Launch of Super Star Health Insurance Policy w.e.

f 07/12/2024, on Atom portal, we

are herewith attaching the Operational Instructions and One pager containing the
product specification.

Kindly communicate the contents to all concerned.

Type of Policy:
 Individual policy
 Floater policy

Entry Age
a. Floater Sum Insured
 For Adults – Minimum - 18 years & Maximum – Any age
 For Dependent Children - Minimum – 91 days & Maximum - Up to 25 years
b. Individual Sum Insured
 Minimum – 18 years & Maximum - Any age.
Under Floater Sum Insured, Family means: Self + Spouse / Live-in Partner +
Dependent Children
Maximum Family Size Covered under Floater Policy: 2 Adults + 4 Children
Policy Term: One year / Two year / Three year
Note: Where the policy is issued for more than 1 year, the Sum Insured including
sub-limits are without any carry over benefit thereof.

Long term discount:

- 10% discount is available on 2nd year premium
- 12.5% discount is available on 3rd year premium
Note: Long term discount will not be available, if premium is paid in instalment mode.
Installment Facility: Premium can be paid in Monthly, Quarterly, Half-yearly and
Yearly. Premium can also be paid on Single Payment basis.
In case of installment mode of payment, there will be loading on annual premium as
given below:
 Monthly: 4%
 Quarterly: 3%
 Half Yearly: 2%
 Yearly: 0%
Sum Insured Options:10,00,000/-, Rs.15,00,000/-, Rs.20,00,000/-,
Rs.25,00,000/-,Rs.50,00,000/-, Rs.1,00,00,000/- & Unlimited Sum Insured
Note: SI options 1 Crore & Unlimited can be offered only up to 65 years’ age, this
condition is applicable at the time of inception of the policy

Zone wise premium – Applicable_3 Zones

Medical Underwriting / Pre-Policy Medical Check-up: The company may ask the
members to be proposed to undergo medical underwriting either through medical
tests or any other medium viz tele underwriting etc. This will vary/depend upon the
Sum Insured/ Medical History/ Zone/Age and covers chosen
If we accept the proposal, we will reimburse at least 50% of the costs incurred by the
member undertaking such Pre-Policy medical check-up.

Waiting Period:

 Initial waiting period of 30 Days (other than accidents)

 24 months waiting period for specified diseases
 36 months waiting period for Pre-existing diseases.

Optional Cover’s Reducing Waiting Periods

 Quick Shield: Notwithstanding anything to the contrary in the Policy, If
Insured Person has PED (Pre-Existing Disease) related to the list of
Diseases/illnesses/Conditions mentioned below at the time of issuance of first
Policy with the Company, then by choosing this Optional cover, the applicable
PED (Pre-Existing Disease) waiting period shall be waived off and coverage
will be available from 31st day of first purchase of this policy under In-patient
Day Care Treatment. Offering Quick shield is subject to the response to
proposal form questions and Underwriter’s approval

o Diabetes
o Hypertension
o Asthma
o Hyperlipidaemia
o Coronary Artery Disease with PTCA done prior to 1 Year

 Reduction of Pre-Existing Diseases Waiting Period (Other than those

listed under Quick Shield - if opted): The Insured Person can reduce the
Pre-Existing Disease/s waiting period from 36 months to 12 months / 24
months. This option is available only for the first purchase of this policy and
 also only upto Sum Insured chosen at that time. This option is not available
for renewal / ported / migrated policies. Offering reduction of Pre-Existing
Diseases waiting period is subject to Underwriter’s approval.
 Reduction of Specified disease / procedure Waiting Period: The Insured
Person can reduce the Specified disease /procedure waiting period from 24
months to 12 months. This option is available only for the first purchase of this
policy and also only upto Sum Insured chosen at that time. This option is not
available for renewal / ported / migrated policies. Offering reduction of
Specified disease / procedure waiting period is subject to Underwriter’s
approval.

Long term discount: available

Instalment Option: available
List of discounts
 Discount on Parents / Parent-in-laws Policy:
 Early Renewal Discount:

List of Optional Covers:

1. Smart Network
2. Quick shield: Medical Underwriting Required
3. Coverage for Non-Medical Items : (Consumables cover Table I (68 items))
4. Future Shield: Medical Underwriting Required (If Ped is disclosed)
5. Maternity Expenses
6. Women Care: Medical Underwriting Required
7. High-end Diagnostics: Medical Underwriting Required (If Ped is disclosed)
8. Personal Accident Cover: Medical Underwriting Required (If Ped is
disclosed) and Financial Underwriting is required if Sum Insured opted is more
than Rs.25 Lakh
For earning member – Sum Insured limit is up to Two times of basic indemnity sum
insured subject to maximum of Rs. 2 Crore.
For dependent spouse - Up to 50% of earning spouse SI (or) Max Up to Rs.15 Lakh;
Entry Age - From 18 years to 65 years and renewal is available up to 75 years.
9. Annual Health Check-up
10. Voluntary Co-payment
11. Voluntary Deductible
12. Room Rent Modification
13. E- International Second Opinion
14. Durable Medical Equipment Cover: (Lifetime limit of Rs 5Lakh)
15. Compassionate Visit
16. Hospital Cash: Medical Underwriting Required (If Ped is disclosed)
 17. Reduction of Specific Diseases Waiting Period: Medical Underwriting
Required,
18. Reduction of Pre-Existing Diseases Waiting Period Other than those listed
under Quick shield if opted Medical Underwriting Required.
(Quick shield and Reduction of PED Waiting period (from 36 months to 12
months) will be available for the persons aged up to 65 years only)
19. Limitless Care: Medical Underwriting Required (If Ped is disclosed)
20. Super Star Bonus: Medical Underwriting Required (If Ped is disclosed)

Enhancement of sum insured:

Enhancement of sum insured is permissible only at the time of renewal. Both the
acceptance and denial of enhancement request will be at the discretion of the
Company. Policies where PED and / or Claim is available then those cases
should be referred to CMU through “Sum Insured enhancement workflow” for
getting approval.

Televerification & Zonal Underwriting Audit Process: Applicable

Medical Underwriting Loading: Company may apply a risk loading on the

premium payable (based upon the declarations made in the proposal form and
the health status of the persons proposed for insurance).
i. The maximum risk loading applicable for an individual shall not exceed
above 125% per diagnosis / medical condition and an overall risk loading up to
200% per insured person.
ii. This loading is applied from the Commencement Date of the Policy
including subsequent renewal(s) with the Company
Pre acceptance Medical tests: (post IT enablement)
Medical Grid for Proposals with Unlimited SI (with or without PED)
Age 1 Crore Unlimited SI
18- 45 Years No Medical Test Tele- U/W (CMU)

46 - 65 Years Medical Examination Medical Examination

Report (MER), HBsAg, Report (MER),
HIV, Anti HCV HBsAg, HIV, Anti
antibody, TCHOL, HCV antibody,
HDL, TMT, 2 D Echo, TCHOL, HDL, TMT, 2
S. Creatinine, USG D Echo, S.
whole abdomen Creatinine, USG
whole abdomen