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EXECUTIVE SUMMARY

Study Period :- 01 January to 12 march 2009.


Place of Study :- Star Health & Allied Insurance om!any
As the nation is de"elo!in# at a much hi#her s!eed than $hat $as e%!ected nearly 2 & '
decades a#o( is )rin#in# in sedentary life style #i"in# rise to o)esity related disorders. So the demand
for !ro!er tertiary care hos!itals is also #oin# u!. *his )rin#s $ith them hi#h amount of out-of !oc+et
e%!enses.
In the li#ht of !resent healthcare cost it is im!ossi)le to )ear the cost out-of !oc+et(
$hich #i"es a ma,or set )ac+ in terms of financial )urden to the earnin# mem)er of the family. So
insurin# healthcare is the )est !ossi)le $ay out.
Around a decade earlier healthcare !ortfolio $as not #i"en much im!ortance. -"en the
#eneral insurance com!anies thin+ it as a )leedin# !ortfolio. .ut no$ !eo!le are more a$are of its
)enefits and are o!tin# for it. As the a$areness is #oin# u! mal!ractices are also #oin# u!( cases of
moral ha/ards are "ery common and hence there is as need of strict medical & non medical under$ritin#
#uidelines $hich $ill )e user friendly and com!ati)le $ith today0s fast mo"in# $orld( $hich can )e
enhanced throu#h $e) ser"ices and alerts.
1y !ro,ect mainly focuses on the com!arison )et$een under$ritin# #uidelines of
different !roduct lines in a !ri"ate sector 2only health insurance om!any3 and a !u)lic sector com!any
2#eneral insurance com!any3. *heir S45* analysis !ertainin# to the restricted #eo#ra!hical area. 4ays
and means throu#h $hich the $or+flo$ can )e enhanced ta+in# the hel! of $e) ser"ices and alerts.

FINDINGS:-
1. *here is a "ast difference in under$ritin# #uidelines of the t$o com!anies.
2. *here is much sco!e to im!ro"ise in the under$ritin# #uidelines of )oth the
com!anies ma+in# them more users friendly.
'. *he com!anies should )e more "i#ilant re#ardin# the dis)ursement of claims as
mal!ractices are "ery common in this sector.
6. 1ore stress should )e #i"en on e"en distri)ution of ris+ amon#st !o!ulation
)oth in rural and ur)an area )y effecti"e cam!ai#nin# and creatin# a$areness.
7. *here is "ast #a! )et$een the demand and need of the health insurance in the
society $hich should )e su!!lied effecti"ely.
8. Peo!le tend to a"ail health insurance in second half of their life. 9oun#er a#e
#rou! should )e encoura#ed more and more to a"ail this facility instead of a
relati"ely a#ed #rou!.
:. A !ro!er health care system should )e im!lemented nation$ide )y ta+in#
e%am!les of other nations.

TABLE OF CONTENTS
.ac+#round
Introduction to Insurance
Health are Insurance Scenario
Star Health & Allied Insurance om!any
5),ecti"es of the study
1ethodolo#y
;imitations of Study
<e"ie$ of literature
=ey >indin#s durin# study in Star Health Insurance & Allied om!any
=ey >indin#s durin# study in ?e$ India Assurance om!any
=ey >indin#s durin# inter"ie$in# the selected !olicy holders
Some #eneral Inter!retation
S45* Analysis
<ecommendations & Su##estions
onclusion
Anne%ure-
A- Questionnaire for selected policy holders
B- Brochures explaining policy benefits to customer

C- Questionnaire for sales managers

INTRODUCTION TO INSURANCE
Definition:-
Insurance is defined as the e@uita)le transfer of the ris+ of a loss( from one entity to another( in
e%chan#e for a !remium( and can )e thou#ht of as a #uaranteed small loss to !re"ent a lar#e( !ossi)ly
de"astatin# loss.
Insurance a!!ears simultaneously $ith the a!!earance of human society. 4e +no$ of t$o ty!es
of economies in human societies:
Money Economie
4ith mar+ets( money( financial instruments and so on........
Non-Money O! N"t#!"$ Economie
4ithout money( mar+ets( financial instruments and so on........
*he second ty!e is a more ancient form than the first. In such an economy and community( $e
can see insurance in the form of !eo!le hel!in# each other. >or e%am!le( if a house )urns do$n( the
mem)ers of the community hel! )uild a ne$ one. Should the same thin# ha!!en to oneAs nei#h)or( the
other nei#h)ors must hel! 5ther$ise( nei#h)ors $ill not recei"e hel! in the future. *his ty!e of
insurance has sur"i"ed to the !resent day in some countries $here modern money economy $ith its
financial instruments is not $ides!read.
>or -%am!le:- ountries in the territory of the former So"iet Bnion.
*urnin# to insurance in the modern sense 2i.e.( insurance in a modern money economy( in $hich
insurance is !art of the financial s!here3( early methods of transferrin# or distri)utin# ris+ $ere !racticed

