STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED

Health Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam,
Personal & Caring Insurance
The Health Insurance Specialist Chennai - 600 034. « Phone : 044 - 28288800 « Email : [email protected]
Website : www.starhealth.in « CIN : U66010TN2005PLC056649 « IRDAI Regn. No. : 129

Kind Attention : Policyholder

Please check whether the details given by you about the insured persons in the proposal form (a copy of which was provided at the time
of issuance of cover for the first time) are incorporated correctly in the policy schedule. If you find any discrepancy, please inform us
within 15 days from the date of receipt of the policy, failing which the details relating to the person/s covered would be taken as correct.
So also the coverage details may also be gone through and in the absence of any communication from you within 15 days from the date
of receipt of this policy, it would be construed that the policy issued is correct and the claims if any arise under the policy will be dealt
with based on proposal / policy details.

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED

Health Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam,
Personal & Caring Insurance
The Health Insurance Specialist Chennai - 600 034. « Phone : 044 - 28288800 « Email : [email protected]
Website : www.starhealth.in « CIN : U66010TN2005PLC056649 « IRDAI Regn. No. : 129

Customer Information Sheet - ACCIDENT CARE INDIVIDUAL INSURANCE POLICY

Unique Identification No. : IRDAI/HLT/SHAI/P-P/V.III/134/2017-18

Refer to
TITLE Description Policy Clause
Number
a. Table A Benefit: Accidental death Table A
Table B
What am I b. Table B Benefit: Accidental Death/Permanent disablement arising out of accident
(1 and 2)
covered for
Table C Benefit: Accidental Death/Permanent Disablement /Temporary total disablement arising out Table C
c. of accident (1,2 and 3)
a. Educational Grant: Rs.10000/- for one dependent child and Rs.20000/- for two dependent child III (1)
Ambulance Charges / Transportation expenses of Mortal Remains:
lump sum of Rs.5000/- for either ambulance charges or transportation of mortal remains to his/her III (2)
b.
place of residence
Health
Travel expenses for one relative:
c. Personal & Caring Insurance
1% of the Total sum insured Up to Rs. 50,000/- for the transport expenses to one relative towards the
death of the Insured Person
III (3)

Extended The Health Insurance Specialist

Vehicle and/or Residence Modification:
Coverage 10% of the Table B and Table C sum insured subject to maximum of Rs.50,000/-towards modification of
d. insured person’s residential accommodation or vehicle modification where there is an admissible claim III (4)
under Permanent Total Disability.

Purchase of Blood:
The company will pay up to 5% of the sum insured under relevant table/tables opted subject to a III (5)
e. maximum of Rs.10,000/- whichever is less towards expenses incurred in purchasing of blood.
Transportation of Imported Medicines:
f. The Company will pay upto 5% of Total sum insured subject to a maximum of Rs.20,000/- towards III (6)
the expenses incurred on freight charges for importing medicines to India

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Star Health and Allied Insurance Co. Ltd.

Refer to
TITLE Description Policy Clause
Number
Medical Expenses Extension Due to Accident
Company will pay amount up to 25% of the valid claim or 10% of the Total sum insured or actual
a. whichever is less, subject to a overall limit of Rs.5,00,000/- per policy period towards medical IV (a)
expenses incurred as an In-patient and as an Out-Patient, provided there is a validclaim under the
policy.

Hospital Cash:
Optional Benefits Cash Benefit of Rs 1000/- for each completed day of Hospitalization(excluding date of admission and
b. date of discharge) arising out of Accident subject to a maximum of 15 days per occurrence and 60 days IV (b)
per policy period

Home Convalescence:
The company will pay Rs 500/- for each completed day subject to a maximum of 15 days
c. peroccurrence and 60 days per policy period towards engaging one attendant at residence after IV (c)
discharge from hospital.

I. All Pre-existing conditions VI (3)

VI (4 ),
II. Intentional self injury and use of intoxicating drugs/alcohol/HIV or AIDS
VI (5)
What are the
Major Exclusions VI (7),
in the policy III. War, Biological nuclear and chemical terrorism and nuclear perils
VI (9)
IV. Engaging in Hazardous sports/activities VI (11)
The exclusions given above are only a partial list. Please refer the policy clause for the complete list.
No waiting
Initial Waiting Period periods
Waiting Periods Specific Waiting Period applicable
for this policy

Fixed amount on the occurrence of a covered event:

Accidental Death Table A

Payment Basis – Accidental Death/Permanent disablement arising out of accident Table B

Benefit Basis Accidental Death/Permanent Disablement /Temporary total disablement arising out of accident Table C
Educational Grant III (1)
Ambulance Charges/Transportation expenses of Mortal Remains III (2)
Travel Expenses for one relative III (3)
Hospital Cash IV (b)
Vehicle and/or Residence modification III (4)
Payment Basis – III (5)
Purchase of Blood
Indemnity Basis
Transportation of Imported medicine III (6)
Medical expenses extension IV (a)
Home Convalescence IV (c)
No cost
Loss Sharing In case of a claim, this policy required you to share the costs sharing
applicable
for this policy
Renewal Life long renewal subject to payment of renewal premium in full before the due date
VIII (13)
Conditions Grace period of 30 days for renewing the policy is provided
Renewal Benefits Cumulative Bonus : Payable for Accidental Death or Permanent total disablement V

Policy can be cancelled on grounds of misrepresentation, fraud, moral hazard, non disclosure of material
Cancellation fact as declared in proposal form / at the time of claim, or non-co-operation by the insured person, by VIII (8)
sending the insured 30 days notice without refund of premium

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Star Health and Allied Insurance Co. Ltd.

Refer to Policy
TITLE Description Clause Number

For Cashless Service:

Claims VII (2)
For Reimbursement of claim:

Servicing /
Grievances / Company Officials IRDAI/(IGMS/Call Centre) Ombudsman VIII (16)
Complaints

Free Look: VIII(5)

Implied renewability VIII (13)
Insured’s Rights Migration and Portability Not Applicable
Increase in SI during policy term Not Applicable
Turn Around Time (TAT) for issue of Pre-Auth and Settlement of Reimbursement VII (1)
Please disclose all pre-existing disease/s or condition/s before buying a policy. Non disclosure may
Insured’s result in claim not being paid VIII(1)
Obligations
Disclosure of Material Information during the policy period such as change in occupation VIII(3)

(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the product brochure and policy document. In case of
any conflict between the Customer Information Sheet and the policy document, the terms and conditions mentioned in the policy
document shall prevail

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 Policy Wordings

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED

Health Regd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam,
Personal & Caring Insurance
The Health Insurance Specialist Chennai - 600 034. « Phone : 044 - 28288800 « Email : [email protected]
Website : www.starhealth.in « CIN : U66010TN2005PLC056649 « IRDAI Regn. No. : 129

ACCIDENT CARE INDIVIDUAL INSURANCE POLICY

Unique Identification No. : IRDAI/HLT/SHAI/P-P/V.III/134/2017-18

The proposal, declaration and other documents if any given by the proposer form the basis of this policy of insurance
The Company by this Policy agrees, subject to the terms and conditions as set out in the Schedule with all its Parts, that on proof to the satisfaction
of the Company, of the compensation having become payable, as set out in the Schedule, upon the happening of an event, to pay the Sum Insured/
appropriate Benefit.

