Accident Care Policy (2009-10)
Accident Care Benefits
- Accidental death
- Permanent disability – total or partial – following an accident
- Temporary total disablement – the Insured Person is eligible for a weekly benefit at 1% of Capital Sum Insured (following an accident) subject to maximum of Rs.5000/- per week for a for 100 weeks
- Educational grant to children (1 Child – Rs.5000/-, 2 Children– Rs.10,000/-)
- Transportation expenses of mortal remains (Rs.3000/-)
- Travel expenses of one relative (Rs.1000/-)
- Cumulative Bonus of 5% accrues to the Insured Person for every claim free year, subject to a maximum of 50%
Optional Benefits
Policy can be extended to cover Medical Expenses on payment of Additional Premium
Risk Features
- For purpose of rating, persons proposed for insurance are classified under three risk groups
- Risk Group I – Persons engaged primarily in administrative functions
- Risk Group II – Persons engaged in manual work other than what is specifically provided for under Group III
- Risk Group III – Persons working in explosives industry, mines workers, high tension electric supply, horse racing including jockeys, athletes and occupations of similar hazards
Claim Procedure
- Call the Star Health 24 hour help-line to register the details of hospitalization.
- Kindly mention your Star Health ID number for easy access to your policy details.
- In case of a planned hospitalization, please register 24 hours prior to admission to the hospital
- In case of emergency hospitalization, please register within 24 hours of hospitalization
- In all network hospitals, the cashless facility on payments can be availed
- For treatment in non-network hospitals, payments must be made up-front to the hospital. Reimbursement of the expenses will be effected by Star Health, on submission of the necessary documents.
Exclusions
- Expenses incurred on events occurring before the commencement of the cover or otherwise outside the Period of Insurance
- Any claim in respect of Pre-existing condition
- Any claim if the insured acts against the advice of a physician
- Any claim arising out of Accidents that the Insured Person has caused intentionally or by committing a crime or as a result of drunkenness or addiction (drugs, alcohol, etc)
- Any claim arising out of mental disorder, suicide or attempted suicide self inflicted injuries, or sexually transmitted conditions, anxiety, etc
- Participation in Hazardous Sport/Hazardous activities
- Persons who are physically and mentally challenged unless specifically agreed and endorsed in the policy.
How much to pay (for individuals)?
Coverage / Risk Group | Group I | Group II | Group III |
Table I | 0.45 per mile | 0.60 per mile | 0.80 per mile |
Table II | 0.80 per mile | 1.30 per mile | 1.75 per mile |
Table III | 1.25 per mile | 1.75 per mile | 2.00 per mile |
For groups
Group Size | % of discount on Premium (Excluding add-on Covers & Service Tax) |
2 - 100 Persons | 5% |
101 - 1000 | 10% |
Can this
Group Policies are allowed without additional benefits. But Group Policies are eligible for a discount on the basic premium when the size of the group increases substantially.
Renewal
The Insurance may be renewed under mutual consent.
Dear Sir, I am Kiran Kothari , 57 years old. sufferinf from controlled diabities and hypothyroid from nearly 10years without any hospitalization. I am fit and having regular walk and exercise session.My medical insurance was covered by corporate policy of my executive son. Now I would like to have medical [health insurance]. policy. Please guide me accordingly. Kiran Kothari
The worst insurance firm ever.. My Father took Senior Citizen Red Carpet Policy [Coverage: 1 Lac; POLICY NO. 006908] from Star Health. On August 29, 2013 when he took policy, he declared that he has Asthma. In October 2013, due to the high blood pressure he was admitted at Sanjeevani Criticare Hospital, Kopar Khairane, Navi Mumbai from 03.10.2013 to 05.10.2013. He spent around Rs. 20,000/- in this process. I had submitted all the papers to Star Health Vashi Office. After which I had no clue on the status of my claim. Every time I called up the helpline, I was flooded with multiple numbers where I need to call and follow-up with each one you in order to have a clear visibility of my claim status. Every time there was a new story that I was hearing from customer support "that the claim in process", but today, I came to know that my Father???s claim has been rejected (claim # 0130102) and it was stated to me that it won???t cover under policy due to norms mentioned as "patient was symptomatic prior to inception of star policy". I do not understand the diagnosis/Analysis been done on this from which you had conclude to reject this normal claim?? I had copied this email to Dr. Sachin Gangavane Sir (Sanjeevani Criticare Hospital) under whose treatment my father???s health was stabilized. As I came to know from your representative that the claim has been rejected on the basis of description written on the indoor paper submitted by hospital, I am sure this is human error and as Health Insurance Company I feel you guys should verify all the medical bills and supporting documents submitted by client before taking such nasty decision. Irrespective of the Policy coverage and terms specified in it you should have thoroughly studied the case history of the client and follow the norms under the same prior you conclude on anything. This is really causing a pain for me to accept your decision under abnormal circumstances. Please let me know, did you find any medical history of my father related to high blood pressure?? On the basis of one note written on some paper how you guys deal with client???s problems before investigating further??? My father felt cheated now as his claim got rejected when he really need it. What is the legal way to handle this issue? Can anybody guide me further on this?
does it covers liposuction treatment
It may be the best .If so answre A senior citizen is issued policy five year back.she paye premium regularly and made bo claim.Can premium jump 100%.She has to pay rs 15000 instead of rs 7000 for sum assured of rs 300000.Is this not misselling.Can you punish Andheri mumbai advisor
This is really sad. We should certainly take some action as permitted by law. Maybe we can go to consumer court and file a petition. Freedom of common man cannot be curbed. Strict action against these demons is the need of the hour....
The worst insurance firm star health allied insurance Andheri Mumbai.The agent cheated us. We have paid regular premium for five years and no claim made but this year the premium is increased 100%. I had complained to all officers and IRDA but they are not afraid. They refuse to give formula of 100% increase There should be action against agent for mis selling. The firm is also refusing to give physical copies of policy if renewed online
These insurance companies know how to dupe people - even educated people. Friends, don't fall into this vicious trap. Also go for renowned companies and consult someone before even talking to these sidey agents.