ii) This benefit will not be applicable where the sanction is on package rates Unlimited Restoration – illustration

iii) Insured stay in Intensive Care Unit or High Dependency Units / wards will not be If there are 2 insured members with Sum Insured of 10 Lacs each, lets understand
counted for this purpose how restoration benefit will apply to each under different circumstances.
23. AYUSH Treatment: Medical expenses for Inpatient Hospitalization incurred on Insured 1 Insured 2
treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in a Sum Insured Rs.10,00,000 Rs.10,00,000
AYUSH Hospital is payable up to the sum insured.
Note No Claim Bonus (NCB) 0 Rs.5,00,000
i. Yoga and Naturopathy systems of treatments are excluded from the scope of Rs.15,00,000
coverage under AYUSH treatment Total Available amount Rs.10,00,000 (Sum Insured 10 Lac +
24. Second Medical Opinion: The Insured Person can obtain a Second Medical Opinion NCB 5 Lac)
from a Doctor in the Company's network of Medical Practitioners. All the medical 1st Claim Rs.5,00,000 Rs.5,00,000
records provided by the Insured Person will be submitted to the Doctor chosen by Claim paid amount Rs.5,00,000 Rs.5,00,000
him/her online and the medical opinion will be made available directly to the Insured
by the Doctor. To utilize this benefit, all medical records should be forwarded to the Will the restoration
1st Claim Rs.5,00,000
kick in? Rs.5,00,000
mail-id e_medicalopinion@starhealth.in or through Post/Courier. (Restored
Yes, Why - Since there (Restored
Special Conditions:- is partial utilization of Sum Insured) Sum Insured)
· This should be specifically requested for by the Insured Person Sum Insured.
· This opinion is given based only on the medical records submitted without Rs.15,00,000
Rs.10,00,000
examining the patient, (Restored SI 5Lac +
Available amount for next claim (Restored SI 5Lac +
· The second opinion should be only for medical reasons and not for medico-legal Balance SI 5Lac+
Balance SI 5Lac)
purposes. NCB 5L)
· Any liability due to any errors or omission or consequences of any action taken in 2nd Claim (For Same /
Rs.15,00,000 Rs.15,00,000
reliance of the second opinion provided by the Medical Practitioner is outside the different illness)
scope of this policy. Claim paid amount Rs.10,00,000 Rs.15,00,000
· Utilizing this facility alone will not amount to making a claim 2nd Claim Will the restoration
Note: Medical Records / Documents submitted for utilizing this facility will not kick in? Rs.10,00,000 Rs.10,00,000
prejudice the Company's right to reject a claim in terms of policy. Yes, Why - Since there (Restored (Restored
is full utilization of Sum Sum Insured) Sum Insured)
25. Coverage for Modern Treatment: The following procedures will be covered Insured.
(wherever medically indicated)either as in patient or as part of day care treatment in a
hospital upto sum insured (including Pre and Post hospitalization expenses) during Rs.10,00,000 Rs.10,00,000
the policy period; Available amount for next claim (SI is Restored (SI is Restored
a) Uterine artery Embolization and HIFU up to 100%) up to 100%)
b) Balloon Sinuplasty 3rd Claim
(For Same / Rs.11,00,000 Rs.11,00,000
c) Deep Brain Stimulation
different illness)
d) Oral Chemotherapy
Claim paid amount Rs.10,00,000 Rs.10,00,000
e) Immunotherapy- Monoclonal Antibody to be given as injection 3nd Claim
f) Intra Vitreal injections Will the restoration
kick in? Rs.10,00,000 Rs.10,00,000
g) Robotic surgeries Yes, Why - Since there (Restored (Restored
h) Stereotactic radio surgeries is full utilization of Sum Sum Insured) Sum Insured)
i) BronchicalThermoplasty Insured.
j) Vaporisation of the prostate (Green laser treatment or holmium laser treatment)
28. Rehabilitation and Pain Management: The company will pay the medical expenses
k) IONM-(Intra Operative Neuro Monitoring) for Rehabilitation and Pain Management up to the sub-limit (or) maximum up to 20%
l) Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for of the sum insured whichever is less, per policy year.
haematological conditions Rehabilitation: The company will pay the expenses for rehabilitation, if availed at
26. Cumulative Bonus: The insured person will be eligible for Cumulative bonus authorized centres as an In-patient/Out-patient, and if there is an admissible claim for
In-patient hospitalization for an injury, disease or illness specified below.
calculated at 25% of sum insured for each claim free year and maximum up to 100% of
1. Poly Trauma
the sum insured
2. Head injury
Special Conditions
3. Diseases of the spine
1. The Cumulative bonus will be calculated on the expiring Sum Insured
4. Stroke
2. If the insured opts to reduce the Sum Insured at the subsequent renewal, the limit
of indemnity by way of such Cumulative bonus shall not exceed such reduced Pain Management treatment
sum insured Name of the covered pain management Sub-limits (Per Policy year)
3. In the event of a claim resulting in; S.No. treatment (Rs.)
a. Partial utilization of Sum Insured, such cumulative bonus so granted will not
Sum Insured (Rs in Lac) 5 / 10 / 15 / 20 25 & Above
be reduced
b. Full utilization of Sum Insured and nil utilization of cumulative bonus Lumbar and cervical medial branch block with
accrued, such cumulative bonus so granted will not be reduced 1 RF ablation for lumbar and cervical facet joint 65,000/- 75,000/-
c. Full utilization of Sum Insured and partial utilization of cumulative bonus arthritis
accrued, the cumulative bonus granted on renewal will be the balance 2 Caudal epidural injection for Discogenic pain 40,000/- 50,000/-
cumulative bonus available and will be reduced at the same rate at which it Lumbar and cervical selective nerve root
has accrued 3 50,000/- 60,000/-
block for Lumbar and Cervical radicular pain
d. Full utilization of Sum Insured and full utilization of cumulative bonus Caudal Neuroplasty for Failed back spine
accrued, the cumulative bonus on renewal will be “nil” 4 85,000/- 1,00,000/-
surgery
27. Automatic Restoration of Sum Insured: The policy provides automatic restoration 5 Stellate ganglion ablation for upper limb CRPS 65,000/- 75,000/-
of sum insured subject to the following condition;
Occipital nerve Pulsed RF lesioning for
· Sum Insured will be restored unlimited number of times and maximum up to
6 Migraines, Cluster headache and cervicogenic 65,000/- 75,000/-
100% each time, which can be utilized for a subsequent hospitalization.
headaches
· The restoration will trigger immediately upon partial/ full utilization of the sum Lumbar sympathetic chain RF ablation for
insured, which can be utilized for a subsequent hospitalization. 7 lower limb CRPS,diabetic periphery painful 65,000/- 75,000/-
· On partial utilization of the Sum Insured, it will be restored up to extent of neuropathy and Ischaemic limb pain
utilization. Gasserian ganglion ablation for Trigeminal
8 65,000/- 75,000/-
· On full utilization of the Sum Insured, it will be restored to 100%. neuralgia
· The Restored Sum Insured can be used for all claims including for modern Intercostal nerve Ablation for post thoracotomy
9 65,000/- 75,000/-
treatment, but for a subsequent hospitalization. pain and Thoracic malignancy pain
· The maximum payable amount for a single claim under restoration benefit shall Coeliac plexus ablation for upper gastrointestinal
10 65,000/- 75,000/-
not be more than the Sum Insured. malignancies pain
Star Health Assure Insurance Policy Unique Identification No.: SHAHLIP23131V022223 POL / SHA / V.7 / 2023 8 of 20