True Value Presentation

Presentation on True Value

Presentation on

TRUE VALUE


Hospitalization Expenses incurred as an inpatient for

Sickness/Illness/Diseases

Accident

Coverages


Hospital, Nursing Home means any institution in India established for indoor care and treatment of sickness and injuriesIt has been registered with the local authorities and is under the supervision of a registered and qualified Medical Practitioner

orShould comply with minimum criteria as under

• It should have at least 15 inpatient beds (10 in Class ‘C’ Towns).

• Fully equipped operation theatre of its own wherever surgical operation is carried out.

• Fully qualified nursing staff under its employment round the clock

• Fully qualified Doctor(s) should be in charge round the clock.

What is a Hospital?


• Self• Spouse• Dependent Children up to 25 Years• Dependent Parents up to 55 Years• Proposals from persons above 45 yrs, age proof in

the form of DL, Pass Port, Ration Card or School Certificate is required

Family Means


Entry Age 5 Months – 55 Yrs renewable upto 70 yrs

Dependent Children can be covered only with any one of their Parents

Age Limits


Minimum Sum Insured - Rs. 30,000/-

Maximum Sum Insured - Rs. 80,000/-

The following Sum Insured options are available

• Rs. 30,000/-• Rs. 40,000/-• Rs. 60,000/-• Rs. 70,000/-• Rs. 80,000/-

Sum Insured


Room rent & boarding charges @ 2% of the sum insured

Nursing charges

Surgeons, Anesthetist, Consultants and Specialists fees

Operation Theatre charges, drugs and medicines diagnostic materials, cost of pace maker etc

Allowable Expenses


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.

Day Care Treatment


Name of the Ailment / Surgery / Procedure

Sub Limit

Cataract surgery Rs. 15,000/-

Sub limits


Age Sum Insured (Rs.)

30000 40000 60000 70000 80000

5 Months to 25 Years

340 400 550 600 660

26 Years to 35 Years

375 450 620 710 850


475 525 700 900 1005


NA NA 1275 1515 1800

Rating


If two persons are Covered – 10% Discount

If more than two persons are covered 15% Discount

Family Discount


Cumulative Bonus at 5% for every Claim Free Year

Upto a maximum of 10 Claim Free Years i.e.,

50%

Cumulative Bonus


To obtain the following benefits there should be a continuous renewal of the expiring policy

(a) Renewal with Cumulative Bonus details• Cumulative Bonus as shown in the Renewal

Notice is given

(b) No Renewal Notice or Renewal Notice without cumulative Bonus details

• Cumulative Bonus as shown in the Previous Policy is given

• A declaration stating No Claim has to be obtained from the insured

Transfer of Policy


Benefits under Section 80-D of the IT ActCashless Service without intervention of TPADirect Tie up with hospitals on an All India Basis24 X 7 In-House Call centerToll Free Telephone line assistanceFull knowledge based website to offer medical information, including Health Tips. Frequent health meets to disseminate info on the health related topics

Other Benefits


Pre and Post Hospitalisation Treatment Pre Existing Diseases (covers after 4 yrs of continuous renewal with us, without break)Any Disease contracted during first 30 daysFirst Year Exclusions

• Benign prostate hypertrophy• Hernia, Hydrocele, Fistula in Anus, Piles• Sinusitis• Renal stone and Gall stone removal

First Two Years Exclusions• Cataract• hysterectomy following menorrhia or fibromyoma• Knee Replacement Surgery• Joint Replacement Surgery• Prolapse of intervertibral• Vericose veins/ulcers

Congenital internal disease/defect

Exclusions


Injury / Disease arising due to War, Invasion, Act of Foreign Enemy, Warlike operationsCircumcision unless necessary for treatment of a diseaseCost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aidsDental treatment or surgeryConvalescence, general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcoholNaturopathy Treatment Expenses incurred on Lasik Laser or Refractive Error Correction treatment

Exclusions (Contd.)


Hospital registration charges, record charges, telephone charges and such

other similar charges.

Expenses incurred on Non Allopathic treatment.

Exclusions (Contd.)


In case of Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)The insured has to send a request for ‘Pre Authorization Form’ signed by the Doctor in the Network HospitalBased on the intimation a field visit will be done by the Star DoctorPre Authorization will be issued to the HospitalBased on the Pre Authorization and the Report by the Star Doctor, Cash Less Treatment will be given by the Network Hospital

Claim Procedure


In case of Non Network HospitalsImmediate intimation to the Call Centre (1800 425 2255)Claim form will be sent to the Insured.Based on the intimation a field visit will be done by the Star DoctorBills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents

• Original Discharge Summary• Main Hospital Bill with Break Up• Investigation Reports with X-Ray Film• Medical Bills with Prescriptions

Claim Procedure (Contd.)


Thank You

True Value Presentation

Health & Medicine

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