)y hinese and .a)ylonian traders as lon# a#o as the 'rd and 2nd millennia .( res!ecti"ely. hinese
merchants tra"ellin# treacherous ri"er ra!ids $ould redistri)ute their $ares across many "essels to limit
the loss due to any sin#le "esselAs ca!si/in#. *he .a)ylonians de"elo!ed a system $hich $as recorded
in the famous ode of Hammura)i( c. 1:70 .( and !racticed )y early 1editerranean sailin# merchants.
If a merchant recei"ed a loan to fund his shi!ment( he $ould !ay the lender an additional sum in
e%chan#e for the lenderAs #uarantee to cancel the loan should the shi!ment )e stolen.
Ac%"emeni"n mon"!c% of Iran $ere the first to insure their !eo!le and made it official )y
re#isterin# the insurin# !rocess in #o"ernmental notary offices.
*he G!ee& and Rom"n introduced the ori#ins of health and life insurance in 800 AC $hen
they or#ani/ed #uilds called D)ene"olent societiesD $hich cared for the families and !aid funeral
e%!enses of mem)ers u!on death.
Insurance as $e +no$ it today can )e traced to the Ereat >ire of ;ondon( $hich in 1888
de"oured 1'(200 houses. In the aftermath of this disaster( ?icholas .ar)on o!ened an office to insure
)uildin#s. In 18F0( he esta)lished -n#landAs first fire insurance com!any( D*he >ire 5ffice(D to insure
)ric+ and frame homes
In#!"nce( in la$ and economics( is a form of ris+ mana#ement !rimarily used to hed#e a#ainst
the ris+ of a contin#ent loss. An In#!e! is a com!any sellin# the insuranceG an In#!e' is the !erson or
entity )uyin# the insurance.
(!emi#m:-
*he in#!"nce !"te is a factor used to determine the amount to )e char#ed for a certain amount of
insurance co"era#e( called the )!emi#m.
In'emnity:-
*he technical definition of DindemnityD means to ma+e $hole a#ain. *here are t$o ty!es of insurance
contractsG
1. an DindemnityD !olicy and

2. a D!ay on )ehalfD or Don )ehalf ofH !olicy.
*he difference is si#nificant on !a!er( )ut rarely material in !ractice. An DindemnityD !olicy $ill ne"er
!ay claims until the insured has !aid out of !oc+et to some third !arty. Bnder the same situation( a D!ay
on )ehalfD !olicy( the insurance carrier $ould !ay the claim and the insured )oth. 1ost modern lia)ility
insurance is $ritten on the )asis of D!ay on )ehalfD lan#ua#e.
Insurers ma+e money in t$o $ays: 213 throu#h Un'e!*!itin+( the !rocess )y $hich insurers select the
ris+s to insure and decide ho$ much in !remiums to char#e for acce!tin# those ris+s and 223 )y
in,etin+ the !remiums they collect from insured !arties.
C$"im: - >inally( claims and loss handlin# is the materiali/ed utility of insuranceG it is the actual
D!roductD !aid for( thou#h one ho!es it $ill ne"er need to )e used.
ommercially insura)le ris+s ty!ically share se"en common characteristics:-
Limite' !i& of c"t"t!o)%ic"$$y $"!+e $oe.
C"$c#$"-$e Lo
Affo!'"-$e (!emi#m
L"!+e Lo
Acci'ent"$ Lo
Definite Lo
A $"!+e n#m-e! of %omo+eneo# e.)o#!e #nit

/EALT/ CARE INSURANCE
Definition :-
*he term %e"$t% in#!"nce is #enerally used to descri)e a form of insurance that !ays for
medical e%!enses.
A health insurance !olicy is a contract )et$een an insurance com!any and an indi"idual( .y
estimatin# the o"erall ris+ of healthcare e%!enses( a routine finance structure 2such as a monthly
!remium or annual ta%3 is de"elo!ed( ensurin# that money is a"aila)le to !ay for the healthcare )enefits
s!ecified in the insurance a#reement. *he ty!e and amount of health care costs that $ill )e co"ered )y
the health !lan are s!ecified in ad"ance( in the mem)er contract or -"idence of o"era#e )oo+let.
*he conce!t of health insurance $as !ro!osed in 1896 )y Hu#h the -lder ham)erlain from the
Peter ham)erlain family. Accident insurance $as first offered in the Bnited States )y the >ran+lin
Health Assurance om!any of 1assachusetts. *his firm( founded in 1F70( offered insurance a#ainst
in,uries arisin# from railroad and steam)oat accidents. .efore the de"elo!ment of medical e%!ense
insurance( !atients $ere e%!ected to !ay all other health care costs out of their o$n !oc+ets( under $hat
is +no$n as the fee-for-ser"ice )usiness model. Curin# the middle to late 20th century( traditional
disa)ility insurance e"ol"ed into modern health insurance !ro#rams.
*oday( most com!rehensi"e !ri"ate health insurance !ro#rams co"er the cost of routine(
!re"enti"e( and emer#ency health care !rocedures( and also most !rescri!tion dru#s( )ut this is not
al$ays the case.

