Oral Chemotherapy, Immuno therapy and Biologicals, except when administered as an in-patient, when clinically indicated
v Free Look Period A free look period of 15 days from the date of receipt of the policy is available to the insured to review the terms and conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and in such an event the Company shall allow refund of premium paid after adjusting the cost of pre-acceptance medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Free look period is not applicable at the time of renewal of the policy
Up to one month
25% of the annual premium
Exceeding one month up to 3 months
40% of the annual premium
Exceeding 3 months up to 6 months
60% of the annual premium
Exceeding 6 months up to 9 months
80% of the annual premium
Exceeding 9 months
Full annual premium
v Portability This policy is portable. If the insured is desirous of porting this policy, application in the appropriate form should be made to the Company at least 45 days before but not earlier than 60 days from the date when the renewal is due. For details contact “
[email protected]” or call Telephone No : +91-044-28288869 v Claims Procedure A Call the 24 hour help-line for assistance : 1800-425-2255 / 1800-102-4477. Inform the ID/Policy number for easy reference A In case of planned hospitalization, inform 24 hours prior to admission in the hospital A In case of emergency hospitalization, information to be given within 24 hours of hospitalization A Cashless facility can be availed in all network hospitals wherever possible A In non-network hospitals payment, must be made up-front and then reimbursement will be effected on submission of documents. v The Company Star Health and Allied Insurance Co. Ltd., commenced its operations in 2006 with the business interests in Health Insurance, Travel and Personal Accident. As an exclusive Health Insurance Company and the first of its kind in India, the Company is committed to setting international benchmarks in service and personal caring. v Star Advantages A No Third Party Administrator, direct in-house claims settlement. A Faster and hassle – free claim settlement. A Cashless hospitalization v Prohibition of Rebates Section 41 of Insurance Act 1938 : No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
10
Insurance plan UIN No. : IRDAI/HLT/SHAI/P-H/V.III/129/2017-18
The information provided in this brochure is only indicative. For more details on the risk factors, terms and conditions, please read the policy wordings before concluding sale Or Visit our website www.starhealth.in
“IRDAI OR ITS OFFICIALS DO NOT INVOLVE IN ACTIVITIES LIKE SALE OF ANY KIND OF INSURANCE OR FINANCIAL PRODUCTS NOR INVEST PREMIUMS. IRDAI DOES NOT ANNOUNCE ANY BONUS. THOSE RECEIVING SUCH PHONE CALLS ARE REQUESTED TO LODGE A POLICE COMPLAINT ALONG WITH DETAILS OF PHONE CALL AND NUMBER”
Buy this insurance online at www.starhealth.in and avail discount 5% Call Toll-free: 1800-425-2255 / 1800-102-4477, sms STAR to 56677 Fax Toll Free No: 1800-425-5522 « Email :
[email protected] CIN : U66010TN2005PLC056649 « IRDAI Regn. No: 129
FAMILY HEALTH OPTIMA Insurance plan
BRO / FHO / V.6 / 2017 - 18
RATE OF PREMIUM TO BE RETAINED
SQPIL-02-04-16-1L-PO:002
PERIOD ON RISK
FAMILY HEALTH OPTIMA
FAMILY HEALTH OPTIMA Insurance plan
sending the Insured 30 days notice by registered letter at the Insured person’s last known address. No refund of premium will be made except where the cancellation is on the grounds of non co-operation of the insured, in which case the refund of premium will be on pro-rata basis. The insured may at any time cancel this policy and in such event the Company shall allow refund after retaining premium at Company’s short Period rate only (table given below) provided no claim has occurred up to the date of cancellation.
Personal & Caring
Health Insurance
The Health Insurance Specialist Personal & Caring
Health Insurance
The Health Insurance Specialist
A Super saver Plan covering the entire family under single sum insured. Loaded with extra benefits. A Super Saver Policy A Single Sum Insured A Extra Benefits A Coverage for entire family A Considerable saving in premium as the family is covered under one policy. ELIGIBILITY A Any person aged between 18 years and 65 years, residing in India, can take this insurance A Beyond 65 years, It can be renewed for life time. A Child above 16 days of age can be covered as part of the family. If, at the commencement of the policy, the new born child as defined in the policy clause is less than 16 days of age, the proposer can opt to cover such child also in the same policy by paying the applicable premium in full. However, the cover for such child will commence only from the 16th day after its birth and continue till the expiry date of the policy. A Family : Proposer, spouse, dependent children from 16 days up to 25 years (Children who are economically dependent on their parents) POLICY BENEFITS v In-Patient Hospitalisation Benefits : A) Room, Boarding, Nursing Expenses as given below :Sum Insured Rs. 1,00,000 2,00,000 3,00,000 4,00,000
Limit Rs. Up to 2,000/- per day Up to 5,000/- per day
5,00,000 10,00,000 15,00,000
Single Standard A/C Room
20,00,000 25,00,000 B) C) E) F)
Surgeon, Anesthetist, Medical Practitioner, Consultants & Specialist Fees. Anesthesia, Blood, Oxygen, Operation Theatre charges, cost of Pacemaker etc. Cost of Medicine and drugs Ambulance Charges : Emergency ambulance charges up to a sum of Rs.750/per hospitalisation and overall limit of Rs.1500/- per policy period. G) Air Ambulance Cover : Up to 10% of the Basic sum insured per policy period. Available for Sum Insured of Rs. 5 Lakhs and above only. v Pre & Post Hospitalization Pre-hospitalization medical expenses incurred up to 60 days are payable. Post-hospitalization medical expenses incurred up to 90 days are payable. v Pre-existing Diseases : Covered after 48 months 2