I. DEFINITIONS OF WORDS AND EXPRESSIONS

In this Policy, the following words and expressions shall have the following meanings, as set forth, unless the context otherwise requires:
Accident / Accidental means a sudden, unforeseen and involuntary event caused by external visible and violent means.
Age means the age of the insured person on his/her completed years as recent birthday as per the English Calendar
Capital sum insured: means the sum insured as specified in the Schedule of this Policy and the Cumulative Bonus as shown in the Schedule
Company means Star Health and Allied Insurance Company Limited
Condition Precedent shall mean a policy term or condition upon which the insurer's liability under the policy is conditional upon.
Covered Medical Expenses means reasonable charges, whether as an In Patient or an out Patient, which is usually and customarily incurred for
services and supplies for any Accident to the Insured Person, covered under the policy.
Cumulative Bonus shall mean any increase in the Sum Insured granted by the insurer without an associated increase in premium
Dependent Child means a child (natural or legally adopted), who is financially dependent on the primary insured or proposer and does not have his
/ her independent sources of income.
Disclosure of information norm means the policy shall be void and all premium paid hereon shall be forfeited to the Company, in the event of
misrepresentation, mis-description or non-disclosure of any material fact.
Family means Insured Person, spouse, dependent children between 5 months and 25 years of age
Grace Period means the specified period of time immediately following premium due date during which the payment can be made to renew or
continue the policy in force without loss of continuity benefits such as waiting period and coverage of pre-existing diseases. Coverage is not
available for the period for which no premium is received
Grievous Injury means emasculation, permanent privation of the sight of either eye, permanent privation of hearing of either ear, privation of any
member or joint, destruction or permanent impairing of the powers of any member or joint, permanent disfiguration of head or face, fracture or
dislocation of a bone or tooth.
Hazardous Sport / Hazardous Activities means engaging whether professionally or otherwise in any sport or activity, which is potentially
dangerous to the Insured Person (whether trained, or not). Such Sport/Activity including but not limited to Winter sports, Ice hockey, Skiing,
Skydiving, Parachuting, Ballooning, Scuba Diving, Bungee Jumping, Mountain Climbing, Riding or Driving in Races or Rallies, caving or pot holing,
hunting or equestrian activities, diving or under-water activity, rafting or canoeing involving rapid waters, yachting or boating outside coastal waters,
jockeys, horseback, Polo, Circus personnel, army/navy/air force personnel and policemen whilst on duty, persons working in underground mines,
explosives, magazines, workers whilst involved in electrical installation with high-tension supply, nuclear installations, handling hazardous
chemicals.
Hospital / Nursing Home means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been
registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the
enactments specified under the Schedule of Section 56(1) of the said Act or complies with all minimum criteria as under:
a. Has qualified nursing staff under its employment round the clock;
b. Has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds in all other places;
c. Has qualified medical practitioner(s) in charge round the clock;
d. Has a fully equipped operation theatre of its own where surgical procedures are carried out;
e. Maintains daily records of patients and makes these accessible to the insurance company's authorized personnel.
Medical Practitioner is a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for
Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its
jurisdiction; and is acting within the scope and jurisdiction of licence
Medical expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of
Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not
been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.
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Star Health and Allied Insurance Co. Ltd. Policy Wordings

Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent and visible and evident
means which is verified and certified by a Medical Practitioner.
Insured Person means the name/s of persons shown in the schedule of the Policy.
Pre-Existing Disease means any condition or ailment or injury or related condition(s) for which the insured person had signs or symptoms and/or
were diagnosed and/or received medical advice /treatment within 48 months prior to insured person's first policy with any Indian Insurance
Company
Policy means the insurance contract, the Policy Schedule and any other endorsements riders and any other attached enrollment forms.
Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the specific provider and
consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury
involved.
Relative means spouse, children, parents, siblings or in-laws
Sum insured means the amount of insurance for each table for which the premium is paid.
Standard type aircraft / Sea Craft means an aircraft/sea-craft duly licensed to carry passengers (for hire or otherwise) by appropriate authority
irrespective of whether such an aircraft is privately owned or charted or operated by a regular airline.
Temporary Total Disablement means the Insured Person is totally disabled from engaging in any occupation or business for a temporary period
following a Grievous injury arising solely and directly from an accident.

II. SCOPE OF COVER

The Company hereby agrees, subject to the terms, conditions and exclusions herein contained or otherwise expressed herein, to pay to the Insured
person or his nominees or his legal heirs, a sum as compensation for any loss occurring during the Period of Insurance as described under different
sections hereunder and as specified in the Schedule to the Policy,
Table-A – ACCIDENTAL DEATH
If at any time during the Period of Insurance, the Insured Person shall sustain any bodily injury resulting solely and directly from Accident caused by
external, violent and visible means and 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 100% of the Capital Sum Insured.
Table-B – ACCIDENTAL DEATH AND PERMANENT DISABLEMENT
If the Insured Person meets with an Accident, which leads to disablement or subsequent death, the Company will provide insurance coverage to the
Insured in the following manner:
1. Accidental Death of Insured Person: If following an Accident that causes death of the Insured Person within 12 Calendar months from the
date of Accident, then the Company will pay an amount as compensation 100% of the Capital Sum Insured.
2. Permanent disablement of the Insured Person: If following an Accident which caused permanent impairment of the Insured's mental or
physical capabilities, then the Company will pay the benefits as provided in the Table of Benefits B1 or Table of Benefits B2 mentioned
herein, depending upon the degree of disablement provided that:
a) The disablement occurs within 12 Calendar months from the date of the Accident.
b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement.
c) Where a covered Accident results in Permanent Disablement falling under Table of benefits B1 (Permanent Total Disablement) and
under Table of benefits B2 (Permanent Partial Disablement) then the higher percentage of the sum insured will be paid.
Table-C – ACCIDENTAL DEATH, PERMANENT DISABLEMENT AND TEMPORARY TOTAL DISABLEMENT: (WEEKLY COMPENSATION)
1. Accidental Death of Insured Person: If following an Accident that causes death of the Insured Person within 12 Calendar months from the
date of Accident, then the Company will pay an amount as compensation 100% of the Capital Sum Insured.
2. Permanent disablement of the Insured Person: If following an Accident which caused permanent impairment of the Insured's mental or
physical capabilities, then the Company will pay the benefits as provided in the Table of Benefits B1 (Permanent Total Disablement) or Table
of Benefits B2 (Permanent Partial Disablement) mentioned herein depending upon the degree of disablement provided that:
a) The disablement occurs within 12 Calendar months from the date of the Accident.
b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement.
c) Where a covered Accident results in Permanent Disablement falling under Table of benefits B1 (Permanent Total Disablement) and
under Table of benefits B2 (Permanent Partial Disablement) then the higher percentage of the sum insured will be paid.
3. Temporary Total Disablement: If at any time during the period of insurance the insured person/s shall sustain Grievous injury arising
solely and directly from an accident and resulting in hospitalization, then the insured person will be paid a sum calculated at 1% of the sum
insured under Table C per completed week but not exceeding Rs.15,000/- per completed week, in all, under all Personal Accident policies, if
such injury be the sole and direct cause of Temporary Total Disablement.
This benefit is subject to a maximum period of 100 weeks from the date of such Temporary Total Disablement.
In no case shall the compensation exceed the sum insured for this benefit.
The payment shall be made only after the termination of such disablement.
All the benefit under this section is subject to exclusions, as mentioned in 'General Exclusions' of this Policy.

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

Special Conditions (Applicable to all Tables)

1. If the Accident affects any physical or mental function, which was already impaired prior to the accident, a deduction as certified by a
Government Doctor will be made in respect of this prior disablement.
2. If the accident impairs a number of physical or mental functions, the degree of disablement given in the Table of Benefits will be added
together, but liability in any case shall not exceed 100% of the Sum Insured (150% in case of Permanent Total Disablement)
3. In case of Permanent Partial Disablement claim the Sum Insured under the policy will be reduced by the amount of admissible claim under
the policy in respect of the Insured Person to whom such sum shall become payable.
4. In the event of Permanent Disablement, the Insured Person will be under obligation:
a) To have himself/herself examined by doctors appointed by the Company / and the Company will pay the costs involved thereof.
b) To authorize doctors providing treatments or giving expert opinion and any other authority to supply the Company any information that
may be required. If the obligations are not met with due to whatsoever reason, the Company may be relieved of its liability to pay.
Provided however the insured shall be deemed to have discharged his duties/obligations if he authorizes / gives consent to the treating
doctor/s or the experts who gave opinion. Any subsequent failure on the part of the treating doctor/experts who gave opinion hospital
will not be held up against the insured.
5. Where a claim for 100% of the Capital Sum Insured (150% for Permanent Total Disablement) is admitted / admissible the coverage under
the policy ceases and the policy cannot be renewed for such relevant person.
6. Where a claim for less than 100% of the Sum Insured is admitted / admissible, the coverage under the policy will continue until expiry for the
balance sum insured and Company would exclude such disability on renewal in respect of such relevant person
Exclusions:
a) Any payment in case of more than one claim under the policy during the period of insurance by which the maximum liability of the Company
in that period would exceed the amount specified in the Schedule
b) Any other claim after a claim has been admitted by the Company and becomes payable for Death or Permanent Total Disablement, as
mentioned in Table of Benefits B1. This would not apply to payment under Educational Grant, Ambulance Charges/Transportation of mortal
remains, Travel expenses of the one Relative and Expenses for Vehicle and /or residence Modification, Purchase of Blood, Transportation
of Imported Medicine.
c) Any claim arising out of an accident related to pregnancy or childbirth, infirmity, whether directly or indirectly.
d) Any exclusion mentioned in the 'General Exclusions' of this Policy.

