YOUNG STAR INSURANCE

POLICY
UIN: SHAHLIP22036V042122

STRICTLY FOR INTERNAL TRAINING PURPOSE ONLY www.starhealth.in Youngstar Insurance Policy_Version 1.0_Feb_2024
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 IN-PATIENT ROOM RENT
HOSPITALIZATION
BENEFITS EXPENSES

PRE & POST EMERGENCY ROAD

HOSPITALIZATION AMBULANCE
DAY CARE
TREATMENTS
E-MEDICAL HEALTH
OPINION CHECK-UP

CUMULATIVE
BONUS
AUTOMATIC ROAD TRAFFIC
RESTORATION OF S.I. ACCIDENT

DELIVERY
EXPENSES (GOLD) HOSPITAL CASH
MODERN
TREATMENTS BENEFIT (GOLD)
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 KEY FEATURES

ENTRY AGE POLICY TERM

Adults: Minimum 18 years
to Maximum 40 years 1 / 2 / 3 Years
Dependent Children: 91
days to 25 years INSTALMENT
FACILITY

Quarterly or
Half-yearly.
Premium can
TYPE OF COVER *PRE-POLICY also be paid
MEDICAL CHECK-UP Annually,
Biennial and
Individual & Floater Not Required Triennial

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 MIDTERM INCLUSION

Permissible on payment of proportionate premium subject to the

following;
a. Newly Married / Wedded spouse and/or legally adopted
child: Intimation about the marriage/adoption should be given
within 45 days from the date of marriage or date of adoption
b. New born baby: Intimation about the new born baby should be
given within 90 days from the date of birth. The cover for new
born commences from 91st day of its birth
Special conditions:
a. Waiting periods as stated in the policy will be applicable from
the date of inclusion of such newly married/wedded spouse,
new born baby, legally adopted child
b. Such midterm inclusion will be subject to underwriter's approval

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 SUM INSURED OPTIONS IN LAKHS (₹)

3
100 5

75

50
₹ 15
10

25 20

Sum Insured Rs. 3,00,000 is available only for Individual Policies

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 HOSPITALIZATION
EXPENSES ON HOSPITALIZATION FOR A MINIMUM PERIOD OF 24 HOURS COVERED

Anywhere Cashless Reimbursement

Network & Non - Network* Non - Network Hospitals

Hospitals

To View The list Of Network Hospital *Only for planned and approved in-patient hospitalizations
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 HOSPITALIZATION - CONNECTED
TREATMENTS COVERED
Professional Fee Medical Services Medicines

Surgeon Anesthesia Drugs

Blood Cost of Pacemaker
Consultant
Oxygen Cost of Implants
Anesthetist
OT charges
Specialist ICU charges

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 ROOM RENT

Room (Single Private A/C room), Boarding

and Nursing Expenses as provided by the
Hospital PRE & POST HOSPITALIZATION

Note: Hospitalization expenses which vary based on the room Pre-hospitalization Expenses: Medical expenses
rent occupied by the insured person will be considered in
proportion to the room rent limit / room category stated in the
incurred up to 60 days immediately
policy or actuals whichever is less. before the insured person is hospitalized

Post Hospitalization Expenses: Medical expenses

incurred up to 90 days immediately
after the insured person is discharged from the
hospital

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DAY CARE PROCEDURES

All day care procedures

are covered

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 EMERGENCY ROAD E-MEDICAL OPINION
AMBULANCE
The Insured Person is given the facility of
obtaining “E Medical Opinion” from the
Company's expert panel, subject to the following
conditions;
This should be specifically requested for by
the Insured Person
Subject to an admissible hospitalization claim, Emergency
This opinion is given without examining the
Road Ambulance expenses incurred for the following are
patient, based only on the medical records
payable; submitted
i. for transportation of the insured person by private The opinion should be only for medical
ambulance service to go to hospital when this is needed for reasons and not for medico-legal purposes
medical reasons Any liability due to any errors or omission or
or consequences of any action taken in reliance
ii. for transportation of the insured person by private of the opinion provided by the Medical
ambulance service from one hospital to another hospital for Practitioner is outside the scope of this policy
better medical treatment Utilizing this facility alone will not amount to
making a claim