v Waiting Periods A 30 days waiting period. A 24 months waiting period for specified illness/diseases/treatments A 36 months waiting period for Assisted Reproduction Treatment. v Day Care Procedures : All day care procedures covered. v Pre-Acceptance Medical Screening : All persons above 50 years of age and those who declare adverse medical history in the proposal form are required to undergo pre-acceptance medical screening at the Company designated Centers The cost of such screening will be borne by the Company. The age for screening and the cost sharing are subject to change. SPECIAL FEATURES v Domiciliary Hospitalization Coverage for medical treatment for a period exceeding three days, for an illness/disease/injury, which in the normal course, would require care and treatment at a Hospital but is actually taken whilst confined at home under any of the following circumstances: A The condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or A The patient takes treatment at home on account of non-availability of room in a hospital. However, this benefit shall not cover Asthma, Bronchitis, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all types of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insipidus, Epilepsy, Hypertension, Influenza, Cough and Cold, all Psychiatric or Psychosomatic Disorders, Pyrexia of unknown origin for less than 10 days, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharingitis, Arthritis, Gout and Rheumatism Pre-hospitalisation and Post-hospitalisation expenses are not payable for this cover v Donor Expenses For Organ Transplantation payable where the insured is the recipient. Maximum payable under this head is 10% of the sum insured or Rupees one lakh whichever is less, subject to availability of the sum insured and provided the claim for transplantation is payable. Donor screening expenses are not payable. v Cost Of Health Check Up 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 and will not impact the Bonus. If a claim is made by any of the insured persons, the health check up benefits will not be available under the policy. 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. 1,00,000/-
Limit Per Policy Period (Rs.) Not Available
2,00,000/3,00,000/-
Up to 750/-
4,00,000/-
Up to 1,000/-
5,00,000/-
Up to 1,500/-
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/-
3
v Coverage for Newborn Baby The coverage for New Born Baby starts from the 16th day after its birth till the expiry date of the policy and is subject to a limit of 10% of the Sum Insured or Rupees Fifty thousand, whichever is less, subject to the availability of the sum insured, provided the mother is insured under the policy for a continuous period of 12 months without break. Note : 1. Intimation about the birth of the New Born Baby should be given to the company and policy has to be endorsed for this cover to commence. 2. 30 days waiting shall not apply for the New Born Baby. 3. All other terms, conditions and exclusions shall apply for the New Born Baby. v Emergency Domestic Medical Evacuation Subject to limits mentioned in the table given below, the Company will reimburse reasonable and necessary expenses incurred towards transportation of the insured person from the hospital where the insured person is currently undergoing treatment to another hospital for further treatment provided : a. The medical condition of the Insured Person is a life threatening emergency, b. Further treatment facilities are not available in the current hospital c. The Medical Evacuation is recommended by the treating Medical Practitioner. d. Claim for Hospitalization is admissible under the policy. Sum Insured Rs.
Limit per hospitalization (Rs.)
Up to 4,00,000/
Up to 5,000/-
5,00,000/- to 15,00,000/-
Up to 7,500/-
20,00,000/- and 25,00,000/-
Up to 10,000/-
undergoes treatment in the suggested hospital, an amount calculated at 1% of Basic Sum Insured subject to a maximum of Rs. 5,000/- per policy period is payable as lump sum. Note : This benefit is available for Basic Sum Insured of Rs. 3,00,000/- and above only. Payment under this benefit does not form part of the sum insured but will impact Bonus. v Shared Accommodation If the Insured person occupies, a shared accommodation during in-patient hospitalization, then amount as per table given below will be payable for each continuous and completed period of 24 hours of stay in such shared accommodation. Payment under this benefit does not form part of the sum insured but will impact Bonus. Sum Insured Rs.
Limit per day Rs.
1,00,000/2,00,000/-
Not Payable
3,00,000/4,00,000/5,00,000/-
800/- per day
10,00,000/15,00,000/20,00,000/25,00,000/-
Note : Payment under this benefit does not form part of the sum insured but will impact the Bonus v Compassionate travel In the event of the insured person being hospitalized for a life threatening emergency at a place away from his usual place of residence as recorded in the policy, the Company will reimburse the transportation expenses by air incurred upto Rs.5,000/- for one immediate family member (other than the travel companion) for travel towards the place where hospital is located, provided the claim for hospitalization is admissible under the policy. Note : This benefit is available for sum insured options of Rs.10,00,000/- and above only. Payment under this benefit does not form part of the sum insured but will impact the Bonus v Repatriation of Mortal Remains Following an admissible claim for hospitalization under the policy, the Company shall reimburse up to Rs.5,000/- per policy period towards the cost of repatriation of mortal remains of the insured person (including the cost of embalming and coffin charges) to the residence of the Insured as recorded in the policy. Payment under this benefit does not form part of the sum insured but will impact the Bonus . v Treatment in Preferred Network Hospitals In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, the Company may suggest an appropriate hospital from the network for treatment. Where the insured accepts the same and 4
1,000/- per day
Note : This benefit is available for Basic Sum Insured of Rs.3,00,000/- and above only v AYUSH Treatment 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: Sum Insured Rs.
Limit per policy period Rs.
