Diabetes Safe Insurance Policy

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About Star Health Insurance

  • Star Health and Allied Insurance Co Ltd started its operations in 2006.
  • The company is based on a capital of Rs.985 crores .
  • Star Health and Allied Insurance company has emerged as India’s first stand alone Health Insurance Company dealing in Personal Accident , Medi Claim and overseas travel insurance

Why Should one get a Diabetes Safe plan?

  • India had approximately 32 million people with diabetes in 2000, but by 2030 this number is expected to increase to almost 80 million. In 2006 it was estimated that deaths from diabetes in India will increase by 35% in the next ten years.
  • Diabetes causes 6 deaths every minute and one in 20 deaths in the world is due to the condition. Every year it is estimated that 3.2 million people in the world die due to the diabetes or its related causes.
  • Almost 90 to 95% of diabetes is of type 2 or maturity onset type; that affects people in their middle age. Type 1 or juvenile diabetes affects 70,000 children under the age of 15 years every year.

Plans





Eligibility

  • Any person between 18 years and 65 years of age who is already living with Diabetes Mellitus can take this insurance.
  • Above 65 years only renewals accepted 
  • No Capping on exit age 
  • Policy is available both for individual and floater basis 
  • Floater Policy can be taken only for a family of 2 provided only either of the person is diabetic .Family for this purpose would means self and spouse . 

Highlights of the Policy

  • It covers hospitalization expenses for complications of Diabities(both type 1 and type 2) and any complications related to Diabities.
  • Policy can be taken on Individual and Floater basis.
  • Two Plans are available – Plan A and Plan B.
  • Plan A – Pre-acceptance medical screening is compulsory.
  • Plan B – There is no pre-acceptance medical screening.
  • No Waiting Period for Plan A. 15 months waiting period for Plan B.
  • Out Patient expenses – for Medical consultations, Diagnostic tests, medicine and drugs


Sum Insured options available


Coverages for Both Plan A and Plan B

  • Section 1 : Covers hospitalization for complications of Diabities 
  • Section 2: Covers hospitalization for all other  ailments and injuries .
  • Section 3: Outpatient Expenses 
  • Section 4: Personal Accident 

Plan




Section 1

If during the policy period, the insured person develops any complications of Diabetes Mellitus and if these complications require hospitalization upon a qualified medical practitioners advice, medical expenses incurred in such a case will be covered under this section upto the limitations indicated but not exceeding  the sum insured.

Room Accommodation : Single Standard A/C room, Boarding and Nursing expenses are covered .
Expenses Covered :Surgeon, Anesthetists, Medical Practitioner, Consultants, Specialists fee
Anesthesia, Blood, Oxygen and Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and diagnostic imaging modalities, X-ray and stent. With regard to coronary stenting, the company will pay such amount up to the extent of cost of bare metal stent/drug eluting cobalt-chromium stent/drug eluting stainless steel stent only.



Pre and Post Hospitalization Charges

Pre Hospitalization Expenses-  Relevant Pre-hospitalization charges incurred upto 30 days prior to hospitalization ,on the disease/illness contracted following an admissible claim under the policy.
Post Hospitalization Expenses -  Expenses incurred up to 60 days after discharge from the hospital. The amount payable shall not exceed the sum equivalent to 7% of the hospitalization expenses subject to a maximum of Rs.5,000/- per hospitalization. 
*NOTE - For the purpose of calculation of the 7%, only nursing expenses, surgeon's / consultants fees, diagnostic charges and cost of drugs and medicines will be taken.

Emergency Ambulance Expenses

Rs 2000 per Policy period for transporting the insured person by a private ambulance service will be covered. 

Special Conditions

  1. Donor expenses for kidney 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 
  2. Expenses incurred on dialysis (inclusive of AV fistula /graft creation charges) are payable up-to Rs.1,000/- per sitting commencing from the policy year in which Chronic Kidney disease occurs and payable for up to 24 consecutive months provided the policy is in force.

 Claims directly or indirectly relating to Cardio Vascular System, Renal System, Diseases of eye, Foot Ulcer, Diabetic Peripheral Vascular Diseases and other complications of diabetes are eligible to be payable under Section 1 only, except where specifically provided for. 
Claim for cataract surgery is payable under Section 2 only 
The expenses as above are payable only where the in-patient hospitalization is for a minimum period of 24 hours. However this time limit will not apply to the day-care treatments detailed elsewhere in the policy. All other expenses relating to the hospitalization will be considered in proportion to the eligible room rent or actual whichever is less. 
Note: Only complications of Diabetes that are declared by the insured and accepted by the company shall be considered as covered under Section 1. c. Exclusions applicable