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 COST OF HEALTH CHECK UP

Expenses incurred towards Cost of Health check-up up to the limits mentioned in the table below
on completion of each policy year (irrespective of claim), provided health check up is done at a
Network facility;

15 Lakhs and
S.I. / POLICY TYPE (₹.) 3 Lakhs 5 Lakhs 10 Lakhs
above

INDIVIDUAL (₹.) 1,500/- 2,000/- 3,000/- 3,500/-

FLOATER (₹.) NA 3,000/- 4,000/- 5,000/-

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 AUTOMATIC RESTORATION OF S.I.

There shall be Automatic Restoration of the Basic Sum Insured once by 100% subject to the following;

1. The automatic restoration shall be immediately upon partial/full utilization of the limit of coverage
2. Such Restored Basic Sum Insured can be utilized for all claims during the policy period
3. The maximum liability of the Company in a Single claim under a policy year shall not exceed the
limit of coverage
4. The unutilized restored Sum Insured cannot be carried forward
5. This Benefit is not available for Modern Treatment

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 CUMULATIVE BONUS
The insured person will be eligible for a Cumulative bonus calculated at 20% of the
Basic Sum Insured for each claim-free year subject to a maximum of 100% of the basic
Sum Insured

Special Conditions:-
1. The Cumulative bonus will be calculated on the expiring Basic Sum Insured
2. If the insured opts to reduce the Basic Sum Insured at the subsequent renewal, the limit of indemnity by way of such
Cumulative bonus shall not exceed such reduced basic sum insured
3. In the event of a claim resulting in;
a. Partial utilisation of Basic Sum Insured, such cumulative bonus so granted will be reduced at the same rate at which it
has accrued
b. Full utilization of Basic Sum Insured and nil utilization of cumulative bonus accrued, such cumulative bonus so granted
will be reduced at the same rate at which it has accrued
c. Full utilization of Basic Sum Insured and partial utilization of cumulative bonus accrued, the cumulative bonus granted
on renewal will be the balance cumulative bonus available and will be reduced at the same rate at which it has accrued
d. Full utilization of Basic Sum Insured and full utilization of cumulative bonus accrued, the cumulative bonus on renewal
will be “Nil”

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 ROAD TRAFFIC ACCIDENT
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.10,00,000/- and subject to the following;

It is evidenced that the insured person was wearing helmet and was either riding
or travelling as pillion rider in a two wheeler at the time of accident as evidenced
by Police record and Hospital record
The additional Basic Sum Insured shall be available only once during the policy
period
The additional Basic Sum Insured shall be available after exhaustion of the limit
of coverage
The additional Basic Sum Insured can be utilized only for that particular
hospitalization following the Road Traffic Accident
Automatic Restoration of Basic Sum Insured shall not apply for this benefit
This benefit shall not be applicable for day care treatment
The unutilized balance cannot be carried forward for the remaining policy period
or for renewal
Claim under this benefit will impact the Cumulative bonus

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 MODERN TREATMENTS
The expenses payable during the entire policy period for the following treatment / procedure (either as a day care or as in-patient exceeding 24hrs of
admission in the hospital) is limited to the amount mentioned in table below;

Oral Chemotherapy* Immunotheraphy -

Uterine artery Deep Brain Intra Vitreal
Sum Insured Balloon Sinuplasty (Sublimits including Pre Monoclonal Antibody to Robotic surgeries
Embolization and Stimulation injections
(Lakh) (Lakh) and Post Hospitalisation) be given as injection (Lakh)
HIFU (Lakh) (Lakh) (Lakh)
(Lakh) (Lakh)