*he )asic conce!t of health insurance is !o!ulation solidarity. *here are inherent ris+s in a
!o!ulation )ut the !o!ulation a)sor)s the cost of ris+s to an indi"idual )y s!readin# the im!act of
incurred costs amon#st the insured !o!ulation. Ho$e"er( if the !o!ulation is s!lit into insured and
uninsured #rou!s( or into selecti"ely #rou!s 2as $ith !ri"ate insurance $ith !re-insurance selection
either )y the insurance com!any or the insured3 the conce!t of !o!ulation solidarity )rea+s do$n. *he
insurance )alances costs across a lar#e( random sam!le of indi"iduals. >or instance( an insurance
com!any has a !ool of 1000 randomly selected su)scri)ers( each !ayin# <s.100 !er month. 5ne !erson
)ecomes "ery ill $hile the others stay healthy( allo$in# the insurance com!any to use the money !aid )y
the healthy !eo!le to !ay for the treatment costs of the sic+ !erson. Ho$e"er( $hen the !ool is self-
selectin# rather than random( as is the case $ith indi"iduals see+in# to !urchase health insurance
directly( ad"erse selection is a #reater concern. Insurance systems must then ty!ically deal $ith t$o
inherent challen#es: ad"erse selection and e%-!ost moral ha/ard.
.ecause of ad"erse selection( insurance com!anies em!loy medical under$ritin#( usin# a
!atientAs medical history to screen out those $hose !re-e%istin# medical conditions !ose too #reat a ris+
for the ris+ !ool. .efore )uyin# health insurance( a !erson ty!ically fills out a com!rehensi"e medical
history form that as+s $hether the !erson smo+es( ho$ much the !erson $ei#hs( $hether the !erson has
)een treated for any of a lon# list of diseases and so on. In #eneral( those $ho !resent lar#e financial
)urdens are denied co"era#e or char#ed hi#h !remiums to com!ensate.
1oral ha/ard occurs $hen an insurer and a consumer enter into a contract under symmetric
information( )ut one !arty ta+es action( not ta+en into account in the contract( $hich chan#es the "alue
of the insurance. A common e%am!le of moral ha/ard is third-!arty !aymentI$hen the !arties in"ol"ed
in ma+in# a decision are not res!onsi)le for )earin# costs arisin# from the decision. An e%am!le is
$here doctors and insured !atients a#ree to e%tra tests $hich may or may not )e necessary. Coctors
)enefit )y a"oidin# !ossi)le mal!ractice suits( and !atients )enefit )y #ainin# increased certainty of
their medical condition. *he cost of these e%tra tests is )orne )y the insurance com!any( $hich may ha"e
had little say in the decision. o-!ayments( deducti)les( and less #enerous insurance for ser"ices $ith
more elastic demand attem!t to com)at moral ha/ard( as they hold the consumer res!onsi)le.

Insurance com!anies li+e to com!are )uyin# health insurance after )ein# dia#nosed $ith a
serious medical condition li+e HJ to tryin# to )uy fire insurance on a )urnin# house. *hat sounds
really lo#icalK.e%ce!tK.most fire insurance !olicies are ne"er used as most houses don0t )urn do$n.
-"eryone has medical !ro)lems( ho$e"er( at one time or another.
*o !re"ent a !erson from )uyin# health insurance only $hen they need it( the insurance industry
uses a !rocedure called Lmedical under$ritin#.H ;oosely translated into !lain -n#lish( it means
Ldiscriminatin# a#ainst anyone $e feel may cost us money.H And this ty!e of discrimination a#ainst
!eo!le $ith health !ro)lems is !erfectly le#al.
*he >rench model of health insurance has )een ran+ed )y the 4orld Health 5r#ani/ation as the )est in
the $orld( )ecause it !ermits a hi#h @uality of care and nearly total !atient freedom. . It $as a
com!romise )et$een Eaullist and ommunist re!resentati"es in the >rench !arliament. *he
onser"ati"e Eaullists $ere o!!osed to a state-run healthcare system( $hile the ommunists $ere
su!!orti"e of a com!lete nationali/ation of health care alon# a .ritish .e"era#e model. *he resultin#
!ro#ramme $as !rofession-)ased. All !eo!le $or+in# $ere re@uired to !ay a !ortion of their income to
a health insurance fund( $hich mutualised the ris+ of illness( and $hich reim)ursed medical e%!enses at
"aryin# rates. hildren and s!ouses of insured !eo!le $ere eli#i)le for )enefits( as $ell. -ach fund $as
free to mana#e its o$n )ud#et and reim)urse medical e%!enses at the rate it sa$ fit.

/EALT/ CARE INSURANCE SCENARIO IN INDIA
*he health care system in India is characteri/ed )y multi!le systems of medicine( mi%ed
o$nershi! !atterns and different +inds of deli"ery structures. Curin# the last 70 years India has
de"elo!ed a lar#e #o"ernment health infrastructure $ith more than 170 medical colle#es( 670 district
hos!itals( '000 ommunity Health enters( 20(000 Primary Health are centers and 1'0(000 Su)-
Health enters. 5n to! of this there are lar#e num)er of !ri"ate and ?E5 health facilities and
!ractitioners scatters thou#h out the country. 5"er the !ast 70 years India has made considera)le
!ro#ress in im!ro"in# its health status.
Pu)lic sector o$nershi! is di"ided )et$een central and state #o"ernments( munici!al and
Panchayat local #o"ernments. Pu)lic health facilities include teachin# hos!itals( secondary le"el
hos!itals( first-le"el referral hos!itals 2Hs or rural hos!itals3( dis!ensariesG !rimary health centres
2PHs3( su)-centres( and health !osts. Also included are !u)lic facilities for selected occu!ational
#rou!s li+e or#ani/ed $or+ force 2-SI3( defense( #o"ernment em!loyees 2EHS3( rail$ays( !ost and
tele#ra!h and mines amon# others.
*he !ri"ate sector 2for !rofit and not for !rofit3 is the dominant sector $ith 70 !er cent of !eo!le
see+in# indoor care and around 80 to :0 !er cent of those see+in# am)ulatory care 2or out!atient care3
from !ri"ate health facilities.
India s!ends a)out 8M of ECP on health e%!enditure. Pri"ate health care e%!enditure is :7M or
6.27M of ECP and most of the rest 21.:7M3 is #o"ernment fundin#. At !resent( the insurance co"era#e is