III. ADDITIONAL BENEFITS

1. EDUCATIONAL GRANT:
The Company will pay as hereinafter mentioned
Following an admissible claim under the policy towards Death/ Permanent Total Disability of the insured person, Educational Grant for a
maximum of two dependent children of the Insured, as mentioned below:
i. If the Insured Person has one dependent child below the age of 18 years, an amount of Rs.10,000/- is payable.
ii. If the Insured Person has more than one dependent child below the age of 18 years an amount of Rs.10,000/- per child but in any case
not more than Rs.20,000/-.
This grant is payable in addition to the sum insured.
2. AMBULANCE CHARGES / TRANSPORTATION EXPENSES OF MORTAL REMAINS
Following an admissible claim under the policy due to an Accident outside the place of the insured's residence, the Company shall pay
during the policy period
Either
a) Towards ambulance charges for emergency treatment to go to the hospital in case of injury
Or
in case of Death
b) Towards transportation of the mortal remains of the insured person (including the cost of embalming and coffin charges) to the
residence of the insured,
The limit of Company's liability towards either Ambulance charges or Transportation of mortal remains is Rs.5,000/- only during the policy
period. This lump sum amount is payable in addition to the sum insured
3. TRAVEL EXPENSES FOR ONE RELATIVE Following an admissible claim under the policy towards Death of the Insured Person due to an
Accident, outside the place of his/her residence, the Company will pay 1% of the Total sum insured for the transport expenses to one
relative of the Insured Person Provided such payment shall not exceed a sum of Rs.50,000/-
This amount is payable in addition to the sum insured
4. VEHICLE AND/OR RESIDENCE MODIFICATION: The Company will pay upto 10% of Table B and Table C sum insured subject to a
maximum of Rs.50,000/- towards the expenses incurred to modify the Insured Person's residential accommodation or vehicle as long as
the modification have been carried out in India and certified by a Doctor to be necessary and directly required as a result of the Accident for
which there is an admissible claim under Permanent Total Disablement.
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Star Health and Allied Insurance Co. Ltd. Policy Wordings

This benefit is applicable only where there is an admissible claim for Permanent Total Disablement
This amount is payable in addition to the sum insured.
5. PURCHASE OF BLOOD: The Company will pay up to 5% of the sum insured under relevant table/tables opted subject to a maximum of
Rs.10,000/- whichever is less towards the expenses incurred in purchasing blood through a Hospital or Government approved blood bank
for the purpose of the Insured Person's medical or surgical treatment provided there is an admissible claim under this policy. This amount is
payable in addition to the sum insured
6. TRANSPORTATION OF IMPORTED MEDICINES: The Company will pay upto 5% of Total sum insured subject to a maximum of
Rs.20,000/- towards the expenses incurred on freight charges for importing medicines to India, provided that:
a. There is an admissible claim under the policy.
b. The medicines, formulations or alternatives of the imported medicines are not available in India, and
c. The medicines are necessary for the medical/surgical treatment of the Insured person in a Hospital following the Accident.
d. The medicines which are imported should be permissible under Government Regulation
e. The medicines shall not include any drugs under clinical trial or medicines, formulations or molecules of unproven efficacy.
This amount is payable in addition to the sum insured

IV. OPTIONAL BENEFITS

If the additional premium is paid by the Insured person and shown in the Schedule of the policy, the following benefits, as applicable, are payable
under the policy in addition to the sum insured.
a. MEDICAL EXPENSES EXTENSION DUE TO ACCIDENT:
The Company will pay any medical expenses necessarily and reasonably incurred and expended by the Insured Person, either as an In Patient or
as an Out Patient, in connection with the accident as specified in the policy for which a claim has been admitted by the Company, 25% of the valid
claim or 10% of the Total sum insured or actuals whichever is less, subject to a overall limit of Rs.5,00,000/- per policy period. Where the policy term
is more than one year, this benefit is applicable for each year. Subject to General Exclusion of this policy sufficient proof for the treatment taken
should to be submitted to the Company.
This benefit is optional and is effective only if
1. Specifically opted for by paying additional premium,
2. Shown in the Policy Schedule and
3. There is an admissible claim under the policy.
This amount is payable in addition to the sum insured
b. Hospital Cash:
If during the policy period the insured person sustains accidental injuries resulting in hospitalization as an in-patient, the Company will pay Cash
Benefit of Rs 1000/- for each completed day of Hospitalization provided such hospitalization happens within 30 days from the date of accident. The
maximum period for which the benefit is payable is 15 days per occurrence and 60 days per policy period. Where the policy term is more than one
year, this benefit limit is applicable for each year. This benefit cannot be cumulated or carried forward.
For the purpose of cash benefit the days of admission and discharge will not be taken into account.
This amount is payable in addition to the sum insured.
This benefit is optional and is effective only if
1. Specifically opted for by paying additional premium,
2. Shown in the Policy Schedule
3. There is an admissible claim under the policy.
c. Home Convalescence:
The Company will pay Rs 500/- for each completed day subject to a maximum of 15 days per occurrence and 60 days per policy period towards the
cost of engaging one attendant at residence immediately after discharge from the hospital provided the same is recommended by the attending
physician. Where the policy term is more than one year, this benefit limit is applicable for each year. This benefit cannot be cumulated or carried
forward
This amount is payable in addition to the sum insured.
This benefit is optional and is effective only if
1. Specifically opted for by paying additional premium,
2. Shown in the Policy Schedule
3. The hospitalization is arising out of Accident.
4. There is an admissible claim under the policy.

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

V. CUMULATIVE BONUS
Compensation payable for an admissible claim for Death or Permanent Total disablement arising out of accidental injuries shall be increased by 5%
thereof in respect of each completed year during which the policy shall have been in force prior to the occurrence of an accident for which the capital
sum insured becomes payable but the amount of such increase shall not exceed 50% of the sum insured stated in the schedule. The cumulative
bonus is applicable to that part of the sum insured which is renewed continuously without break.
The Cumulative Bonus will not be lost if the policy is renewed within 30 days. Cumulative bonus is not applicable for the Additional Benefits Or
Optional Benefits