3 0.375 0.15 0.75 0.375 0.75 0.15 0.75

5 1.25 0.50 2.5 1.25 2.5 0.50 2.5

10 1.50 1 3 2 4 0.75 3
15 1.75 1.25 4 2.5 5 1 4
20 2 1.50 4.5 2.75 5.5 1.25 4.5
25 2 1.50 5 3 6 1.50 5
50 2.25 1.75 6 4 7.5 1.75 6
75 2.50 2 7 5 9 2 7
100 3 2 7.5 6 10 2 7.5

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 MODERN TREATMENTS
The expenses payable during the entire policy period for the following treatment / procedure (either as a day care or as in-patient exceeding 24hrs of admission in
the hospital) is limited to the amount mentioned in table below;

Stem cell therapy :

Sum Insured Vaporisation of the prostate Hematopoietic stem cells for
Stereotactic radio IONM-(Intra Operative Neuro
(Lakh) Bronchial Thermoplasty (Green laser treatment or bone marrow transplant for
surgeries (Lakh) Monitoring)
holmium laser treatment) haematological conditions
(Lakh)

5 0.75 0.75

7.5 2 2.50
10 2.25 4
15 2.5 Up to Sum Insured 5
20 2.75 5.5
25 3 6
50 3.5 7.5
75 3.75 9
100 4 10
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 DELIVERY EXPENSES
(AVAILABLE IN GOLD PLAN)

Expenses for a Delivery including Delivery by Caesarean section (including pre-natal and post natal expenses) up-to
Rs.30,000/- per delivery is payable, subject to the following;

1. This benefit is available only for a maximum of 2 deliveries in the life time under this policy
2. This Benefit is subject to a waiting period of 36 months from the date of first commencement of Young Star Insurance Policy
and its continuous renewal thereof with the Company
3. A waiting period of 24 months will apply afresh following a claim under this benefit
4. Pre Hospitalization and Post Hospitalization expenses and Hospital Cash Benefit are not applicable for this section
5. This cover is available only when
i. both Self and Spouse are covered under this policy either on floater basis or on individual basis and both Self and Spouse
have been covered for a continuous period of 36 months under Young Star Insurance Policy
ii. the policy covering the Self and Spouse are in force when this benefit becomes payable
6. Claims under this section will not reduce the Sum Insured
7. Claim under this section will impact the Cumulative bonus

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 HOSPITAL CASH BENEFIT
(AVAILABLE IN GOLD PLAN)

The Company will pay a Cash Benefit of ₹1000/- for each completed day of hospitalization subject to a Maximum of 7
days per hospitalization and 14 days per policy period, provided, there is a valid claim for hospitalization under this
policy

Note:-
1. This benefit is subject to 1 day Deductible
2. Payment under this benefit does not form part
of the Basic Sum Insured.
3. Claim under this section will impact the
Cumulative bonus.

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 DISCOUNTS AVAILABLE IN THE PREMIUM

STAR Wellness Program Discount (on renewals):

Wellness Points Earned Discount in Premium
200 to 350 2%
351 to 600 5%
601 to 750 7%
751 to 1000 10%

Special Condition:
If the Insured person avails this policy before the age of 36 years and has continuously renewed without any break, then, on
completion of 40 years of age the insured person will be offered a discount of 10% on the premium applicable at renewal at
the age of 40 years for the sum insured opted at the inception of this policy. This discount is available for all the subsequent
renewals. The discount is not cumulative. This discount will not be given if the insured person migrates to any other policy
offered by the Company.
If an individual policy is converted into family floater policy at the time of renewal, then the discount is available on the family
floater policy only if the age of the insured person added under the family floater policy is less than the age of 36 years

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 WAITING PERIODS
For the first 30 days of cover, no treatment benefits for any diseases/surgeries (Other than Accidents) (Code Excl 03)
For the first 12 consecutive months of cover, certain identified surgeries/medical conditions/diseases (Code Excl 02)
For the first 12 consecutive months - Pre-Existing Diseases (PED) – Declared and endorsed in the policy (Code Excl 01)