1,00,000/2,00,000/-
v Assisted Reproduction Treatment : The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility subject to: 1. A waiting period of 36 months from the date of first inception of this policy with the Company for the insured person. The maximum liability of the Company for such treatment shall be limited to Rs.1,00,000/- for Sum Insured of Rs.5,00,000/- and Rs.2,00,000/- for Sum Insured of Rs.10,00,000/- and above for every block of 36 months and payable on renewal 2. For the purpose of claiming under this benefit, in- patient treatment is not mandatory. 3. Automatic Restoration of Basic Sum Insured, Recharge Benefit shall not be applicable for this benefit. Note : To be eligible for this benefit both husband and spouse should stay insured continuously without break under this policy for every block. This coverage is available only for sum insured options of Rs.5,00,000/- and above. This benefit covers intrauterine insemination (IUI), Intra-Cytoplasmic Sperm Injection (ICSI), In-Vitro Fertilisation( IVF) and TESA / TESE (Testicular / Epididymal Sperm Aspiration / Extraction) v Additional Sum Insured for Road Traffic Accident (RTA) : Additional Sum Insured for Road Traffic Accident (RTA) : If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of Rs. 5,00,000/-. This benefit is payable only if the insurend person was wearing a helmet and travelling in a two wheeler either as a rider or as a pillion rider. The additional sum insured shall be available only once during the policy period and should be used for the particular hospitalization following RTA & cannot be carried forward. Automatic Restoration of Basic Sum Insured and Recharge Benefit shall not apply for this benefit v Automatic Restoration of Sum Insured : There shall be automatic restoration of the Basic Sum Insured immediately upon exhaustion of the limit of coverage which has been defined during the policy period. Such Automatic Restoration is available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one. 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 v Limits for cataract surgery : Expenses incurred on treatment of Cataract is subject to the limits as per the following table
Up to 10,000
3,00,000/Sum Insured Rs.
4,00,000/5,00,000/- to 15,00,000/-
Up to 15,000
20,00,000/- and 25,00,000/
Up to 20,000
1,00,000/2,00,000/-
Note : Payment under this benefit forms part of the sum insured and will impact the Bonus v Second Medical Opinion The Insured Person is given the facility of obtaining a Medical Second Opinion from a Doctor in the Company's network of Medical Practitioners. To utilize this benefit, all medical records should be forwarded to the mail-id :
[email protected]
Limit per eye Rs.
Limit per policy period Rs.
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/-
Up to 40,000/-
Up to 60,000/-
10,00,000/15,00,000/20,00,000/-
Up to 50,000/-
Up to 75,000/-
v Recharge Benefit If the limit of coverage under the policy is exhausted / exceeded during the policy period, additional indemnity upto the limits stated in the table given below would be provided once for the remaining policy period. Such additional indemnity can be utilized even for the same hospitalization or for the treatment of diseases / illness / injury / for which claim was paid / payable under the policy. This is in addition to the 'Restore' benefit available under the policy.The unutilized Recharge amount cannot be carried forward. Sum Insured (Rs.)
Limit Rs.
5. 6. 7. 8. 9. 10.
100000/200000/-
Not Available
300000/-
75,000/-
400000/-
1,00,000/-
11. 12.
500000/1000000/1500000/-
1,50,000/-
2000000/2500000/-
13.
v Bonus In respect of a claim free year of Insurance, for the Basic Sum Insured options Rs.3,00,000/- and above, the insured would be entitled to benefit of bonus of 25% of the expiring Basic Sum Insured in the second year and additional 10% of the expiring Basic sum Insured for the subsequent years. The maximum allowable bonus shall not exceed 100% The Bonus will be calculated on the expiring sum insured or on the renewed sum insured whichever is less. Bonus will be given on that part of sum insured which is continuously renewed. If the insured opts to reduce the sum insured at the subsequent renewal, the limit of indemnity by way of such Bonus shall not exceed such reduced sum insured. Bonus shall be available only upon timely renewal without break or upon renewal within the grace period allowed. In the event of a claim, such bonus so granted will be reduced at the same rate at which it has accrued. However the Basic sum insured, will not be reduced. v Co-Payment This policy is subject to co-payment of 20% of each and every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is above 60 years. v 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. Circumcision, Preputioplasty, Frenuloplasty, Preputial Dilatation and Removal of SMEGMA 2. Inoculation or Vaccination (except for post–bite treatment and for medical treatment for therapeutic reasons) 3. Congenital External Condition / Defects / Anomalies 4. Dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization. (Dental implants are not payable)
14. 15. 16. 17.
18.
19.
20.
21. 22. 23.
Convalescence, general debility, run-down condition or rest cure, Nutritional deficiency states. Psychiatric, mental and behavioral disorders. Intentional self injury Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing Venereal Disease and Sexually Transmitted Diseases, 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) Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials All expenses arising out of any condition directly or indirectly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV-III) or Lymphadenopathy Associated Virus (LAV) or HIV / AIDS. It is however made clear that such of those who are positive for HIV (Human Immuno Deficiency Virus) would be entitled for expenses incurred for treatment, other than for opportunistic infections and for treatment of HIV/AIDS, provided at the time of first commencement of insurance under this policy, their CD4 count is not less than 350. Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these (other than ectopic pregnancy). Treatment for Sub-Fertility, Assisted Conception and or other related complications of the same except to the extent covered under 1 S Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity. Medical and / or surgical treatment of Sleep apnea, treatment for genetic and endocrine disorders. 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 no.17. Expenses incurred on Lasik Laser or other procedures Refractive Error Correction and its complications, all treatment for disorders of eye requiring intra-vitreal injections. Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home. Admission primarily for diagnostic purpose with no positive existence of sickness / disease / ailment / injury and no further treatment is indicated. Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician of the hospital where the insured underwent treatment. Unconventional, Untested, Unproven, Experimental therapies. Stem cell Therapy, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy. Oral Chemotherapy, Immuno therapy and Biologicals, except when administered as an in-patient, when clinically indicated and hospitalization warranted.
