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For Health Insurance India Enquiries Contact: Ria Insurance Brokers Pvt Ltd, 449 Kailash Tower -2, East Of Kailash,
New Delhi, India-110065, Phone. 011-26417566,46581566,24525374 Mob. 9810090853 Email:- ibidelhi@gmail.com |
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Star Health Mediclaim Policy  |
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| STAR SENIOR CITIZENS’ RED CARPET INSURANCE POLICY |
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| The proposal, Declaration and other documents if any given by the proposer form the basis of this policy of insurance. |
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In consideration of the premium paid and subject to the terms and conditions as set out in the Schedule with all its Parts the Company by this Policy agrees as under:
Subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon, the Company undertake that if during the period stated in the Schedule or during the continuance of this policy by renewal if the insured person shall contract any disease or suffer from any illness (hereinafter called DISEASE) or sustain any bodily injury through accident (hereinafter called INJURY) and if such disease or injury shall require any such injured Person, upon the advice of the duly Qualified Physician/Medical Specialist /Medical Practitioner (hereinafter called MEDICAL PRACTITIONER) or of duly Qualified Surgeon (hereinafter called SURGEON) to incur Hospitalization expenses for medical/surgical treatment at any Nursing Home / Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient the Company will pay to the Insured Person the amount of such expenses as are reasonably and necessarily incurred in respect by or on behalf such Insured Person up-to the limits indicated but not exceeding the sum insured in aggregate in any one period stated in the schedule hereto. |
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1.0 In the event of any claims becoming admissible under this Scheme, the Company will pay to the Insured Person or the estate of the Insured Person
2.0 the amount of such expenses as would fall under different heads up to the limits mentioned, and as are reasonably and necessarily incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum insured in aggregate mentioned in the schedule hereto. |
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| (A) Room, Boarding Expenses as provided by the Hospital / Nursing Home at 1% of the sum insured per day. |
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| (B) Nursing expenses. |
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| (C) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees subject to a maximum of 25% of the sum insured per hospitalisation |
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| (D) Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses subject to a maximum of 50% of the sum insured per hospitalisation |
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| (E) Emergency ambulance charges up-to a sum of Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policy period for transportation of the insured person by private ambulance service when this is needed for medical reasons to go to hospital for treatment provided such hospitalisation claim is admissible as per the Policy. |
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| (F) A sum equivalent to 7% of the hospitalisation expenses incurred comprising of Nursing Charges, Surgeon/Consultant fees, Diagnostic charges, Medicines and Drugs only subject to a maximum of Rs.5000/= per occurrence towards Post-Hospitalisation medical expenses wherever recommended by the attending Medical Practioner. |
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| Where Package rates are charged by the hospitals the Post-Hospitalisation benefit will be calculated after taking the room and boarding charges at 1% of the Sum Insured per day. |
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| Expenses on Hospitalization for minimum period of 24 hours are admissible. However this time limit will not apply for Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery, Lithotripsy (Kidney stone removal) Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotheraphy, taken in the Hospital / Nursing Home and the Insured is discharged on the same day. |
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| The amount payable respect of the following treatment is up-to the limit mentioned there-against: |
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Cataract surgery- Rs.15000 in respect of one or both eyes in the entire policy period
Lithotripsy (Kidney stone removal) – Rs.20,000
Tonsillectomy- Rs.7,500
Cutting and Draining of Abscess- Rs.1,500
Liver Aspiration- Rs.2,000
Pleural Effusion Aspiration- Rs.2,000
Colonoscopy- Rs.2,000
Sclerotheraphy – Rs.5,000
Provided the waiver of the minimum period of 24 hours hospitalisation is limited to the above noted treatments only.
The expenses payable in during the entire policy period in respect of the following diseases/conditions is limited to the amount mentioned there against: |
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| (a) Treatment for Cardio-Vascular Diseases / Cerebro-Vascular Accident / Cancer and breakage of bones: Rs.75,000 |
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| (b) Renal complications : Rs.75,000 |
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| (c) All other Major Surgeries: Rs.60,000. |
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| Note: -Company’s liability in respect of all claims admitted during the period of insurance shall not exceed the Sum insured per person mentioned in the Schedule. |
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