SPECIFIC DISEASES/PROCEDURE - CODE EXCL 2

List of specific diseases/procedures;
i. Diseases of ENTand Thyroid
ii. All types of Hydrocele, Hernia, Varicocele, Piles, Fistula, and
Fissure in Ano
iii. Diseases of Female Reproductive system
iv. Calculus diseases of the Gall Bladder, Kidney and Urinary Tract

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 PERMANENT EXCLUSIONS
Investigation & Evaluation – (Code- Excl 04)
Rest Cure, rehabilitation and respite care – (Code Excl 05)
Obesity/Weight Control – (Code Excl 06)
Change-of-Gender treatments – (Code Excl 07)
Cosmetic or plastic surgery – (Code Excl. 08)
Hazardous or Adventure sports - (Code Excl. 09)
Breach of law – (Code Excl. 10)
Excluded Providers – (Code Excl 11)
Treatment for alcoholism, drug or substance abuse or any addictive condition - (Code Excl 12)
Treatments received in health hydros, nature cure clinics, spas or similar establishments or
Private beds registered as a nursing home - (Code Excl. 13)

TAX BENEFITS
Insured is eligible for relief under Section 80D of the Income Tax Act when premium is paid by any mode
other than cash
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 CLAIM
PROCESS
(CASHLESS)
On admission in the Obtain the pre-authorization
Call the 24-hour helpline for
Inform the ID number for hospital, produce the ID form from the hospital
assistance -1800 425 2255
easy reference card issued by the helpdesk, complete the patient
Senior Citizens may call at
company at the hospital information and re-submit to
044 40020888
helpdesk the hospital helpdesk

Once all the details are The company will

In case of emergency The treating doctor will
furnished, the company will
hospitalization, process the request and complete the hospitalization/
process the request as per the
information to be given call for additional treatment information and the
terms and conditions, as well
within 24 hours documents/clarifications hospital will fill up expected
as the exclusions therein, and
after hospitalization if the information cost of treatment. This form is
either approve or reject the
request based on the merits furnished is inadequate submitted to the company

Cashless facility can be availed only in networked Hospitals. For details of Network Hospitals, the insured may visit www.starhealth.in or contact the nearest branch23
 CLAIM Pre Admission
Duly completed Discharge Summary
PROCESS claim form
investigations and
from the hospital
(REIMBURSEMENT) treatment papers

KYC (Identity proof with

Certificate from the
Address) of the proposer, Cash receipts from
attending doctor Receipts from doctors,
where hospital, chemists
claim liability is above regarding the surgeons, anesthetist Cash receipts and reports
Rs 1 Lakh as per AML diagnosis.
for tests done
Guidelines

Type of Claim Prescribed Time Limit

Reimbursement of hospitalization, Claim must be filed within 15 days from the date of discharge
daycare and pre-hospitalization expenses from the hospital

Within 15 days after completion of 180 days from the date of

Reimbursement of post-hospitalization expenses
discharge from hospital

Note: Call the 24 hour help-line for assistance - 1800 425 2255 / 1800 102 4477, Senior Citizens may call at 044 40020888 24
 ANTI-MONEY LAUNDERING (AML)

Anti-Money Laundering (AML) measures are of paramount importance in the health insurance business due to several key
reasons which are as follows:

First and foremost, health insurance involves substantial financial transactions, making it susceptible to potential money
laundering activities, where ill-gotten gains are disguised as legitimate insurance premiums.

By implementing robust AML protocols, health insurance companies can prevent the infiltration of illicit funds into their
operations, safeguarding the integrity of the industry and ensuring that policyholders' premiums are derived from
legitimate sources.

Moreover, effective AML practices enable the identification and reporting of suspicious transactions, enhancing overall
financial security, and mitigating the risks of fraud, terrorism financing, and other illicit activities that could harm the
insurance sector and its stakeholders.

Therefore it is the responsibility of every employee in the organization and every intermediary to know the latest AML
Guidelines and adhere by the same.
To know more about AML CLICK
HERE

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 THANK YOU

STRICTLY FOR INTERNAL TRAINING PURPOSE ONLY www.starhealth.in Youngstar Insurance Policy_Version 1.0_May_2024