ne#li#i)le. 1ost of the !u)lic fundin# is for !re"enti"e( !romoti"e and !rimary care !ro#rames $hile
!ri"ate e%!enditure is lar#ely for curati"e care. 5"er the !eriod the !ri"ate health care e%!enditure has
#ro$n at the rate of 12.F6M !er annum and for each one !ercent increase in !er ca!ital income the
!ri"ate health care e%!enditure has increased )y 1.6:M. ?um)er of !ri"ate doctors and !ri"ate clinical
facilities are also e%!andin# e%!onentially.
1) Increasing health care costs,
2) High financial burden on poor eroding their incomes,
3) Increasing burden of new diseases and health risks and
4) Neglect of preventive and primar care and public health functions due to under
funding of the government health care!
Around 26M of all !eo!le hos!itali/ed in India in a sin#le year fall )elo$ the !o"erty line due to
hos!itali/ation (World Bank, !!"# An analysis of financin# of hos!itali/ation sho$s that lar#e
!ro!ortion of !eo!leG es!ecially those in the )ottom fourincome @uintiles )orro$ money or sell assets to
!ay for hos!itali/ation (World Bank, !!"#
Ei"en the a)o"e scenario e%!lorin# health-financin# o!tions )ecomes critical. In li#ht of the
fiscal crisis facin# the #o"ernment at )oth central and state le"els( in the form of shrin+in# !u)lic health
)ud#ets( escalatin# health care costs cou!led $ith demand for health-care ser"ices( and lac+ of easy
access of !eo!le from the lo$-income #rou! to @uality health care( health insurance is emer#in# as an
alternati"e mechanism for financin# of health care.
Health insurance is "ery $ell esta)lished in many countries. As #lo)al insurance !remiums #re$
)y or 7M in real terms to reach N'.: trillion due to im!ro"ed !rofita)ility and a )eni#n economic
en"ironment characteri/ed )y solid economic #ro$th( moderate inflation and stron# e@uity mar+ets.
Ad"anced economies account for the )ul+ of #lo)al insurance. *he to! four countries accounted for

nearly t$o-thirds of !remiums in 2008. *he B.S. and Ja!an alone accounted for 6'M of $orld insurance(
much hi#her than their :M share of the #lo)al !o!ulation. -mer#in# mar+ets accounted for o"er F7M of
the $orld0s !o!ulation )ut #enerated only around 10M of !remiums. .ut in India the health insurance
mar+et is "ery limited co"erin# a)out 10M of the total !o!ulation. It is a ne$ conce!t e%ce!t for the
or#ani/ed sector em!loyees. In India only a)out 2 !er cent of total health e%!enditure is funded )y
!u)licOsocial health insurance $hile 1F !er cent is funded )y #o"ernment )ud#et. In many other lo$ and
middle income countries contri)ution of social health insurance is much hi#her.
T"-$e 0
(e!cent"+e of tot"$ %e"$t% e.)en'it#!e f#n'e' t%!o#+% )#-$ic1oci"$
in#!"nce "n' 'i!ect +o,e!nment !e,en#e
COUNTRY
Soci"$ /e"$t%
In#!"nce
Go,e!nment
B#'+et
Al#eria ': M '8M
.oli"ia 20 M '' M
hina '1 M 1' M
=orea 2' M 10 M
Jietnam 2 M 20 M
India 2 M 1F M

It is estimated that the Indian health care industry is no$ $orth of <s. 98(000 crore and e%!ected
to sur#e )y 10(000 crore annually. *he share of insurance mar+et in a)o"e fi#ure is insi#nificant.
Eeneral Insurance or!oration 2EI3 and its four su)sidiary com!anies and ;ife Insurance or!oration
2;I3 of India ha"e "arious health insurance !roducts. *hese are Ashadee! Plan II and Jee"an Asha Plan
II )y ;ife Insurance or!oration of India and "arious !olicies )y Eeneral Insurance or!oration of India
as under: Personal Accident Policy( Jan Aro#ya Policy( <a, <a,esh$ari Policy( 1ediclaim Policy(
5"erseas 1ediclaim Policy( ancer Insurance Policy( .ha"ishya Aro#ya Policy and Creaded Cisease
Policy 2Sri"asta"a 19993 -tc.
5f the "arious schemes offered( 1ediclaim is the main !roduct of the EI. *he 1edical
Insurance Scheme or 1ediclaim $as introduced in ?o"em)er 19F8 and it co"ers indi"iduals and #rou!s
$ith !ersons a#ed 7 & F0 yrs. hildren 2' months & 7 yrs3 are co"ered $ith their !arents. *his scheme
!ro"ides for reim)ursement of medical e%!enses 2no$ offers cashless scheme3 )y an indi"idual to$ards
hos!itali/ation and domiciliary hos!itali/ation as !er the sum insured. *here are e%clusions and !re-
e%istin# disease clauses. Premiums are calculated )ased on a#e and the sum insured( $hich in turn "aries
from <s 17 000 to <s 7 00 000.