VI. GENERAL EXCLUSIONS (APPLICABLE TO ALL SECTIONS OF THE POLICY)

The Company shall not be liable to make any payments in respect of:
1. Any payment, in case of more than one claim under the Policy, during any one period of insurance by which the maximum liability of the
Company in that period would exceed the capital sum insured payable under this Policy except in case of Permanent Total Disability claim,
in which case the amount payable is 150% of the sum insured. This exclusion will not apply to payments made under medical expenses
extension, Hospital cash, Home Convalescence, Educational Grant, Ambulance Charges /Transportation of mortal remains, Travel
expenses of the one Relative and Expenses for Vehicle and /or residence Modification, Purchase of Blood and Transportation of Imported
Medicine.
2. Any claim relating to events occurring before the commencement of the cover or otherwise outside the Period of Insurance.
3. Any injuries/conditions which are Pre-existing.
4. Any claim for Death or Disablement of the Insured Person from (a) intentional self-injury / suicide or attempted suicide or (b) whilst under the
influence of intoxicating liquor or drugs or (c) self-endangerment unless in self-defense or to save life.
5. Any claim arising out of mental disorder, suicide or attempted suicide self inflicted injuries, or sexually transmitted conditions, anxiety,
stress, depression, venereal disease or any loss directly or indirectly attributable to HIV (Human Immunodeficiency Virus) and / or any HIV
related illness including AIDS (Acquired Immunodeficiency Syndrome), insanity and / or any mutant derivative or variations thereof
howsoever caused.
6. Insured Person engaging in Air Travel unless he/she flies as a fare-paying passenger on an aircraft properly licensed to carry passengers.
For the purpose of this exclusion Air Travel means being in or on or boarding an aircraft for the purpose of flying therein or alighting there
from.
7. Accidents that are results of war and warlike occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection,
civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, seizure capture arrest restraints
detainments of all kings princes and people of whatever nation, condition or quality whatsoever.
8. Participation in riots, confiscation or nationalization or requisition of or destruction of or damage to property by or under the order of any
government or local authority.
9. Any claim resulting or arising from or any consequential loss directly or indirectly caused by or contributed to or arising from:
A. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
or from any nuclear waste from combustion (including any self sustaining process of nuclear fission) of nuclear fuel.
B. Nuclear weapons material
C. The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
D. Nuclear, chemical and biological terrorism
10. Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semi-
professional sports persons.
11. Participation in Hazardous Sport / Hazardous Activities
12. Persons who are physically and mentally challenged, unless specifically agreed and endorsed in the policy.
13. Any loss arising out of the Insured Person's actual or attempted commission of or willful participation in an illegal act or any violation or
attempted violation of the law.

VII. GENERAL CONDITIONS (APPLICABLE TO ALL SECTIONS UNDER THIS POLICY)

The conditions below apply throughout this insurance. Failure to comply with them may be prejudicial to a claim:
1. Obligations of the Insured Person: Intimation about an event or occurrence that may give rise to a claim under this policy must be given
within 30 days of its happening. Claims for insurance benefits must be submitted to the Company not later than one (1) month after the
completion of the treatment or after transportation of the mortal remains/ burial in the event of Death.
Note: The Company will examine and relax the time limit mentioned herein above depending upon the merits of the case
1. Claim intimation:
Where the claim intimation is received by the call centre/Corporate office details as to coverage is collected.
2. Documents to be submitted for reimbursement claims:
Duly completed claim form and

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

For Death Claims:-

· Death Certificate
· Post-mortem Certificate, if conducted
· FIR (wherever required)
· Police Investigation report (wherever required)
· Viscera Sample Report (wherever required)
· Forensic Science Laboratory report (wherever required)
· Legal Heir Certificate
· Succession Certificate (wherever required)
For Disability Claims:
· Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its percentage.
Note: The Company authorized doctor may examine the insured if required Certificate from the employer confirming leave of absence from duty
Travel expenses for one relative
· Proof of expenses incurred (original)
Vehicle and/or residence modification
· Certificate from the doctor confirming the Disability and the requirement of modification
· Estimate from Workshop
· Cash receipt for having carried the vehicle modification
· Estimate from civil engineer
· Cash receipt for completion of the civil work modification
Purchase of blood:
· Original receipt for purchase of blood (wherever applicable)
Transportation of imported medicines:
· Prescription of the treating doctor with confirmation that the medicine is not available in India.
· Original receipt for the freight incurred for import of the medicine, along with a copy of invoice
Educational grant
· Death Certificate
· Certificate from the school in which the child / children is/are studying, confirming their study
Ambulance charges / transportation expenses of mortal remains
· Death Certificate or
· Proof of hospitalisation
· Proof of utilized services of either Ambulance or Mortuary Van
For Claim under Optional benefits:
Medical expenses due to accident:
· Original Discharge Summary (wherever applicable)
· Original Medical Reports
· Original Invoices/Bills,
· Original Payment Receipts
Hospital Cash and Home Convalescence
· Discharge Summary (Where original is required for other purposes, a certified copy may be submitted)
· Recommendation by the treating doctor for appointing an attendant at home for continuation of treatment.
· Cash receipt for payment made to the attendant
Note: The Company reserves the right to call for additional documents wherever required.
2. Claims Settlement: Benefits payable under this policy will be paid within 7 days from the time of receipt of all documents the Company
requires.
Note: In case of delay in payment of any claim that has been admitted as payable under the Policy terms and conditions, beyond the time
period as prescribed under IRDA (Protection of Policyholders Regulation), 2002, the Company shall be liable to pay interest at a
rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is approved by the Company.
For the purpose of this clause, 'bank rate' shall mean the existing bank rate as notified by Reserve Bank of India, unless the extent
regulation requires payment based on some other prescribed interest rate

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

3. The Company shall be released from any obligation to pay insurance benefits if any of the term and conditions are breached.
4. Geographical Scope: The insurance cover applies Worldwide.

VIII. STANDARD TERMS AND CONDITIONS (APPLICABLE TO ALL BENEFITS UNDER THIS POLICY)

1. Incontestability and Duty of Disclosure: The Policy shall be null and void and no benefit shall be payable in the event of untrue or
incorrect statements, misrepresentation, mis-description or on non-disclosure in any material particular in the proposal form or at the time
of claim, personal statement, declaration and connected documents, or any material information having been withheld, or a claim being
fraudulent or any fraudulent means or devices being used by the Insured Person or any one acting on his behalf to obtain any benefit under
this Policy.
2. Observance of terms and conditions: The due observance and fulfillment of the terms, conditions and endorsement of this Policy in so
far as they relate to anything to be done or complied with by the Insured Person, shall be a condition precedent to any liability of the
Company to make any payment under this Policy.
3. Material change: The Insured Person shall immediately notify the Company in writing of any change in his business or occupation or
physical defect or infirmity with which he has become affected since the payment of last preceding premium.
4. Automatic Termination of Insurance: This policy shall automatically terminate upon the Insured Person's death or payment of the Capital
Sum Insured. In case of family cover, the surviving members would continue to have the cover for their respective sum insured, till the
expiry date of the policy.
5. Free Look Period: A free look period of 15 days from the date of receipt of the policy is available to the insured to review the terms and
conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and
in such an event the Company shall allow refund of premium paid after adjusting the stamp duty charges and proportionate risk premium for
the period concerned provided no claim has been made until such cancellation.
Free look Period is not applicable at the time of renewal of the policy.
6. Duties of the insured on occurrence of loss
On the occurrence of any loss, within the scope of cover under the Policy the Insured Person / representative shall file / submit a Claim Form
in accordance with 'Obligation of the Insured Person' Clause as provided in General Conditions.
If the Insured Person/representative does not comply with the provisions of this Clause or other obligations cast upon the Insured
Person/representative under this Policy, in terms of the other clauses referred to herein or in terms of the other clauses in any of the Policy
documents, all benefits under the Policy shall be forfeited.
7. Fraudulent claims
If any claim is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent
means or devices are used by the Insured Person or anyone acting on his behalf to obtain any benefit under this Policy shall be forfeited and
the policy will be cancelled without any refund of premium.
8. Cancellation/termination
The Company may cancel this policy on grounds of misrepresentation, fraud, moral hazard, non disclosure of material fact as declared in
proposal form and/or claim form at the time of claim or non-co-operation of the insured person, by sending the Insured 30 days notice by
registered letter at the Insured person's last known address and no refund of premium will be made. The insured may at any time cancel this
policy and in such event the Company shall allow refund after retaining premium at Company's short period rate only (table given below)
provided no claim has occurred up to the date of cancellation
*Short period scales:

For policy with one year term

Period on Risk Rate of premium to be retained
For a period not exceeding 15 days 10% of the Annual Premium
For a period not exceeding 1 month 15% of the Annual Premium
For a period not exceeding 2 months 30% of the Annual Premium
For a period not exceeding 3 months 40% of the Annual Premium
For a period not exceeding 4 months 50% of the Annual Premium
For a period not exceeding 5 months 60% of the Annual Premium
For a period not exceeding 6 months 70% of the Annual Premium
For a period not exceeding 7 months 75% of the Annual Premium
For a period not exceeding 8 months 80% of the Annual Premium
Exceeding 8 months Full Annual Premium

