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    Co-Payment, Waiting Periods & Exclusions-1

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    pranjalmajumdar24
    The document contains information about waiting periods and exclusions for various health insurance plans. 1) Waiting periods for pre-existing diseases range from 1 to 4 years depending on the plan, while waiting periods for common ailments and surgeries like hernia and piles is 2 years. 2) Co-payment percentages range from 5% to 30% depending on the entry age and plan. 3) Common exclusions include dental treatment, cosmetic procedures, injuries due to alcohol/drugs, and pre-existing diseases for the first 48 months.

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    Co-Payment, Waiting Periods & Exclusions-1

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    pranjalmajumdar24
    4 views7 pages
    The document contains information about waiting periods and exclusions for various health insurance plans. 1) Waiting periods for pre-existing diseases range from 1 to 4 years depending on the plan, while waiting periods for common ailments and surgeries like hernia and piles is 2 years. 2) Co-payment percentages range from 5% to 30% depending on the entry age and plan. 3) Common exclusions include dental treatment, cosmetic procedures, injuries due to alcohol/drugs, and pre-existing diseases for the first 48 months.

    Original Description:

    Star Healh Waiting Periods and Exclusions as per different Policy Schemes

    Original Title

    Co-payment,waiting periods & Exclusions-1

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    The document contains information about waiting periods and exclusions for various health insurance plans. 1) Waiting periods for pre-existing diseases range from 1 to 4 years depending on the plan, while waiting periods for common ailments and surgeries like hernia and piles is 2 years. 2) Co-payment percentages range from 5% to 30% depending on the entry age and plan. 3) Common exclusions include dental treatment, cosmetic procedures, injuries due to alcohol/drugs, and pre-existing diseases for the first 48 months.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    4 views7 pages

    Co-Payment, Waiting Periods & Exclusions-1

    Uploaded by

    pranjalmajumdar24
    The document contains information about waiting periods and exclusions for various health insurance plans. 1) Waiting periods for pre-existing diseases range from 1 to 4 years depending on the plan, while waiting periods for common ailments and surgeries like hernia and piles is 2 years. 2) Co-payment percentages range from 5% to 30% depending on the entry age and plan. 3) Common exclusions include dental treatment, cosmetic procedures, injuries due to alcohol/drugs, and pre-existing diseases for the first 48 months.

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    of 7

    PED WAITING

    PLAN NAMES WAITING PERIODS

    FAMILY HEALTH OPTIOMA, 48 MONTHS(4 YEARS)


    MEDICLASSIC, HEALTH GAIN,
    AROGYA SANJIVANI
    COMPREHENSIVE 36 MONTHS(3YEARS),IN BUY BACK
    OPTION PED 1 YR
    RED CARPET(SR.CITIZEN), SUPER 12 MONTHS(1YEAR)
    SURPLUS, YOUNG STAR
    STAR ASSURE 36 MONTHS,IN CASE OF 3YRS
    ADVANCE PREMIUM WAITING
    PERIOD REDUCE TO TWO & HALF
    YRS
    WOMEN CARE 24 MONTHS(2 YEARS)

    CO-PAY
    PLAN NAMES CO-PAY PERCENTAGE
    FAMILY HEALTH OPTIMA 20 % CO-PAYMENT FOR 61 AND
    ABOVE ENTRY AGE
    AROGYA SANJIVANI FLAT 5% FOR ANY AGE
    RED CARPET (SR.CITIZEN) 30% CO PAY FOR ALL CLAIMS

    COMPREHENSIVE, MEDICLASSIC, 10% CO-PAYMENT FOR 61 AND


    SUPER SURPLUS, HEALTH GAIN ABOVE ENTRY AGE
    STAR ASSURE 10% CO-PAYMENT FOR 61 AND
    ABOVE ENTRY AGE
    WOMEN CARE NO CO PAYMENT FOR ANY AGE

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    COMMON EXCLUSIONS

    FIRST 30 DAYS WAITING FOR ANY DISEASE / ILLNESS OTHER THAN CAUSED BY
    AN ACCIDENT.

    24 MONTHS WAITING FOR FIXED DISEASES / ILLNESS


    1. HERNIA
    2. FISTULA/ FISSURE
    3. PILES
    4. HYDROCELE
    5. ANY CALCULI OR STONE OF GALL BLADDER / KIDNEY / URINARY TRACT
    6. ANY TYPES OF BENIGN CYST / TUMOURS
    7. ULCERS
    8. PROSTATE DISEASES
    9. THYROID DISEASES
    10. CATARACT
    11. TONSILECTOMY / SINUSITIS
    12. ANY ENT PROBLEMS
    13. DISEASE OF BONES/ JOINTS/ LIGAMENTS/ VERTEBRAL DISC
    (EXCEPT ACCIDENTAL)
    14. GYNECOLOGICAL PROBLEMS
    15. ALL TYPES OF ORGAN TRANSPLANT AND RELATED SURGERIES
    16. ALL OBSTRUCTIVE UROPATHIES
    17. PANCRIATIC PROBLEMS
    18. STRESS INCONTINENCE AND CONGINETAL INTERNAL DISEASE/ DEFFECTS

    MORE DETAILS ABOUT BENEFITS AND EXCLUSIONS CHECK POLICY BROCHURE/PROSPECTUS

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    First 2 Years Waiting Period
    Common Types of Hernia

    Tonsils Gall Stone Renal Stone

    First 2 Years Waiting Period

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    Degenrative Disc Varicose Veins Varicose Ulcers
    First 2 Years Waiting Period

    Vertebral Diseases Prolaspse of Intervertebral Disc


    Cholesteatoma Ossicles

    Deviated Nasal Septum Haemorrhoids Chronic Supparative Otitis Media

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    First 2
    Years
    Waiting modenal
    common
    Obstruction

    Neural

    Period
    Trachea

    Compressed lung

    Compressed heartBowel

    Inflammation Uterus Related


    Cogenital Internal Pancreatic Stones Disorders
    Disease

    Arthroscopic Benign Prostate


    Repair/RemovaI Hydrocele Hypertrophy
    Pre-Existing Covered After 4 Years of
    Continuous
    Diseases Renewal With Company
    First30 Days Any thing apart from Accident
    Waiting Period covered after 30 Days

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    Permanent exclusions
    • Dental Treatment (Apart from accident & If
    mentioned in Policy)
    • Pure Diagnostic tests
    • Run Down / General Weakness, etc..
    • Bodily Injury I illness Under Influence of Alcohol I
    Durgs & Against Law
    • Cosmetic Treatments Including Refractive Error or Lasik
    Operation
    • Treatment For Weight Loss

    Please read Policy wordings for detailed list of


    Exclusions

    When will my Mediclaim Policy Cover


    Start
    Accident Related FROM DAY 1
    Surgical (Newly Diagnosed Critical AFTER 30
    illness) DAYS
    Non-Surgical (Eg : Dengue, Jaundice, AFTER 30
    Malaria, Typhoid etc.. DAYS
    Other Surgery Such as Piles, Hernia AFTER 24 Months
    etc...
    All Pre-Existing Diseases ( Diseases
    which you or yr family member have AFTER48
    before buying mediclaim policy
    Months
    "RELATED TO" or " CAUSING DUE TO
    Suicide, Cosmetic, Alcohol, Tabacco, Against NO CLAIM IS
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    Law, Pure Diagnostic, Daily Medicine, Weight PAYABLE
    Loss, Lasik, Dental, General Weakness

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