STAR /EALT/ 2 ALLIED INSURANCE COM(ANY
Star Health and Allied Insurance o. is a ,oint "enture )et$een 5man Insurance
om!any( 1r. Syed 1ohamed Salahuddin(1r. -ssa A)dullah Al Ehurair(leadin# Indian industrialists and
)usiness houses. It is thier endea"or to !ro"ide dedicated( afforda)le and @uality health insurance that
!reser"es and "alues human li"es. *his com!any aim to )e the most fa"ored )rand in the health insurance
se#ment. 4e offer a $ide ran#e of health insurance ser"ices and related !roducts at afforda)le !rices. 5ur
!rime o),ecti"e is to offer ser"ices in the health se#ment that ena)le you to mana#e stressful situations.
Star Health and Allied Insurance om!any ;imited 2Star Health3 has a ca!ital )ase of
<s.10F crores( more than $hat is ade@uate to form a Eeneral Insurance om!any. Ho$e"er( Star Health
has chosen to )e in the field of Health and $as the >irst t"n'-"$one /e"$t% In#!"nce Com)"ny in
In'i" and deals in Personal Accident( 1ediclaim and 5"erseas *ra"el Insurance.
M!3 V3 4"+"nn"t%"n( hairman cum 1ana#in# Cirector. He is a doyen of the Insurance
industry $ith o"er 60 years of e%!erience in Insurance. He has held "arious !ositions of authority(
includin# that of 1C of one of IndiaAs lar#est Pu)lic Sector insurance com!anies.
BOARD OF DIRECTORS
M!3 Sye' Mo%"me' S"$"%#''in - hairman - -meritus. 1ana#in# Cirector of -*A AS5? and -*A
S*A< #rou! of om!anies in Cu)ai( B.A.-
M!3 E" A-'#$$"% A$ G%#!"i! $as educated in San Cie#o( BSA. *he Al Ehurair family has )usiness
interests in .an+in#( >ood & .e"era#es and <eal estates.

D!3 M3 Y3 5%"n is currently the hairman of the .an+in# and Ad"isory council of 9-S .an+ ;td.
M!3 D3 R3 5""!t%i&ey"n is currently a "isitin# !rofessor in many !resti#ious institutions.
M!3 V3(3 N"+"!"6"n is the -%ecuti"e Cirector of -*A AS5? and -*A S*A< #rou! of om!anies
head@uartered in Cu)ai( BA-.
M!3 Mo%"mme' /""n is a !rominent educationalist and industrialist and has $ide +no$led#e in the
STAR /EALT/ 2 ALLIED INSURANCE COM(ANY :-
$s the first stand alone health insurance company in $ndia# $t speciali%es in &ealth
$nsurance, pro'ides (uality ser'ice at the best rates, and commits itself to the
ser'ice of the insured#
)ffers hassle free cashless settlement to the insured# *here is no *hird Party
Administrator in'ol'ed, +hich means better ser'ice, in shorter time and no
hassles### at all,
Pro'ides a -o Claim .iscount - one that has ne'er been offered before in the
country#
&as a round-the-clock /P ser'ice, +hich pro'ides counseling and ad'ice # When
necessary the insured +ill be guided to the Company0s large net+ork of doctors in
different localities#
Pro'ides periodic health check ups for the clients# &as a range of policies suited to
e'ery age group, different health aspects and concerns#
1 And last but not the least, 2*A3 &4A5*& is first and foremost, a dedicated insurer +ho
cares for your health###in e'ery +ay,
E.c$#i,e Fe"t#!e :
ashless ser"ice $ithout *PA inter"ention the BSP of the om!any
Cirect tie-u! $ith hos!itals on all India )asis

INTRODUCTION TO STUDY

*his study focus on understandin# the under$ritin# Euidelines O Procedures !racticed in t$o different
com!anies from t$o different sectors mainly focusin# on Pri"ate Sector om!any
1. Star Health & Allied Insurance om!any ;td.2Pri"ate Sector om!any3
2. ?e$ India Assurance om!any 2Pu)lic Sector om!any3
*he study $ill ha"e follo$in# ty!es of insurance !olicies :-
1. 1ediclaim Policy
2. Accidental Insurance
'. 5"erseas 1ediclaim
OB4ECTIVES
1. *o study the under$ritin# EuidelinesO!rocedure of selected !olicies $hich are )ein# !racticed in
the insurance com!any.
2. *o calculate & su##est !ossi)le $ays to decrease the turn around time in the under$ritin#
!rocedure for each !olicy.
'. *o do a S45* analysis for the !ur!ose of com!arison.
6. *o study the e%istin# $e) ser"ices & alerts for the !ur!ose of !olicy under$ritin# & !ost !olicy

ser"ices.
FLO7 C/ART FOR UNDER7RITTING
T/E MEDICLAIM (OLICY
Sales 1ana#er OA#ent
Su)mits the Pro!osal to Bnder$riter
Underwriter checks all the Mandatory felds flled in
the Proposal Form
Proposals below50 yrs.
Of age are Proceeded
for underwriting
Proposals aboe 50
yrs. Of age are sent for
Pre!medical
e"amination
#mproperly flled forms
are sent back for
upgradation
Properly flled forms are
preceded for underwriting
$ccording to the proposal
with%without loading on premium
policy is underwritten and issued
to the proposer.