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

For policy with two year term

Period on Risk Rate of premium to be retained
Up to 1 year 65% of the premium
Up to 2 years Full Premium
For policy with three year term
Period on Risk Rate of premium to be retained
Up to 1 year 45% of the premium
Up to 2 years 85% of the premium
Up to 3 years Full Premium
9. Currency for payments: All claims payable shall be paid in Indian Rupee only.
10. Important Note: The terms, conditions and exclusions that appear in the policy or in any endorsement are part of the contract and must
be complied with. Failure to comply may result in the claim being denied.
Note 1: It is hereby made clear that in policies which are issued for a period of two or three years, the sum insured and the other benefits
shall be limited to the sum mentioned for each of the year, without any carry over benefit thereof.
Note 2: In so far as the benefits which are relatable to policy periods, such benefits shall be available for each year but limited to such
sums mentioned for each year.
Note 3: Where the policy is issued covering the family, the benefits are applicable individually for each person covered
The attention of the policy holder is drawn to our website www.starhealth.in for anti fraud policy of the Company for necessary compliance
by all stake holders.
11. Policy Disputes: Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained herein is
understood and agreed to by both the Insured and the Company to be subject to Indian Law.
12. Arbitration clause
If any dispute or difference shall arise as to the quantum to be paid under this Policy (liability being otherwise admitted) such difference
shall independently of all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties to the
dispute/difference, or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be
referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference
and the third arbitrator to be appointed by such two arbitrators. Arbitration shall be conducted under and in accordance with the provisions
of the Arbitration and Conciliation Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referred to arbitration, as hereinbefore provided, if the Company
has disputed or not accepted liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this Policy that the
award by such arbitrator/ arbitrators of the amount of the loss or damage shall be first obtained.
It is also further expressly agreed and declared that if the Company shall disclaim liability to the Insured for any claim hereunder and such
claim shall not, within three years from the date of such disclaimer have been made the subject matter of a suit in a Court of Law, then the
claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
13. Renewal Clause
The policy will be renewed except on grounds of misrepresentation / fraud committed.
A grace period of 30 days from the date of expiry of the policy is available for renewal. If renewal is made within this 30 days period the
continuity of benefits will be allowed. However the actual period of cover will start only from the date of payment of premium. In other
words no protection is available between the policy expiry date and the date of payment of premium for renewal.
Every renewal premium (which shall be paid and accepted in respect of this policy) shall be so paid and accepted upon the distinct
understanding that no alteration has taken place in the facts contained in the proposal or declaration herein before mentioned and that
nothing is known to the Insured that may result to enhance the risk of the Company under the insurer.
Where a claim for 100% of the Capital Sum Insured is admitted / admissible, the policy cannot be renewed for such relevant person.
Where a claim for less than 100% of the Sum Insured is admitted / admissible, the Company would exclude such disability on renewal in
respect of such relevant person.
In the event of this policy being withdrawn / modified with revised terms and/or premium with the prior approval of the Competent
Authority, the insured will be intimated three months in advance and accommodated in any other equivalent insurance policy offered by
the Company, if requested for by the Insured Person, at the relevant point of time.
Renewal premium is subject to change with prior approval from the Regulator. Change of options/plans within same product are
permissible only at the time of renewal.
14. Notices: Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or facsimile / email to
Star Health and Allied Insurance Company Limited, No 1, New Tank Street, Valluvar Kottam High Road, Chennai-600034., Toll Free
Fax No.: 1800-425-5522, Toll Free No.:1800-425-2255 / 1800-102-4477, E-Mail : [email protected].

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

15. Customer Service: If at any time the Insured Person requires any clarification or assistance, the Insured may contact the offices of the
Company at the address specified, during normal business hours.
16. Grievances
In case the Insured Person is aggrieved in any way, the Insured may contact the Company at the specified address, during normal
business hours.
Grievance Department : Star Health and Allied Insurance Company Limited, No1, New Tank Street, Valluvar Kottam High Road,
Nungambakkam, Chennai 600034, Phone: 044-28243921 during normal business hours. or Send e-mail to [email protected].
Senior Citizens may Call 044-28243923.
In the event of the following grievances:
a. any partial or total repudiation of claims by an insurer;
b. any dispute regard to premium paid or payable in terms of the policy;
c. any dispute on the legal construction of the policies in so far as such disputes relate to claims;
d. delay in settlement of claims;
e. non-issuance of any insurance document to customer after receipt of the premium.
the Insured Person may approach the Insurance Ombudsman, within whose jurisdiction the branch or office of Star Health and Allied
Insurance Company Limited is located.

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

LIST OF OMBUDSMAN
OFFICE DETAILS JURISDICTION

AHMEDABAD
Office of the Insurance Ombudsman, Gujarat,
6th Floor, Jeevan Prakash Bldg., Near S.V. College, Relief Road, Ahmedabad - 380001. Dadra & Nagar Haveli,
Phone: 079 - 25501201-02-05-06 Email ID : [email protected] Daman and Diu.
Website : www.ecoi.co.in

BENGALURU
Office of the Insurance Ombudsman, Jeevan Soudha Building, PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase,Bengaluru – 560 078. Karnataka.
Tel.: 080 - 26652048 / 26652049
Email:[email protected]

BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market,
Bhopal – 462 003. Madhya Pradesh, Chattisgarh.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 -2769203
Email:[email protected]

BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455 Orissa.
Fax: 0674 -2596429
Email:[email protected]

CHANDIGARH
Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor,
Punjab, Haryana,
Batra Building, Sector 17 –D,Chandigarh – 160 017.
Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468
Jammu & Kashmir, Chandigarh.
Fax: 0172 -2708274
Email:[email protected]

CHENNAI
Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,CHENNAI – 600 018. Tamil Nadu,
Tel.: 044 - 24333668 / 24335284 Pondicherry Town and
Fax: 044 -24333664 Karaikal (which are part of Pondicherry).
Email:[email protected]

DELHI
Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building,
Asaf Ali Road, New Delhi – 110 002. Delhi.
Tel.: 011 - 23239633 / 23237532
Fax: 011 -23230858Email:[email protected]

GUWAHATI
Office of the Insurance Ombudsman, Assam,Meghalaya,Manipur,Mizoram,
Jeevan Nivesh, 5th Floor, Nr. Panbazar over bridge, S.S. Road,Guwahati Arunachal Pradesh,
–781001(ASSAM). Nagaland and Tripura.
Tel.: 0361 - 2132204 / 2132205
Fax: 0361 -2732937
Email:[email protected]

HYDERABAD
Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Court", Lane Opp. Saleem
Andhra Pradesh,Telangana,
Function Palace, A. C. Guards, Lakdi-Ka-Pool,Hyderabad - 500 004.
Yanam and
Tel.: 040 - 65504123 / 23312122
part of Territory of Pondicherry.
Fax: 040 -23376599
Email:[email protected]

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

LIST OF OMBUDSMAN
OFFICE DETAILS JURISDICTION
JAIPUR
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg,Jaipur - 302 005. Rajasthan.
Tel.: 0141 -2740363
Email:[email protected]

ERNAKULAM
Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard,
M. G. Road,Ernakulam - 682 015. Kerala,Lakshadweep,Mahe-
Tel.: 0484 - 2358759 / 2359338 a part of Pondicherry.
Fax: 0484 -2359336
Email:[email protected]
KOLKATA
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor, 4, C.R. Avenue,KOLKATA - 700 072. West Bengal,Sikkim,
Tel.: 033 - 22124339 / 22124340 Andaman & Nicobar Islands.
Fax : 033 -22124341
Email:[email protected]
Districts of Uttar Pradesh : Laitpur, Jhansi,
Mahoba, Hamirpur, Banda, Chitrakoot,
Allahabad, Mirzapur, Sonbhabdra,
LUCKNOW
Fatehpur, Pratapgarh, Jaunpur,Varanasi,
Office of the Insurance Ombudsman,
Gazipur, Jalaun, Kanpur, Lucknow, Unnao,
6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj,
Sitapur, Lakhimpur, Bahraich, Barabanki,
Lucknow - 226 001.
Raebareli, Sravasti, Gonda, Faizabad,
Tel.: 0522 - 2231330 / 2231331
Amethi, Kaushambi, Balrampur, Basti,
Fax: 0522 -2231310
Ambedkarnagar, Sultanpur, Maharajgang,
Email:[email protected]
Santkabirnagar, Azamgarh, Kushinagar,
Gorkhpur, Deoria, Mau, Ghazipur,
Chandauli, Ballia, Sidharathnagar.

