. During the first year of continuous operation of Insurance Policy, any expenses on
a) During the first year of operation of the Insurance cover, the expenses on treatments (conservative,
interventional, laparoscopic and open) related to Hepato-pancreato-biliary diseases including Gall bladder
and Pancreatic calculi, all types of management for kidney and genitourinary tract calculi., all Diseases of
Prostate, all types of Hernia,, Hydrocele, Congenital Internal disease/defect anomalies (Except to the
extent covered under Newborn Baby Cover if specifically opted) Pilonidal sinus and Fistula / Fissure in
ano, Piles, Sinusitis and related disorders, If these are Pre-Existing at the time of proposal they will be
covered subject to exclusion number 4 mentioned below.
b) Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases
related to Thyroid, Prolapse of intervertebral disc (other than caused by accident), Varicose veins and
Varicose ulcers, all Stricture Urethra, all Obstructive Uropathies, Epididymal Cyst, Benign Tumours of
Epididymis, Spermatocele, Varicocele, Hemorrhoids, Rectal Prolapse, Stress Incontinence.
c) Desmoid tumour of anterior abdominal wall.
d) All treatments (conservative, interventional, laparoscopic and open) related to all Diseases of Uterus,
Fallopian tubes, Cervix and Ovaries, Uterine bleeding, Pelvic Inflammatory Diseases, Benign breast
diseases, Umbilical sinus, Umbilical fistula.
e) Conservative, operative treatment and all types of intervention for Diseases related to Tendon, Ligament,
Fascia, Bones and Joint Including Arthroscopy and Arthroplasty [other than caused by accident]
f) Degenerative disc and Vertebral diseases including Replacement of bones and joints and Degenerative
diseases of the Musculo-skeletal system
g) Subcutaneous Benign lumps, Sebaceous cyst, Dermoid cyst, Mucous cyst lip / cheek, Carpal tunnel
syndrome, Trigger finger, Lipoma , Neurofibroma, Fibroadenoma, Ganglion and similar pathology
h) Any transplant and related surgery
Note : If these are pre-existing at the time of proposal, they will be covered subject to exclusion number 3
mentioned below
3. Pre Existing Diseases as defined in the policy until 36 consecutive months of continuous coverage have
elapsed under this Star Group Health Insurance Policy For Bank Customers since inception of the first policy
with the Company.
Note : In the event of this Star Group Health Insurance Policy For Bank Customers not being renewed or
when the Individual member of the group leaves the group on account of resignation / retirement / termination
or otherwise, such individual member has the option to migrate to any individual health insurance policy on
indemnity basis offered by the Company. In such an event the continuity of benefits with respect to waiting
periods under exclusions 1, 2, and 3 will be given in the individual health insurance policy according to the
number of years covered continuously under this Star Group Health Insurance Policy For Bank Customers
4. Circumcision, Preputioplasty, Frenuloplasty, Preputial Dilatation and Removal of SMEGMA, Inoculation or
Vaccination (except for post–bite treatment and for medical treatment other than for prevention of diseases)
5. Congenital External diseases/condition defects or anomalies
6. Dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization.
(Dental implants are not payable)
 STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
Regd. & Corporate Office : 1, New Tank Street, ValluvarKottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : U66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129

7. Convalescence, general debility, run-down condition or rest cure, Nutritional deficiency states, Psychiatric,
mental and behavioral disorders, Venereal disease and Sexually transmitted diseases(Other than HIV),
intentional self injury and use of intoxicating drugs / alcohol, smoking and tobacco chewing
8. Injury/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign
enemy, warlike operations (whether war be declared or not)
9. Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials
10. Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of
these (other than ectopic pregnancy), family planning treatment and all types of treatment for infertility and its
complications thereof.
11. Expenses incurred on weight control services including surgical procedures for treatment of obesity, medical
treatment for weight control, treatment for endocrine disorders, treatment for sleep apnea
12. Expenses incurred on High Intensity Focused Ultra Sound, Uterine fibroid embolisation, Balloon Sinoplasty,
Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain
Stimulation, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D,
Low level laser therapy, Photodynamic therapy and such other therapies similar to those mentioned herein
under exclusion no12
13. Expenses incurred on Lasik Laser or Refractive Error Correction and its complications all treatment for
disorders of eye requiring intra-vitreal injections and related procedures.
14. Charges incurred at Hospital or Nursing Home primarily for diagnostic, Radiology or laboratory Tests not
consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any
ailment, sickness or injury, for which confinement is required at hospital/nursing home.
15. Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the
attending Physician.
16. Naturopathy Treatment, unconventional, untested, unproven, experimental therapies.
17. Stem cell Therapy, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular
injection therapy. Immunotherapy without proper indication.
18. Oral Chemotherapy, Immuno therapy and Biologicals, except when administered as an in-patient, when
clinically indicated and hospitalization warranted.
19. Hospital registration charges, admission charges, record charges, telephone charges and such other charges
20. Change of sex or cosmetic or aesthetic treatment of any description, plastic surgery (other than as
necessitated due to an accident or as a part of any illness), all treatment for Priapism and erectile
dysfunctions.
21. Cost of spectacles and contact lens, hearing aids, Cochlear implants and procedures, walkers and crutches,
wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar
aids.
22. Other expenses as detailed in the website “ www.starheath.in”

Premium : Please Contact Quotes Department.

 STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
Regd. & Corporate Office : 1, New Tank Street, ValluvarKottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : U66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129

Claim Procedure

In the event of any claim, intimation should be given to Star Health immediately, through toll free no: 1800 425 2255 or 1800
102 4477, or email: [email protected] or fax - 1800 425 5522.
For Cashless Treatment:
a. Call the 24 hour toll free no. for assistance - 1800 425 2255 / 1800 102 4477
b. Inform the ID number for easy reference
c. On admission in the hospital, produce the ID Card issued by Star Health at the Hospital Helpdesk
d. Obtain the Pre-authorisation Form from the Hospital Help Desk, complete the Patient Information and resubmit to the
Hospital Help Desk.
e. The Treating Doctor will complete the hospitalisation/ treatment information and the hospital will fill up expected cost of
treatment.
f. This form should be submitted to Star Health
g. Star Health will process the request and call for additional documents/ clarifications if the information furnished is
inadequate.
h. Once all the details are furnished, Star Health will process the request as per the terms and conditions as well as the
exclusions therein and either approve or reject the request based on the merits.
i. In case of emergency hospitalization information to be given within 24 hours after hospitalization
j. Cashless facility can be availed only in Networked Hospitals. Please visit www.starhealth.in for information on Networked
Hospitals.
k. In non-network hospitals payment must be made up-front and then reimbursement will be effected on submission of
documents
Please note that denial of cashless is in no way to be construed as denial of treatment or denial of coverage. The Insured
Person can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
Documents to be submitted for Reimbursement claims:
a. Duly completed claim form, and
b. Pre Admission investigations and treatment papers.
c. Discharge Summary from the hospital in original
d. Cash receipts from hospital, chemists
e. Cash receipts and reports for tests done
f. Receipts from doctors, surgeons, anesthetist
g. Certificate from the attending doctor regarding the diagnosis.
h. Copy of PAN Card
Note: Star Health reserves the right to call for additional documents wherever required.