UNDER7RITTING
*he most com!licated as!ect of the insurance )usiness is the under$ritin# of !olicies. *here are 2
different methods of a!!lication that anyone loo+in# for !ersonal health insurance must )e a$are of.
*hese are
1. >ull 1edical Bnder$ritin# 2>1B3
2. 1oratorium 215<3.
Bnder$ritin# in relation to health insurance )asically in"ol"es the disclosure of certain
information to an insurance com!any $hich they can then access to decide $hen !re-e%istin# conditions
should )e e%cluded from co"er. 4ith some !olicies one $ill )e re@uired to com!lete an a!!lication form
that details full medical history $here as $ith a moratorium !olicy your medical history $ill only
)ecome an issue at the !oint you need to ma+e a claim.
Policies re@uirin# a medical history declaration( or full medical under$ritin#( re@uire the
a!!licant to com!lete an a!!lication form that details the full medical history for each a!!licant. Pri"ate
health insurance com!anies consult an a!!licantAs EP in order to "erify conditions or to in"esti#ate an
a!!licantAs medical history further. Ha"in# su)mitted medical history a decision $ill )e made )y the
health insurance com!any as to $hether or not they $ill co"er any !re"ious medical conditions.
*he rules surroundin# PCuty of CisclosureA $hen a!!lyin# for !ersonal health insurance are @uite
strict. It is one0s duty to disclose any fact or circumstance a)out your health that is +no$n to you at your
time of a!!lication. *he main reason )ehind this disclosure is to identify if you ha"e any !re-e%istin#
conditions that $ill )e e%cluded from treatment from your health insurance !olicy.
1ost health insurance !ro"iders $ill not !ay )enefits for any conditions that you ha"e )een
treated for in the !ast or ha"e arran#ed treatment for !rior to ta+in# out your medical insurance !olicy.
*his also includes any chronic conditions that ha"e )een dia#nosed )efore the health insurance !olicy
$as #ranted. If you fail to disclose details of any illness at the start of your health insurance a!!lication
then you could )e denied a future claim or your !ersonal health insurance could )e deemed in"alid.
Some health insurance !ro"iders may a#ree to co"er !re-e%istin# conditions in e%chan#e for
additional !remiums( )ut this $ill de!end entirely u!on the condition in @uestion and its se"erity( ho$

lon# you ha"e had it and $hat treatment you ha"e had or are still ha"in# for that condition. A#ain( each
health insurance com!any is different $ith different !olicies so ma+e sure you al$ays do your
home$or+ $ith re#ards to $hat is and $hat is not included.
If you o!t for a !olicy that re@uires full medical under$ritin# then all your medical history $ill
)e a"aila)le to your insurers u! front ena)lin# them to ma+e an informed ,ud#ement )efore confirmin#
your !olicy. A moratorium !olicy is ho$e"er a little )it different as this ty!e of a!!lication !rocess does
not re@uire disclosure of medical history $hen ,oinin#. Instead any illness is assessed at the !oint of
ma+in# a claim.
4ith moratorium you do not need to fill in a health @uestionnaire. Instead( !re-e%istin#
conditions for $hich you 2and any de!endant included in your a!!lication3 ha"e recei"ed treatment
andOor medication( or as+ed ad"ice on( or had sym!toms of 2$hether or not dia#nosed3( durin# the four
years immediately )efore your !ri"ate health insurance co"er started $ill automatically )e e%cluded
from co"er.
Ho$e"er( if you do not ha"e any sym!toms( treatment( medication( or ad"ice for those !re-
e%istin# conditions( and any directly related conditions( for t$o continuous years after your !olicy starts(
then insurers may reinstate co"er for those conditions.
4hen choosin# a !ersonal health insurance !ro"ider it is "ital that you understand the
differences )et$een !olicies and $hich one is )est suited. 4ith any insurance com!any thou#h it is
al$ays )etter to )e honest from the outset to a"oid any disa!!ointment or hefty medical )ills further
do$n the line. 4ith >ull 1edical Bnder$ritin# the )oundaries are !erha!s clearer as e"erythin# $ill )e
documented from the outset and assessed )y your insurer )efore the !olicy is a!!ro"ed lea"in# you $ith
a clear understandin# of e%actly $hat your !ersonal health insurance co"ers you for. Bsin# a $ide
assortment of data( insurers !redict the li+elihood that a claim $ill )e made a#ainst their !olicies and
!rice !roducts accordin#ly. *o this end( insurers use actuarial science to @uantify the ris+s they are
$illin# to assume and the !remium they $ill char#e to assume them. Cata is analy/ed to fairly
accurately !ro,ect the rate of future claims )ased on a #i"en ris+. Actuarial science uses statistics and
!ro)a)ility to analy/e the ris+s associated $ith the ran#e of !erils co"ered( and these scientific !rinci!les
are used to determine an insurerAs o"erall e%!osure. B!on termination of a #i"en !olicy( the amount of