25,00,000/5
6
7
8
v
v
v
v
v
v
v
24. All types of Cosmetic, Aesthetic treatment of any description, all treatment for erectile dysfunctions, Change of Sex. 25. Plastic surgery (other than as necessitated due to an accident or as a part of any illness), 26. Cost of spectacles and contact lens, hearing aids, walkers and crutches, wheel chairs, Nutritional Supplements, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis [CAPD], infusion pump and such other similar aids, Cochlear implants and procedure related hospitalization expenses 27. Hospital registration charges, admission charges, record charges, telephone charges and such other charges 28. Other excluded expenses as detailed under “Other Excluded Expenses” Renewal and Grace Period The policy will be renewed except on grounds of misrepresentation / Nondisclosure of material fact as declared in the proposal form and at the time of claim, fraud committed / moral hazard non cooperation of the insured. There is no exit age. Lifelong renewal allowed. A grace period of 120 days from the date of expiry of the policy is available for renewal. If renewal is made within this 120 days period, the continuity of benefits with reference waiting periods stated will be available. Any Disease/illness contracted or injury sustained during the grace period will be deemed as Pre existing and will be subject to waiting period of 48 months. Note : 1. The actual period of cover will start only from the date of receipt of premium. 2. Renewal premium is subject to change with prior approval from Regulator Withdrawal of the policy The Company reserves the right to withdraw the product with prior approval of the Competent Authority. In such an event the insured will be intimated three months in advance and the insured shall have the option to choose to be covered by an equivalent or similar policy offered by the Company. Modification of the terms of the policy The Company reserves the right to modify the policy terms and conditions or modify the premium of the policy with the prior approval of the Competent Authority. In such an event the insured will be intimated three months in advance Revision in Sum Insured Any revision in sum insured is permissible only at the time of renewal. The Insured Person can propose such revision and may be allowed subject to Company's approval and payment of appropriate premium. Automatic Termination The insurance under this policy with respect to each relevant insured person policy shall terminate immediately on the earlier of the following events: A Upon the death of the Insured Person This means that, the cover for the surviving members of the family will continue, subject to other terms of the policy. A Upon exhaustion of the sum insured under the policy Tax Benefits Payment of premium by any mode other than cash for this insurance is eligible for relief under Section 80D of the Income Tax Act 1961. Cancellation The Company may cancel this policy on grounds of misrepresentation, fraud, moral hazard, non disclosure of material fact as declared in the proposal form and/or claim form at the time of claim and non co-operation of the insured by 9
Sum Insured Options (In Lakh ) P+Sp+3C
1 year
4
15
3
Sum Insured Options (In Lakh )
Rs.2,000/-
Rs.2,500/-
2A+1C
(Self + Spouse)
2A
1A+3C
1A+2C
1A+1C
Plan Type
9,790 11,230
16days-35 36-45
23,900
40,590
above 80
56-60
37,645
19,130
34,915
71-75 76-80
15,490
31,255
66-70
51-55
26,610
61-65
46-50
21,445
56-60
18,955
46-50
17,055
14,190
36-45
13,695
12,830
16days-35
51-55
41,030
above 80
46-50
38,050
76-80
9,500
34,660
71-75
8,015
31,030
36-45
25,540
61-65 66-70
16days-35
19,870
56-60
54,585
16,240
51-55
above 80
13,465
46-50
50,600
10,125
36-45
46,070
9,400
16days-35
71-75
36,860
76-80
34,185
76-80 above 80
41,220
31,150
71-75
66-70
27,895
66-70
35,945
22,280
61-65
61-65
17,545
56-60
23,115
13,630
51-55
28,365
38,480
11,315
46-50
51-55
35,080
7,925
36-45
26,960
21,615
17,445
12,675
11,065
45,655
42,350
39,295
35,200
29,995
24,210
19,290
15,435
10,740
9,075
61,325
56,865
51,790
46,355
40,450
31,960
26,080
21,330
15,990
14,465
46,145
42,805
39,010
34,945
28,795
22,445
18,375
15,180
11,435
10,625
41,470
31,435
25,145
19,840
15,455
12,770
8,975
8,175
7,210
400000 16days-35
56-60
X : Not Available;
28,955