Exclusions

  • 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 the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS and sexually transmitted diseases.
  • Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these (other than ectopic pregnancy), family planning treatment. All types of treatment for infertility and its complications there of.
  • Expenses incurred on weight control services including surgical procedures for treatment of obesity, medical treatment for weight control, treatment for, genetic and other endocrine disorders, Sleep Apnea.
  •  Convalescence, general debility, run-down condition or rest cure, nutritional deficiency states, psychiatric, mental and behavioral disorders, Venereal diseases and Sexually transmitted diseases, intentional self injury and use of intoxicating drugs / alcohol, smoking and tobacco chewing .
  • Congenital External diseases/conditions defects or anomalies
  • 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.8 
  • Expenses incurred on Lasik Laser or Refractive Error Correction and its complications, all treatment for eye disorders requiring intra-vitreal injections and related procedures. 
  • 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. 
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician.
  • Naturopathy Treatment, unconventional, untested/unproven, experimental therapies. 
  • Stem cell Therapy, Artificial Pancreas, Chondrocyte Implantation, Immunotherapy without proper indication. 
  • Hospital registration charges, admission charges, record charges, telephone charges and such other charges
  •  Expenses incurred for treatment of diseases/illness/accidental injuries by systems of medicines other than Allopathy 
  • 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 erectile dysfunction 
  •  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. 
  • Any specific time-bound or life time exclusions applied, specified and accepted by the insured. 


Section 2

  • If during the period stated in the Schedule the insured person, upon the advice of a duly Qualified Physician/Medical Specialist /Medical Practitioner or of duly Qualified Surgeon to incur Hospitalization expenses for medical/surgical treatment for any disease/illness/sickness (Other than those falling under Section 1 above), accidental injuries at any Nursing Home / Hospital in India as an in-patient, the Company will pay to the Insured Person/s the amount of such expenses as are reasonably and necessarily incurred up-to the limits indicated but not exceeding the sum insured in aggregate in any one period stated in the schedule hereto.
  1. Room Accommodation :Room, Boarding and Nursing Expenses at 1.5% of the sum insured subject to a maximum of Rs. 8,500/- per day.
  2. Expenses Covered :Surgeon, Anesthetists, Medical Practitioner, Consultants, Specialists fee
  3. Anesthesia, Blood, Oxygen and Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and diagnostic imaging modalities, X-ray and stent. With regard to coronary stenting, the company will pay such amount up to the extent of cost of bare metal stent/drug eluting cobalt-chromium stent/drug eluting stainless steel stent only.

Pre and Post Hospitalization Charges

  • Pre Hospitalization Expenses-  Relevant Pre-hospitalization charges incurred upto 30 days prior to hospitalization ,on the disease/illness contracted following an admissible claim under the policy .
  • Post Hospitalization Expenses -  Expenses incurred up to 60 days after discharge from the hospital. The amount payable shall not exceed the sum equivalent to 7% of the hospitalization expenses subject to a maximum of Rs.5,000/- per hospitalization. 
*NOTE - For the purpose of calculation of the 7%, only nursing expenses, surgeon's / consultants fees, diagnostic charges and cost of drugs and medicines will be taken.
Where Package rates are charged by the hospitals the Post-Hospitalization benefit will be calculated after taking the room, boarding and nursing charges at 1.5% of sum insured subject to a maximum of Rs.8,500/- per day

Expenses for Treatment of Cataract



Emergency Ambulance Expenses

Rs 2000 per Policy period for transporting the insured person by a private ambulance service will be covered. 

Special Conditions

  • The expenses as above are payable only where the in-patient hospitalization is for a minimum period of 24 hours. However this time limit will not apply to the day-care treatments detailed elsewhere in the policy.
  •   All other expenses relating to the hospitalization will be considered in proportion to the eligible room rent or actual whichever is less. 

Section 3 –Outpatient Expenses

The Company will pay the amount of such expenses as are reasonably and necessarily incurred at the network hospitals/diagnostic centers as an Out Patient, provided the policy is in force
The Cost of Fasting and Post Prandial and HbA1C tests - once every six months – upto Rs.750/- per event upto Rs.1500/- per policy period.
Other expenses like medical consultation, other diagnostics, medicines and drugs upto the limits given below per policy period.

 

Section 4- Personal Accident

If at any time during the Period of Insurance, the Insured Person shall sustain any bodily injury resulting solely and directly from an Accident caused by external, violent and visible means and if such accident causes death of the Insured Person within 12 Calendar months from the date of Accident, then the Company will pay an amount as compensation the Sum Insured mentioned in the Schedule.
Note : 
This Section is applicable for the person specifically mentioned in the Schedule.
At any point of time only one person will be eligible to be covered under this Section.

Enquiry

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