!remium collected and the in"estment #ains thereon minus the amount !aid out in claims is the insurerAs
under$ritin# !rofit on that !olicy. 5f course( from the insurerAs !ers!ecti"e( some !olicies are $inners
2i.e.( the insurer !ays out less in claims and e%!enses than it recei"es in !remiums and in"estment
income3 and some are losers 2i.e.( the insurer !ays out more in claims and e%!enses than it recei"es in
!remiums and in"estment income3.
*he )usiness model can )e reduced to a sim!le e@uation:
Profit Q earned !remium R in"estment income - incurred loss - under$ritin# e%!enses.
Insurers ma+e money in t$o $ays:
*hrou#h #n'e!*!itin+( the !rocess )y $hich insurers select the ris+s to insure and decide ho$
much in !remiums to char#e for acce!tin# those ris+s.
.y in,etin+ the !remiums they collect from insured !arties.
Insurance com!anies also earn in"estment !rofits on LfloatH. L>loatH or a"aila)le reser"e is
the amount of money( at hand at any #i"en moment( that an insurer has collected in insurance !remiums
)ut has not )een !aid out in claims. Insurers start in"estin# insurance !remiums as soon as they are
collected and continue to earn interest on them until claims are !aid out.
Some insurance industry insiders( most nota)ly Han+ Ereen)er#( do not )elie"e that it is
fore"er !ossi)le to sustain a !rofit from float $ithout an under$ritin# !rofit as $ell( )ut this o!inion is
not uni"ersally held. ?aturally( the LfloatH method is difficult to carry out in an economically de!ressed
!eriod. .ear mar+ets do cause insurers to shift a$ay from in"estments and to tou#hen u! their
under$ritin# standards. So a !oor economy #enerally means hi#h insurance !remiums. *his tendency to
s$in# )et$een !rofita)le and un!rofita)le !eriods o"er time is commonly +no$n as the D#n'e!*!itin+D
or Lin#!"nce cyc$eH

MEDIAL UNDER7RITING:-



5n recei"in# an a!!lication from an indi"idual for health insurance( the insurance
com!any carefully scrutini/es the a!!licantAs medical history and other factors to decide $hether to offer
co"era#e or not and if yes( then on $hat rate and on $hat conditions. -ach insurance com!any de"elo!s
its o$n under$ritin# #uidelines to outline the characteristics the com!any considers desira)le and those
that ma+e an a!!licant ineli#i)le for co"era#e. Health insurers a"oid indi"iduals or #rou!s that they
thin+ may )e li+ely to ma+e claims( either )ecause of !oor health or )ecause the !erson or com!any is
financially unsta)le. Insurance com!anies use the term D"',e!e e$ectionD to descri)e the tendency for
only those $ho $ill )enefit from insurance to )uy it. S!ecifically $hen tal+in# a)out health insurance(
unhealthy !eo!le are more li+ely to !urchase health insurance )ecause they antici!ate lar#e medical
)ills. 5n the other side( !eo!le $ho consider themsel"es to )e reasona)ly healthy may decide that
medical insurance is an unnecessary e%!enseG if they see the doctor once a year and it costs <s.270O-(
thatAs much )etter than ma+in# monthly insurance !ayments of <s.60O- 2e%am!le fi#ures3.

.ecause of ad"erse selection( insurance com!anies em!loy me'ic"$ #n'e!*!itin+( usin# a
!atientAs medical history to screen out those $hose !re-e%istin# medical conditions !ose too #reat a ris+
for the ris+ !ool. .efore )uyin# health insurance( a !erson ty!ically fills out a com!rehensi"e medical
history form that as+s $hether the !erson smo+es( ho$ much the !erson $ei#hs( $hether the !erson has
)een treated for any of a lon# list of diseases and so on. 5ne lar#e industry sur"ey found that rou#hly 1'
!ercent of a!!licants for com!rehensi"e( indi"idually !urchased health insurance $ho $ent throu#h the
medical under$ritin# in 2006 $ere denied co"era#e. Ceclination rates increased si#nificantly $ith a#e(
risin# from 7 !ercent for indi"iduals 1F and under to ,ust under a third for indi"iduals a#ed 80 to 86.
Amon# those $ho $ere offered co"era#e( the study found that :8M recei"ed offers at standard !remium
rates( and 22M $ere offered hi#her rates.
*he !remium structure is not desi#ned for the e%tra ris+ assumed )y insurin# !ersons $ho drin+
into%icants to e%cess( $ho are "ictims of dru# ha)its( $ho are rec+less in their manner of li"in# or
choice of associates or $ho ha"e @uestiona)le re!utations. Such !ersons are not eli#i)le for health
insurance.D All com!anies sellin# indi"idual ma,or medical insurance !olicies e%amine the medical
history of e"ery a!!licant( usin# @uestions on the a!!lication( follo$-u! !hone calls( 1edical
Information .ureau re!orts( !aramedical e%ams( and )lood and urine sam!les. 1edical under$ritin#
manuals are e%tensi"e and include detailed discussions of +no$n illness for each of the )odyAs systems
2circulatory( ner"ous( re!roducti"e( etc.3
1oral ha/ard occurs $hen an insurer and a consumer enter into a contract under symmetric
information( )ut one !arty ta+es action( not ta+en into account in the contract( $hich chan#es the "alue
of the insurance. A common e%am!le of moral ha/ard is third-!arty !aymentI$hen the !arties in"ol"ed
in ma+in# a decision are not res!onsi)le for )earin# costs arisin# from the decision. An e%am!le is
$here doctors and insured !atients a#ree to e%tra tests $hich may or may not )e necessary. Coctors
)enefit )y a"oidin# !ossi)le mal!ractice suits( and !atients )enefit )y #ainin# increased certainty of
their medical condition. *he cost of these e%tra tests is )orne )y the insurance com!any( $hich may ha"e

had little say in the decision. o-!ayments( deducti)les( and less #enerous insurance for ser"ices $ith
more elastic demand attem!t to com)at moral ha/ard( as they hold the consumer res!onsi)le.
Bnder$ritin# is a $ay of determinin# the insura)ility of the client )y re"ie$in# hisOher medical
and financial details usin# "arious ris+ classification models. *his !ractice can )e dated )ac+ to 1F00
..( $hen underta+in# ris+( or under$ritin# ris+( of shi!s $ith #oods $as done. >rom those days(
under$ritin# has e"ol"ed #reatly and is !resently cate#ori/ed into life and non-life under$ritin#( )oth
includin# financial under$ritin#. ;ife under$ritin# can )e further di"ided technically into medical and
non-medical under$ritin#.