23,335
18,380
13,545
11,915
48,615
45,145
41,930
37,620
32,145
26,065
20,890
16,345
11,585
9,895
65,100
60,405
55,070
49,355
43,145
34,215
28,030
22,315
16,905
15,360
49,135
45,620
41,630
37,355
30,890
24,205
19,930
16,085
12,290
11,465
44,220
41,070
37,495
33,665
27,050
21,470
16,855
13,640
9,795
8,985
35,350
28,540
23,290
17,210
15,155
59,170
54,965
51,065
45,850
39,215
31,845
25,580
20,730
14,740
12,620
79,140
73,455
66,990
60,065
52,540
41,720
34,230
28,235
21,435
19,490
59,795
55,540
50,710
45,530
37,690
29,595
24,415
20,400
15,630
14,595
53,845
50,030
45,695
41,055
33,040
26,280
20,690
17,330
12,495
11,475
1000000
41,935
33,905
27,485
20,310
17,885
70,045
65,080
60,485
54,325
46,500
37,805
30,405
24,460
17,400
14,895
93,610
86,900
79,275
71,105
62,225
49,455
40,615
33,320
25,295
23,000
70,785
65,765
60,060
53,950
44,700
35,145
29,035
24,075
18,445
17,225
63,760
59,260
54,145
48,670
39,210
31,235
24,640
20,450
14,750
13,540
1500000
Sum Insured in Rs. 500000
46,980
37,985
30,870
22,835
20,125
78,465
72,905
67,755
60,860
52,095
42,355
34,070
27,485
19,575
16,770
1,04,860
97,340
88,800
79,650
69,705
55,400
45,505
37,405
28,420
25,855
79,290
73,670
67,280
60,435
50,075
39,380
32,530
27,055
20,750
19,385
71,425
66,385
60,660
54,520
43,930
34,995
27,610
22,995
16,610
15,260
2000000
51,705
41,815
34,050
25,215
22,230
86,340
80,220
74,560
66,975
57,330
46,615
37,505
30,330
21,625
18,540
1,15,370
1,07,105
97,710
87,645
76,700
60,970
50,085
41,240
31,355
28,530
87,250
81,065
74,035
66,505
55,115
43,345
35,810
29,850
22,920
21,415
78,595
73,050
66,750
60,000
48,350
38,520
30,395
25,390
18,360
16,875
2500000
20,710
16,600
13,430
9,760
8,520
35,100
32,560
30,205
27,055
23,050
18,595
14,810
11,885
8,270
6,985
47,165
43,730
39,825
35,645
31,095
24,560
20,035
16,420
12,310
11,140
35,480
32,910
29,990
26,860
22,125
17,235
14,105
11,685
8,805
8,180
31,885
29,580
26,960
24,160
19,315
15,230
11,855
9,835
6,915
6,295
300000
Zone 1A
a a a
23,390
18,785
15,145
11,030
9,640
39,505
36,660
34,020
30,490
26,005
21,020
16,780
13,410
9,360
7,925
53,015
49,170
44,795
40,110
35,020
27,700
22,630
18,490
13,890
12,575
39,930
37,050
33,780
30,275
24,975
19,495
15,990
13,190
9,965
9,260
35,900
33,320
30,390
27,250
21,825
17,250
13,470
11,110
7,840
7,150
400000
25,825
20,850
16,570
12,250
10,795
43,225
40,150
37,305
33,495
28,650
23,265
18,685
14,750
10,500
8,990
57,810
53,655
48,935
43,880
38,380
30,475
25,005
20,080
15,250
13,870
43,680
40,575
37,040
33,260
27,535
21,620
17,835
14,515
11,130
10,395
39,330
36,545
33,380
29,990
24,135
19,200
15,115
12,335
8,905
8,180
500000
32,350
26,160
21,355
15,825
13,960
54,005
50,180
46,640
41,895
35,865
29,165
23,470
19,025
13,585
11,655
72,160
66,990
61,115
54,820
47,980
38,140
31,335
25,850
19,670
17,905
54,575
50,710
46,315
41,605
34,480
27,120
22,410
18,730
14,395
13,450
49,165
45,695
41,755
37,535
30,250
24,105
19,025
15,940
11,545
10,615
1000000
38,395
31,095
25,200
18,680
16,475
63,950
59,440
55,260
49,660
42,545
34,640
27,915
22,450
16,030
13,755
85,375
79,275
72,340
64,915
56,840
45,230
37,200
30,505
23,210
21,125
64,625
60,060
54,875
49,320
40,910
32,225
26,670
22,100
16,985
15,875
58,235
54,145
49,500
44,520
35,920
28,665
22,670
18,810
13,620
12,525
1500000
Sum Insured in Rs.
43,020
34,840
28,315
21,010
18,545
71,640
66,585
61,905
55,635
47,665
38,810
31,280
25,240
18,045
15,495
95,635
88,800
81,035
72,720
63,675
50,675
41,675
34,255
26,085
23,755
72,390
67,280
61,475
55,250
45,835
36,105
29,880
24,845
19,115
17,870
65,240
60,660
55,450
49,875
40,245
32,120
25,405
21,155
15,350
14,120
2000000
47,350
38,355
31,240
23,205
20,490
78,830
73,270
68,120
61,225
52,460
42,720
34,435
27,855
19,945
17,140
1,05,225
97,710
89,170
80,015
70,070
55,770
45,870
37,775
28,790
26,220
79,660
74,035
67,650
60,805
50,445
39,745
32,900
27,420
21,120
19,750
71,790
66,750
61,025
54,890
44,295
35,360
27,975
23,365
16,975
15,625
2500000
means Chennai, Bangalore, Pune, Nasik, Ernakulam, Trivandrum and Rest of Gujarat.
PREMIUM CHART EXCLUDING TAX
a:
Waiting Periods
means Mumbai, Thane, Delhi including Faridabad, Gurgaon, Ghaziabad and Noida, Ahmedabad, Baroda Surat
300000
Zone 1
S.I : Sum Insured;
Age in yrs.
A -Adult,C-Child
Age of the oldest family member covered should be taken for premium calculation.