MUMBAI
Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road,
Goa,
Santacruz (W), Mumbai - 400 054.
Mumbai Metropolitan Region
Tel.: 022 -26106552 / 26106960
excluding Navi Mumbai & Thane.
Fax: 022 -26106052
Email:[email protected]

State of Uttaranchal and the following

Districts of Uttar Pradesh: Agra, Aligarh,
NOIDA Bagpat, Bareilly, Bijnor, Budaun,
Office of the Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor, Main Road, Bulandshehar, Etah, Kanooj, Mainpuri,
Naya Bans, Sector 15, Distt: Gautam Buddh Nagar,U.P-201301. Mathura, Meerut, Moradabad,
Tel.: 0120 - 2514250 / 2514252 / 2514253 Muzaffarnagar, Oraiyya,
Email:[email protected] Pilibhit, Etawah, Farrukhabad, Firozbad,
Gautambodhanagar, Ghaziabad, Hardoi,
Shahjahanpur,

PATNA
Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna - 800 006. Bihar,Jharkhand.
Tel.: 0612-2680952
Email:[email protected]

PUNE
Office of the Insurance Ombudsman, Maharashtra,
Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Area of Navi Mumbai and Thaneexcl
Peth, Pune – 411 030. uding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email:[email protected]

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

Permanent Total Disablement Table of Benefits B1

Table of Benefits B 1
Benefits Percentage of Sum Insured
1. Permanent Total Disablement : Payable only when the insured person, following accidental 150%
injuries is unable to engage in each and every occupation or employment for compensation
or profit for which he is reasonably qualified by education, training or experience for the rest
of his life. If at the time of loss the insured person is unemployed, Permanent Total Disability
shall mean the total and permanent inability to perform all of the usual and customary
duties and activities of a person of like age and sex even with the use of special equipment
routinely available to help and having taken any appropriate prescribed medication
2. Total and irrevocable loss of
(i) Sight of both eyes 100%
(ii) Physical separation of two entire hands 100%
(iii) Physical separation of two entire foot 100%
(iv) One entire hand and one entire foot 100%
(v) Sight of one eye and loss of one hand 100%
(vi) Sight of one eye and loss of one entire foot 100%
(vii) Use of two hands 100%
(viii) Use of two foot 100%
(ix) Use of one hand and one foot 100%
(x) Sight of one eye and use of one hand 100%
(xi) Sight of one eye and use of one foot 100%
(xii) Sight of one eye 50%
(xiii) Physical separation of one entire hand 50%
(xiv) Physical separation of one entire foot 50%
(xv) Use of one hand without physical separation 50%
(xvi) Use of one foot without physical separation 50%
Loss of foot / hand means total severance through or above the ankle/ wrist joints respectively. Loss of eye means entire and irrevocable
loss of sight. Thumb and index finger means severance through or above the joint that meets the hand at the palm.

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

Permanent Partial Disablement Table of Benefits B 2

Benefits Percentage Of Sum Insured
Loss of toes all All 20
Loss of Great toe both phalanges 5
1 Loss of Great toe one phalanx 2
Other than Great, if more than
One toe lost, for each toe For each toe 1

Loss of hearing both ears Both ears 75

2
Loss of hearing one ear One ear 30
Loss of four fingers and
3 40
thumbs of One hand
Loss of four fingers 35
4 Both phalanges 25
Loss of thumb both phalanges
One phalanx 10
Three phalanges 10
5 Loss of index finger three phalanges Two phalanges 8
One phalanx 4
Three phalanges 6
6 Loss of middle finger Two phalanges 4
One phalanx 2
Three phalanges 5
7 Loss of ring finger Two phalanges 4
One phalanx 2
Three phalanges 4
8 Loss of little finger Two phalanges 3
One phalanx 2
First or second 3
9 Loss of metacarpals Additional(third
fourth or fifth) 2

Any other Permanent Percentage as assessed by the Medical

10 partial disablement Board or by the government doctor

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

Sl. Other Excluded Expenses NOT PAYABLE (HOWEVER

No. 49 DVD, CD CHARGES IF CD IS SPECIFICALLY
TOILETRIES/ COSMETICS/ PERSONAL COMFORT OR SOUGHT THEN PAYABLE)
CONVENIENCE ITEMS 50 EYELET COLLAR NOT PAYABLE
1 HAIR REMOVAL CREAM NOT PAYABLE 51 FACE MASK NOT PAYABLE
BABY CHARGES (UNLESS 52 FLEXI MASK NOT PAYABLE
2 NOT PAYABLE 53 GAUSE SOFT NOT PAYABLE
SPECIFIED/INDICATED)
54 GAUZE NOT PAYABLE
3 BABY FOOD NOT PAYABLE
55 HAND HOLDER NOT PAYABLE
4 BABY UTILITES CHARGES NOT PAYABLE
56 HANSAPLAST/ ADHESIVE BANDAGES NOT PAYABLE
5 BABY SET NOT PAYABLE
57 INFANT FOOD NOT PAYABLE
6 BABY BOTTLES NOT PAYABLE
REASONABLE COSTS
7 BRUSH NOT PAYABLE
FOR ONE SLING IN CASE
8 COSY TOWEL NOT PAYABLE 58 SLINGS OF UPPER ARM
9 HAND WASH NOT PAYABLE FRACTURES WILL BE
CONSIDERED
10 MOISTURISER PASTE BRUSH NOT PAYABLE
11 POWDER NOT PAYABLE ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
12 RAZOR PAYABLE WEIGHT CONTROL PROGRAMS/
59 NOT PAYABLE
13 SHOE COVER NOT PAYABLE SUPPLIES/ SERVICES
14 BEAUTY SERVICES NOT PAYABLE COST OF SPECTACLES/ CONTACT
60 NOT PAYABLE
PAYABLE FOR LENSES/ HEARING AIDS ETC.,
SURGERY OF DENTAL TREATMENT EXPENSES THAT DO
15 BELTS/ BRACES 61 NOT PAYABLE
THORACIC OR NOT REQUIRE HOSPITALISATION
LUMBAR SPINE 62 HORMONE REPLACEMENT THERAPY NOT PAYABLE
16 BUDS NOT PAYABLE 63 HOME VISIT CHARGES NOT PAYABLE
17 BARBER CHARGES NOT PAYABLE INFERTILITY/ SUBFERTILITY/ ASSISTED
64 NOT PAYABLE
18 CAPS NOT PAYABLE CONCEPTION PROCEDURE
19 COLD PACK/HOT PACK NOT PAYABLE OBESITY (INCLUDING MORBID OBESITY)
65 NOT PAYABLE
20 CARRY BAGS NOT PAYABLE TREATMENT IF EXCLUDED IN POLICY
21 CRADLE CHARGES NOT PAYABLE PSYCHIATRIC & PSYCHOSOMATIC
66 NOT PAYABLE
22 COMB NOT PAYABLE DISORDERS
DISPOSABLES RAZORS CHARGES ( for site CORRECTIVE SURGERY FOR
23 PAYABLE 67 NOT PAYABLE
preparations) REFRACTIVE ERROR
24 EAU-DE-COLOGNE / ROOM FRESHNERS NOT PAYABLE TREATMENT OF SEXUALLY
68 NOT PAYABLE
25 EYE PAD NOT PAYABLE TRANSMITTED DISEASES
26 EYE SHEILD NOT PAYABLE 69 DONOR SCREENING CHARGES NOT PAYABLE
27 EMAIL / INTERNET CHARGES NOT PAYABLE 70 ADMISSION/REGISTRATION CHARGES NOT PAYABLE
FOOD CHARGES (OTHER THAN PATIENT's HOSPITALISATION FOR EVALUATION/
28 NOT PAYABLE 71 NOT PAYABLE
DIET PROVIDED BY HOSPITAL) DIAGNOSTIC PURPOSE
29 FOOT COVER NOT PAYABLE E X P E N S E S F O R I N V E S T I G AT I O N /
30 GOWN NOT PAYABLE 72 TREATMENT IRRELEVANT TO THE DISEASE NOT PAYABLE
FOR WHICH ADMITTED OR DIAGNOSED
PAYABLE WHERE
ANY EXPENSES WHEN THE PATIENT IS
31 LEGGINGS SURGERY ITSELF DIAGNOSED WITH RETRO VIRUS + OR
IS PAYABLE. 73 SUFFERING FROM /HIV/ AIDS ETC IS NOT PAYABLE
32 LAUNDRY CHARGES NOT PAYABLE DETECTED/ DIRECTLY OR INDIRECTLY
33 MINERAL WATER NOT PAYABLE
NOT PAYABLE EXCEPT
34 OIL CHARGES NOT PAYABLE STEM CELL IMPLANTATION/ SURGERY BONE MARROW
74 and Storage
35 SANITARY PAD NOT PAYABLE TRANSPLANTATION IF
36 SLIPPERS NOT PAYABLE COVERED BY POLICY
37 TELEPHONE CHARGES NOT PAYABLE ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE
SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE SERVICE IS
38 TISSUE PAPER NOT PAYABLE
39 TOOTH PASTE NOT PAYABLE PAYABLE UNDER OT
75 WARD AND THEATRE BOOKING CHARGES CHARGES, NOT PAYABLE
40 TOOTH BRUSH NOT PAYABLE SEPARATELY
41 GUEST SERVICES NOT PAYABLE
RENTAL CHARGED BY
42 BED PAN NOT PAYABLE THE HOSPITAL PAYABLE.
43 BED UNDER PAD CHARGES NOT PAYABLE 76 ARTHROSCOPY & ENDOSCOPY PURCHASE OF
INSTRUMENTS INSTRUMENTS NOT
44 CAMERA COVER NOT PAYABLE
PAYABLE.
45 CLINIPLAST NOT PAYABLE
PAYABLE UNDER OT
46 CREPE BANDAGE NOT PAYABLE 77 MICROSCOPE COVER CHARGES, NOT
47 CURAPORE NOT PAYABLE SEPARATELY.
48 DIAPER OF ANY TYPE NOT PAYABLE

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

SURGICAL BLADES,HARMONIC PAYABLE UNDER OT CHARGES,

78 ADMINISTRATIVE OR NON-MEDICAL CHARGES
SCALPEL,SHAVER NOT SEPARATELY
PAYABLE UNDER OT CHARGES, 107 ADMISSION KIT NOT PAYABLE
79 SURGICAL DRILL
NOT SEPARATELY 108 BIRTH CERTIFICATE NOT PAYABLE
PAYABLE UNDER OT CHARGES, BLOOD RESERVATION CHARGES AND
80 EYE KIT 109 NOT PAYABLE
NOT SEPARATELY ANTE NATAL BOOKING CHARGES
PAYABLE UNDER OT CHARGES, 110 CERTIFICATE CHARGES NOT PAYABLE
81 EYE DRAPE
NOT SEPARATELY 111 COURIER CHARGES NOT PAYABLE
PAYABLE UNDER RADIOLOGY 112 CONVENYANCE CHARGES NOT PAYABLE
82 X-RAY FILM CHARGES, NOT AS CONSUMABLE
113 DIABETIC CHART CHARGES NOT PAYABLE
PAYABLE UNDER INVESTIGATION DOCUMENTATION CHARGES /
83 SPUTUM CUP CHARGES, NOT AS CONSUMABLE 114 NOT PAYABLE
ADMINISTRATIVE EXPENSES
PART OF OT CHARGES, NOT 115 DISCHARGE PROCEDURE CHARGES NOT PAYABLE
84 BOYLES APPARATUS CHARGES
SEPARATELY
116 DAILY CHART CHARGES NOT PAYABLE
BLOOD GROUPING AND CROSS PART OF COST OF BLOOD, NOT
85 ENTRANCE PASS / VISITORS PASS
MATCHING OF DONORS SAMPLES PAYABLE 117 NOT PAYABLE
CHARGES
Antiseptic or disinfectant lotions NOT PAYABLE-PART OF
86
DRESSING CHARGES TO BE CLAIMED BY
EXPENSES RELATED TO PRESCRIPTION
118 PATIENT UNDER POST
BAND AIDS, BANDAGES, STERLILE NOT PAYABLE-PART OF ON DISCHARGE
87 HOSP IF ADMISSIBLE
INJECTIONS, NEEDLES, SYRINGES DRESSING CHARGES
NOT PAYABLE-PART OF 119 FILE OPENING CHARGES NOT PAYABLE
88 COTTON INCIDENTAL EXPENSES / MISC. CHARGES
DRESSING CHARGES
120 NOT PAYABLE
NOT PAYABLE-PART OF (NOT EXPLAINED)
89 COTTON BANDAGE
DRESSING CHARGES 121 MEDICAL CERTIFICATE NOT PAYABLE
90 MICROPORE/ SURGICAL TAPE NOT PAYABLE 122 MAINTAINANCE CHARGES NOT PAYABLE
91 BLADE NOT PAYABLE 123 MEDICAL RECORDS NOT PAYABLE
NOT PAYABLE-PART OF HOSPITAL 124 PREPARATION CHARGES NOT PAYABLE
92 APRON SERVICES / DISPOSABLE LINEN 125 PHOTOCOPIES CHARGES NOT PAYABLE
TO BE PART OF OT/ICU CHARGES
PATIENT IDENTIFICATION BAND / NAME
126 NOT PAYABLE
NOT PAYABLE(SERVICE IS TAG
CHARGED BY HOSPITALS,
93 TORNIQUET 127 WASHING CHARGES NOT PAYABLE
CONSUMABLES CANNOT BE
SEPARATELY CHARGED) 128 MEDICINE BOX NOT PAYABLE

94 ORTHOBUNDLE, GYNAEC BUNDLE PART OF DRESSING CHARGES PAYABLE UPTO 24 HRS,

129 MORTUARY CHARGES SHIFTING CHARGES NOT
95 URINE CONTAINER NOT PAYABLE PAYABLE
ELEMENTS OF ROOM CHARGE MEDICO LEGAL CASE CHARGES (MLC
130 NOT PAYABLE
ACTUAL TAX LEVIED BY CHARGES)
GOVERNMENT IS PAYABLE. PART
96 LUXURY TAX EXTERNAL DURABLE DEVICES
OF ROOM CHARGE FOR SUB
LIMITS 131 WALKING AIDS CHARGES NOT PAYABLE
PART OF ROOM CHARGE NOT 132 BIPAP MACHINE NOT PAYABLE
97 HVAC
PAYABLE SEPARATELY 133 COMMODE NOT PAYABLE
PART OF ROOM CHARGE NOT 134 CPAP/ CAPD EQUIPMENTS DEVICE NOT PAYABLE
98 HOUSE KEEPING CHARGES
PAYABLE SEPARATELY
135 INFUSION PUMP – COST DEVICE NOT PAYABLE
SERVICE CHARGES WHERE PART OF ROOM CHARGE NOT
99 OXYGEN CYLINDER (FOR USAGE OUTSIDE
NURSING CHARGE ALSO CHARGED PAYABLE SEPARATELY 136 NOT PAYABLE
THE HOSPITAL)
TELEVISION & AIR CONDITIONER PAYABLE UNDER ROOM CHARGES
100
CHARGES NOT IF SEPARATELY LEVIED 137 PULSEOXYMETER CHARGES DEVICE NOT PAYABLE
PART OF ROOM CHARGE NOT 138 SPACER NOT PAYABLE
101 SURCHARGES
PAYABLE SEPARATELY 139 SPIROMETRE DEVICE NOT PAYABLE
NOT PAYABLE-PART OF ROOM 140 SPO2 PROBE NOT PAYABLE
102 ATTENDANT CHARGES
CHARGES
141 NEBULIZER KIT NOT PAYABLE
PART OF NURSING CHARGES,
103 IM IV INJECTION CHARGES 142 STEAM INHALER NOT PAYABLE
NOT PAYABLE
143 ARMSLING NOT PAYABLE
PART OF LAUNDRY/HOUSEK
104 CLEAN SHEET EEPING NOT PAYABLE NOT PAYABLE
144 THERMOMETER
SEPARATELY (PAID BY PATIENT)
145 CERVICAL COLLAR NOT PAYABLE
EXTRA DIET OF PATIENT(OTHER
PATIENT DIET PROVIDED BY 146 SPLINT NOT PAYABLE
105 THAN THAT WHICH FORMS PART HOSPITAL IS PAYABLE
OF BED CHARGE) 147 DIABETIC FOOT WEAR NOT PAYABLE
NOT PAYABLE-PART OF ROOM 148 KNEE BRACES ( LONG/ SHORT/ HINGED) NOT PAYABLE
106 BLANKET/WARMER BLANKET
CHARGES KNEE IMMOBILIZER/SHOULDER
149 NOT PAYABLE
IMMOBILIZER