P : Proposer; Sp : Spouse; C : Child;
48 months – for Pre-existing diseases
24 months – for specified illness / diseases
Available;
Rs.1,50,000/-
a
For S.I 10 Lakh to 25 Lakh – 2,00,000/-
a
Up to Rs.20,000/-
25% of Sum Insured after first year if claim free and additional 10% for the subsequent years
Rs. 1,00,000/-
Up to Rs.15,000/-
25
For S.I 20 / 25 Lakh – Rs.1,000/-
Bonus – Maximum allowable bonus is 100%
a a a
20 Up to Rs.5,000/- Per Hospitalization
15
Up to Rs.5,000/- per policy period
10
Up to 25% of Sum Insured subject to a maximum of Rs.5,00,000/- (once in a policy period)
30 days - for fresh proposals excluding accidental hospitalization
Rs.3,500/-
For S.I – 20 / 25 Lakh - Upto Rs.10,000/-
Up to 1% of S.I subject to a maximum of Rs.5,000/- per policy period
X
5
For S.I 3 Lakh to 15 Lakh – Rs.800/-
Rs.75,000/- Rs.1,00,000/-
a
X
a
Upto Rs.10,000/-
X
4
For S.I - 5 / 10 / 15 Lakh – Upto Rs.7,500/-
Additional Sum Insured for Road Traffic Accident (RTA)
Recharge Benefit (Provided once during the policy period)
Assisted Reproduction Treatment (payable after a waiting period of 36 months) Automatic Restoration of Basic Sum Insured 3 times during the policy period, 100% each time
Second Medical Opinion
AYUSH Treatment (per policy period)
Share Accommodation (benefit per day in )
Treatment in Preferred Network Hospitals (payable as lump-sum)
Repatriation of Mortal Remains (benefit in )
Compassionate Travel
Upto Rs.5,000/-
Rs.1,500/-
25
Upto 10% of S.I or maximumof Rs.50,000/-subject to availability of the S.I (from 16 day to till the expiry of the policy)
Rs.1,000/-
Additional Benefits (In-built) Cost of Health Check-up – (benefit payable up to in ) (available after every claim free year per policy) Coverage for New Born Baby (provided if mother is insured for 12 months without break) Emergency Domestic Medical Evacuation (per Hospitalization)
Organ Donor Expenses
Rs.3,000/-
a
a
th
90 days
90 days
Post-Hospitalization
Rs.750/-
60 days
Upto 10% of S.I or maximum of Rs.1,00,000/-
Up to 10% of the Sum Insured
X 60 days
Domiciliary Hospitalization – for period exceeding three days
20
Upto Rs.750/- per hospitalization and overall limit of Rs.1,500/- per policy period
All
Actual
Single Standard A/C Room
P+Sp+3C
1 year
Applicable
10
Applicable
5
All
Actual
Up to Rs.5,000/-
3
Pre-Hospitalization
Air Ambulance (per policy period)
Ambulance Charges – By Road
Sub-Limits for Treatment of Cataract
No. of Day Care Treatments / Procedures covered
ICU/ Operation Theatre Charges
Hospitalization-Room Rent Limit per day
Family definition (Dependent child from 16 days up to 25 years)
Policy Period
Family Health Optima Insurance Plan - Schedule of Benefits
66,710
59,390 64,080
76-80 above 80
2A+3C
2A+2C
2A+1C
2A+1C
(Self + Spouse)
2A
1A+3C
1A+2C
1A+1C
Plan Type
28,995 31,785
18,435 23,045 25,715 28,210 30,400 7,820 8,415 11,160 13,470 16,455
61-65 66-70 71-75 76-80 above 80 16days-35 36-45 46-50 51-55 56-60
13,265 17,645 21,605
28,600 31,380 33,825
10,635 11,755 15,665 19,120
71-75 76-80 above 80
16days-35 36-45 46-50 51-55
10,540
31,045 33,465 8,140 9,320
76-80 above 80 16days-35 36-45
40,095
33,050 35,630 9,980 11,025 14,685
76-80 above 80 16days-35 36-45 46-50
37,720 41,385 44,610 14,830 16,390 21,870 26,740 32,770 39,110 44,815 50,060 54,960 59,270
26,190 30,000 33,505 36,780 39,660 13,150 14,545 19,435 23,705 29,085 34,745 39,840 44,530 48,900 52,750
61-65 66-70 71-75 76-80 above 80 16days-35 36-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 above 80
20,270
33,790
29,525
24,785
17,930 21,955
51-55 56-60
16,545
12,450
11,280
37,205
30,115
71-75
33,920
30,400
26,575 26,975
9,220
28,805
71-75
23,555
37,675
25,805
66-70
61-65
34,965
21,990
61-65
66-70
29,090 32,455
17,750
56-60
17,940
20,070 24,815
14,140
51-55
22,325
16,030
11,345
46-50
19,765
12,805
7,905
36-45
15,845
8,950
6,680
16days-35
51-55
7,585
44,955
76-80 above 80
56-60
50,540
41,685
71-75
14,460
46,880
37,965
66-70
12,820
38,250 42,715
33,985
61-65
46-50
26,430 33,405
23,430 29,655
56-60
12,010
38,080
35,335
32,220
28,885
23,835
21,110 25,620
61-65 66-70
18,620
15,280
12,595
9,525
8,855
34,240
26,000
20,840
16,480
12,880
10,620
11,330
9,390
46-50
7,505
14,545
6,610
36-45
6,845
400000
51-55
6,025
16days-35
71,960
56-60
300000
Age in yrs.
A -Adult,C-Child
Zone 2
60,740
54,065
54,350
48,355
47,400
39,680
71-75
35,255
56-60
32,335
26,475
66-70
28,700
51-55 42,150
23,550
46-50
19,805
17,895
54,100
50,170
45,705
40,925
35,725
29,950
24,455
19,990
15,000
13,575
48,600
45,080
41,080
36,795
400000 32,135
61-65
15,890 17,595
36-45
48,130
above 80 16days-35
40,640 44,625
71-75 76-80
36,370
66-70
26,570 31,730
21,665
51-55 56-60 61-65
17,760
46-50
43,225
above 80 12,030
40,080
76-80
13,305
36,510
71-75
36-45
32,680
66-70
16days-35
300000 28,520
Age in yrs. 61-65
Please take the age of the Eldest person
2A+3C
2A+2C
2A+1C
Plan Type
Zone 1
1,09,600
1,01,705
92,730
83,120
72,670
61,060
50,015
41,055
31,025
28,160
82,745
76,835
70,125
62,935
55,120
46,435
38,175
31,305
23,805
21,660
74,480
69,185
63,170
56,725
1500000 49,720
1,22,765
1,13,920
1,03,875
65,070
60,375
55,035
49,310
43,095
36,185
29,610
23,960
18,100
16,425
49,090
45,575
41,580
37,300
32,645
27,480
22,560
18,265
13,885
12,630
44,170
41,020
37,440
33,600
29,435
24,800
20,020
16,030
11,840
10,425
41,530
38,575
35,840
32,175
27,515
22,340
17,940
14,265
10,140
8,675
55,555
51,560
47,025
42,160
36,875
29,275
24,015
19,440
14,755
13,415
41,970
38,980
35,585
31,950
26,445
20,760
17,120
14,040
10,750
10,035
37,790
35,110
32,070
28,805
23,180
18,430
14,505
11,925
8,590
7,885
82,070
76,165
69,455
62,265
54,450
45,770
37,505
30,930
23,425
21,285
61,985
57,570
52,550
47,170
41,325
34,830
28,650
23,635
18,025
16,425
55,805
51,845
47,345
42,525
37,285
31,460
25,455
20,775
15,410
13,600
52,490
48,775
45,335
40,730
34,875
28,370
22,840
18,515
13,235
11,360
70,115
65,095
59,390
53,280
46,635
37,085
30,475
25,140
19,140
17,425
53,040
49,285
45,020
40,445
33,530
26,385
21,810
18,225
14,020
13,105
47,785
44,420
40,595
36,500
29,425
23,455
18,525
15,515
11,250
10,350
1000000
97,065
90,095
82,175
73,695
64,470
54,225
44,475
36,490
27,640
25,110
73,360
68,150
62,225
55,880
48,980
41,315
34,025
27,890
21,265
19,375
66,065
61,395
56,085
50,395
44,215
37,345
30,255
24,510
18,180
16,040
62,155
57,770
53,715
48,280
41,370
33,695
27,170
21,845
15,610
13,400
82,955
77,030
70,300
63,090
55,250
43,980
36,180
29,660
22,580
20,555
62,805
58,375
53,340
47,945
39,785
31,350
25,955
21,505
16,535
15,460
56,605
52,635
48,120
43,285
34,940
27,895
22,075
18,305
13,270
12,210
1500000
Sum Insured in Rs.
500000
93,110
81,405
68,405
56,035
46,070
34,840
31,630
92,685
86,070
78,555
70,500
61,750
52,025
42,770
35,155
26,755
24,355
83,430
77,500
70,765
63,545
2000000 55,700
1,35,070
1,25,340
1,14,290
1,02,445
89,575
75,270
61,665
50,770
38,415
34,885
1,01,985
94,705
86,440
77,580
67,950
57,255
47,075
38,765
29,520
26,880
91,800
85,280
77,870
69,930
2500000 61,295
55,350
51,305
46,715
41,795
36,445
30,500
24,850
20,380
15,245
13,780
41,600
38,580
35,145
31,460
27,460
23,015
18,785
15,390
11,550
10,450
37,370
34,660
31,580
28,280
300000 24,695
62,180
57,655
52,510
47,000
41,010
34,355
28,020
22,925
17,175
15,530
46,785
43,400
39,550
35,430
30,945
25,970
21,230
17,335
13,035
11,805
42,045
39,010
35,560
31,865
400000 27,850
1,08,730
1,00,925
92,055
82,555
72,225
60,750
49,830
40,965
31,050
28,215
82,180
76,345
69,710
62,600
54,875
46,290
38,125
31,330
23,910
21,795
74,010
68,780
62,830
56,460
49,535
41,840
33,905
27,550
20,455
18,060
69,630
64,720
60,175
54,090
46,355
37,755
30,445
24,560
17,580
15,100
92,925
86,290
78,750
70,675
61,895
49,275
40,540
33,315
25,385
23,120
70,360
65,395
59,760
53,715
44,575
35,130
29,085
24,175
18,615
17,405
63,415
58,965
53,910
48,495
39,150
31,260
24,745
20,595
14,960
13,765
2000000
1,19,630
1,11,045
1,01,290
90,840
79,475
66,855
54,845
45,155
34,250
31,135
90,430
84,010
76,710
68,890
60,395
50,950
41,965
34,555
26,400
24,065
81,440
75,685
69,145
62,135
54,520
46,055
37,325
30,395
22,595
19,960
76,620
71,225
66,225
59,530
51,020
41,560
33,520
27,110
19,430
16,705
1,02,245
94,950
86,660
77,775
68,115
54,230
44,620
36,740
28,015
25,525
77,425
71,965
65,765
59,120
49,060
38,675
32,025
26,690
20,570
19,245
69,785
64,895
59,335
53,375
43,095
34,420
27,245
22,750
16,550
15,240
2500000
48,025
44,530
40,550
36,290
31,660
26,515
21,620
17,720
13,275
12,005
36,125
33,505
30,530
27,345
23,880
20,035
16,370
13,400
10,075
9,125
32,460
30,115
27,450
24,590
21,485
18,040
14,480
11,705
8,525
7,455
30,495
28,295
26,260
23,530
20,060
16,205
12,930
10,365
7,235
6,125
40,940
37,965
34,585
30,965
27,030
21,370
17,455
14,295
10,735
9,720
30,825
28,600
26,070
23,360
19,265
15,030
12,320
10,195
7,700
7,160
27,710
25,715
23,450
21,020
16,830
13,295
10,370
8,590
6,065
5,530
300000
Zone 3
53,980
50,060
45,610
40,835
35,650
29,890
24,405
19,950
14,970
13,545
40,650
37,720
34,385
30,820
26,940
22,630
18,525
15,110
11,385
10,320
36,545
33,920
30,935
27,735
24,255
20,395
16,405
13,210
9,650
8,450
34,345
31,880
29,600
26,545
22,660
18,340
14,670
11,710
8,205
6,960
46,045
42,715
38,930
34,870
30,465
24,125
19,740
16,110
12,125
10,985
34,715
32,220
29,390
26,355
21,765
17,025
13,990
11,520
8,725
8,120
31,225
28,995
26,455
23,735
19,040
15,080
11,805
9,720
6,890
6,290
400000
PREMIUM CHART EXCLUDING TAX
92,690
86,000
78,395
70,250
61,395
51,555
42,195
34,790
26,290
23,865
69,930
64,925
59,240
53,145
46,520
39,160
32,160
26,530
20,175
18,355
62,925
58,440
53,345
47,880
1000000 41,945
Coimbatore, Indore City, and Rest of Kerala.