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

ESSENTIAL AND WILL BE PAID 171 ZYTEE GEL PAYABLE WHEN PRESCRIBED
SPECIFICALLY FOR CASES
ROUTINE VACCINATION NOT
WHO HAVE UNDERGONE
150 LUMBO SACRAL BELT 172 VACCINATION CHARGES PAYABLE/POST BITE
SURGERY OF LUMBAR SPINE IF
VACCINATION PAYABLE
SURGERY IS COVERED
PART OF HOSPITAL’S OWN COSTS AND NOT PAYABLE
PAYABLE FOR ANY ICU PATIENT
REQUIRING MORE THAN 3 NOT PAYABLE-
DAYS IN ICU, ALL PATIENTS 173 AHD PART OF HOSPITAL’S
NIMBUS BED OR WATER OR AIR BED WITH PARAPLEGIA/ INTERNAL COST
151 QUADRIPLEGIA FOR ANY
CHARGES NOT PAYABLE-PART OF
REASON AND AT REASONABLE 174 ALCOHOL SWABES HOSPITAL’S INTERNAL COST
COST OF APPROXIMATELY
RS.200/DAY NOT PAYABLE-PART OF
175 SCRUB SOLUTION/STERILLIUM
HOSPITAL’S INTERNAL COST
152 AMBULANCE COLLAR NOT PAYABLE
OTHERS
153 AMBULANCE EQUIPMENT NOT PAYABLE
176 VACCINE CHARGES FOR BABY NOT PAYABLE
154 MICROSHEILD NOT PAYABLE
177 AESTHETIC TREATMENT / SURGERY NOT PAYABLE
ESSENTIAL AND SHOULD BE
PAID IN POST SURGERY 178 TPA CHARGES NOT PAYABLE
PATIENTS OF MAJOR 179 VISCO BELT CHARGES NOT PAYABLE
ABDOMINAL SURGERY
ANY KIT WITH NO DETAILS
INCLUDING TAH, LSCS,
155 ABDOMINAL BINDER INCISIONAL HERNIA REPAIR, 180 MENTIONED [DELIVERY IT,ORTHOKIT, NOT PAYABLE
RECOVERY KIT, ETC]
EXPLORATORY LAPAROTOMY
FOR INTESTINAL
OBSTRUCTION, LIVER 181 EXAMINATION GLOVES NOT PAYABLE
TRANSPLANT ETC. 182 KIDNEY TRAY NOT PAYABLE
183 MASK NOT PAYABLE
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
184 OUNCE GLASS NOT PAYABLE
BETADINE \ HYDROGEN PEROXIDE\
156 NOT PAYABLE OUTSTATION CONSULTANT'S/
SPIRIT\DISINFECTANTS ETC 185 NOT PAYABLE
SURGEON'S FEES
BETADINE \ HYDROGEN PEROXIDE\
156 NOT PAYABLE 186 OXYGEN MASK NOT PAYABLE
SPIRIT\DISINFECTANTS ETC
187 PAPER GLOVES NOT PAYABLE
PRIVATE NURSES CHARGES- POST HOSPITALIZATION
157 SPECIAL NURSING CHARGES NURSING CHARGES NOT SHOULD BE PAYABLE IN CASE
PAYABLE OF PIVD REQUIRING TRACTION
188 PELVIC TRACTION BELT
AS THIS IS GENERALLY NOT
NUTRITION PLANNING CHARGES - PATIENT DIET PROVIDED BY
158 REUSED
DIETICIAN CHARGES-DIET CHARGES HOSPITAL IS PAYABLE
189 REFERAL DOCTOR'S FEES NOT PAYABLE
PAYABLE-SUGAR FREE
VARIANTS OF ADMISSIBLE NOT PAYABLE PRE
159 SUGAR FREE Tablets MEDICINES ARE NOT HOSPITALIZATION OR POST
EXCLUDED 190 ACCU CHECK ( Glucometery/ Strips) HOSPITALIZATION/ REPORTS
AND CHARTS REQUIRED/
CREAMS POWDERS LOTIONS DEVICE NOT PAYABLE
(TOILETERIES ARE NOT PAYABLE,
PAYABLE WHEN PRESCRIBED
160 ONLY PRESCRIBED MEDICAL 191 PAN CAN NOT PAYABLE
PHARMACEUTICALS PAYABLE)
192 SOFNET NOT PAYABLE
PAYABLE WHEN 193 TROLLY COVER NOT PAYABLE
161 Digestion gels
PRESCRIBED 194 UROMETER, URINE JUG NOT PAYABLE

UPTO 5 ELECTRODES ARE PAYABLE-AMBULANCE

REQUIRED FOR EVERY CASE FROM HOME TO HOSPITAL OR
VISITING OT OR ICU, FOR 195 AMBULANCE INTERHOSPITAL SHIFTS IS
LONGER STAY IN ICU, MAY PAYABLE/RTA AS SPECIFIC
162 ECG ELECTRODES REQUIREMENT IS PAYABLE
REQUIRE A CHANGE AND AT
LEAST ONE SET EVERY
PAYABLE-MAXIMUM OF 3 IN
SECOND DAY MUST BE 196 TEGADERM / VASOFIX SAFETY 48 HRS AND THEN 1 IN 24 HRS
PAYABLE.
STERILIZED GLOVES PAYABLE WHERE MEDICALLY
PAYABLE/UNSTERILIZED NECESSARY TILL A
163 GLOVES 197 URINE BAG
GLOVES NOT PAYABLE REASONABLE COST-MAXIMUM
1 PER 24 HRS
PAYABLE - PAYABLE PRE
164 HIV KIT 198 SOFTOVAC NOT PAYABLE
OPERATIVE SCREENING
165 LISTERINE/ ANTISEPTIC MOUTHWASH PAYABLE WHEN PRESCRIBED ESSENTIAL FOR CASE LIKE
199 STOCKINGS CABG ETC, WHERE IT SHOULD
166 LOZENGES PAYABLE WHEN PRESCRIBED BE PAID
167 MOUTH PAINT PAYABLE WHEN PRESCRIBED
IF USED DURING
168 NEBULISATION KIT HOSPITALIZATION IS PAYABLE
REASONABLY
169 NOVARAPID PAYABLE WHEN PRESCRIBED
170 VOLINI GEL/ ANALGESIC GEL PAYABLE WHEN PRESCRIBED

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Star Health and Allied Insurance Co. Ltd. Policy Wordings

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POL / ACI / V.5 / 2017 - 18

Health
Personal & Caring Insurance
The Health Insurance Specialist

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