76,280
70,760
64,485
57,760
50,455
42,335
34,605
27,530
20,770
18,840
57,500
53,365
48,675
43,645
38,175
32,105
26,325
20,960
15,905
14,460
51,715
48,015
43,805
39,300
500000 34,400
Zone 1A
Rest of India
84,480
78,395
71,485
64,080
56,030
47,085
38,575
31,810
24,085
21,875
63,790
59,240
54,070
48,530
42,510
35,815
29,450
24,300
18,520
16,870
57,420
53,345
48,710
43,745
1000000 38,345
99,910
92,730
84,575
75,835
66,340
55,785
45,745
37,540
28,420
25,815
75,495
70,125
64,025
57,490
50,385
42,490
34,980
28,675
21,855
19,910
67,980
63,170
57,700
51,840
1500000 45,475
59,305
55,035
50,180
44,980
39,325
33,045
27,065
22,290
16,860
15,310
44,775
41,580
37,945
34,055
29,830
25,130
20,660
17,015
12,955
11,795
40,300
37,440
34,185
30,695
26,905
22,695
18,350
14,945
11,065
9,750
37,905
35,215
32,730
29,400
25,165
20,460
16,455
13,310
9,490
8,135
50,655
47,025
42,895
38,475
33,670
26,760
21,980
18,100
13,760
12,520
38,305
35,585
32,500
29,195
24,190
19,020
15,715
13,100
10,055
9,395
34,500
32,070
29,300
26,335
21,220
16,905
13,335
11,140
8,055
7,400
500000
76,165
70,700
64,485
57,830
50,590
42,550
34,900
28,785
21,840
19,855
57,570
53,480
48,830
43,850
38,435
32,425
26,700
22,035
16,840
15,355
51,845
48,180
44,010
39,550
34,695
29,305
23,745
19,385
14,415
12,740
48,775
45,335
42,150
37,885
32,465
26,445
21,320
17,290
12,400
10,665
65,095
60,445
55,165
49,505
43,355
34,510
28,390
23,425
17,870
16,280
49,285
45,810
41,860
37,625
31,220
24,605
20,370
17,025
13,125
12,280
44,420
41,305
37,760
33,970
27,420
21,895
17,325
14,515
10,565
9,730
1000000
90,095
83,645
76,310
68,455
59,920
50,430
41,405
33,960
25,765
23,425
68,150
63,320
57,840
51,960
45,575
38,480
31,725
25,995
19,865
18,115
61,395
57,070
52,150
46,885
41,160
34,800
28,235
22,870
17,005
15,030
57,770
53,715
49,955
44,925
38,530
31,420
25,380
20,400
14,630
12,580
77,030
71,545
65,315
58,635
51,380
40,945
33,720
27,640
21,080
19,210
58,375
54,275
49,610
44,615
37,060
29,250
24,255
20,085
15,485
14,485
52,635
48,955
44,780
40,300
32,575
26,050
20,665
17,125
12,460
11,475
1500000
Sum Insured in Rs.
67,705
62,820
57,265
51,315
44,850
37,660
30,825
24,735
18,700
16,975
51,080
47,425
43,275
38,820
33,985
28,610
23,495
18,870
14,355
13,065
45,965
42,690
38,965
34,975
500000 30,640
1,00,925
93,700
85,485
76,690
67,125
56,500
46,390
38,130
28,950
26,330
76,345
70,940
64,795
58,215
51,060
43,110
35,550
29,210
22,345
20,380
68,780
63,935
58,425
52,530
46,115
38,990
31,640
25,710
19,140
16,925
64,720
60,175
55,970
50,335
43,170
35,210
28,440
22,940
16,475
14,185
86,290
80,150
73,170
65,690
57,560
45,875
37,785
31,050
23,705
21,605
65,395
60,800
55,580
49,985
41,520
32,780
27,180
22,590
17,440
16,320
58,965
54,850
50,170
45,155
36,500
29,195
23,160
19,275
14,050
12,950
2000000
1,11,910
1,03,875
94,740
84,950
74,315
62,495
51,245
42,135
31,920
29,005
84,570
78,555
71,720
64,400
56,445
47,600
39,190
32,210
24,570
22,390
76,155
70,765
64,640
58,075
2000000 50,945
1,11,045
1,03,095
94,065
84,385
73,865
62,180
51,060
42,040
31,940
29,055
84,010
78,060
71,305
64,065
56,195
47,455
39,135
32,225
24,670
22,515
75,685
70,355
64,300
57,810
50,760
42,920
34,835
28,375
21,150
18,710
71,225
66,225
61,595
55,395
47,515
38,760
31,315
25,330
18,220
15,700
94,950
88,195
80,515
72,290
63,345
50,490
41,595
34,250
26,170
23,865
71,965
66,915
61,170
55,015
45,705
36,085
29,930
24,940
19,275
18,045
64,895
60,365
55,215
49,700
40,180
32,145
25,505
21,295
15,550
14,340
2500000
1,23,130
1,14,290
1,04,240
93,475
81,775
68,770
56,400
46,440
35,205
32,000
93,055
86,440
78,925
70,870
62,115
52,390
43,135
35,525
27,120
24,720
83,795
77,870
71,130
63,910
2500000 56,065