Here are a fe$ ti!s for !rudent medical under$ritin#:
1. Ue yo#! "n"$ytic"$ min' - A&8 9Doe it m"&e ene:
Al$ays as+ yourself $hether the data #i"en ma+es sense. In most of the cases the data !resented can )e
mani!ulated or it can )e false !ositi"es. >or e%am!le( a client can ta+e a hy!o#lycemic dru# and #o for a
fastin# )lood #lucose test or the "alue of nine #i"en can )e H)A1( $hen a H)A1c test $as to )e
!erformed.
;3 Re"' -et*een t%e $ine
Analy/e $hat is not #i"en in the data !ro"ided or find the !otential ris+s the medical re!orts !oint to.
>or e%am!le( a 66-year-old female under#oin# tooth e%traction $as also as+ed to under#o an
electrocardio#ram and fastin# )lood su#ar test. *his data created a dou)t and $hen further in"esti#ated
re"ealed dia)etes mellitus.
<3 St#'y me'ic"$ %ito!y "n' +enetic #ce)ti-i$ity
arefully analy/e the medical history as it can #i"e you a lot of information a)out the client0s current
health status and !ossi)le endothelial dama#e( $hich must ha"e occurred in their )ody. >or e%am!le( in
the case of dia)etes( hy!ertension alon# $ith the date of dia#nosis can !ro"ide a clear idea on the ris+s
in"ol"ed. Also some disorders are #enetically manifested( for e%am!le arthritis( thallassemia( dia)etes(
arthritis and o)esity to name a fe$. Hence understandin# the medical history of the client and his first
line relati"es can !ro"ide su)stantial data for classifyin# the ris+ to him.
=3 Do not $oo& f!om " c$inic"$ )oint of ,ie*
<emem)er insurance medicine is different from clinical medicine. 9ou as medical under$riter are not
re@uired to identify the root cause of the disease( )ut to identify the !atholo#y and analy/e ho$ much
ris+ it !resents to the life of the client and also $ithin ho$ much time the client is #oin# to suffer from
that e%!ected disease.

>3 Ue )!o-"-i$ity )!inci)$e
Bse !ro)a)ility !rinci!les to e"aluate the chances of death or susce!ti)ility to critical illnesses co"ered
)y the health insurance !roduct !ro!osed $ithin that s!an of the co"era#e )y the com!any.
?3 Do not t%in& $on+ te!m
A medical under$riter should not thin+ from a lon#-term !oint of "ie$. <emem)er you should only )e
interested u! to the e%tent of the duration of the !lan !ro!osed. In addition( you need to e"aluate if the
ris+ co"era#e money 2!remium3 is reco"ered $ithin the first fe$ years of the !lan. *hen you should
e"aluate the ris+ and under$rite( ta+in# into consideration only that duration of time.
@3 Co!!e$"te "$$ fin'in+
Human )ody mechanisms are com!le% and interrelated !rocesses. *ry to find the correlation )et$een
the different !atholo#ies and sum them u! to find the total ris+ !resented )y the client. >or e%am!le( a
!erson $ith dia)etes mellitus and smo+in# !resents a hi#her ris+ than that !resented )y the !erson $ith
only dia)etes mellitus.
A3 A))$y Cot Benefit "n"$yi
A medical under$riter is also re@uired to ha"e an understandin# of financial terms li+e cost )enefit
analysis and use them !rudently to e"aluate the ris+.

5ey Fin'in+ in St"! /e"$t% 2 A$$ie' In#!"nce Com)"ny
Lt'
It is the first stand alone health insurance com!any in India. It s!eciali/es in Health Insurance(
!ro"ides @uality ser"ice at the )est rates( and commits itself to the ser"ice of the insured.*he om!any
is led )y a #rou! of leadin# industrialists and )usiness houses in the su)continent.
5man Insurance om!any is one of the leadin# Insurance om!anies in the 1iddle -ast. 1r.
-ssa A)dullah Al Ehurair hails from the !rominent Al Ehurair family in the B.A.-. 4ith a net $orth of
BSC '.: )illion( the family has )een ran+ed as one of the $orldAs richest )y >or)es ma#a/ine...
*he com!any has it0s /e"' Office in hennai( Co!)o!"te Office in 1um)ai & Re+ion"$ Office
in Pune from last three years. ;oo+in# at the !otential of "idar)ha re#ion the com!any started its )ranch
office in na#!ur in octo)er 200F.
*he or#anisational structure for this )ranch is as follo$s:

PolicyBnder$riter
.ranch 1ana#er
&ales
Managers
'ariable &ales
Managers
$disors $disor
s
Medical
O(cer

*he com!any has "ery stron# financial )ac+u! & "ery #ood leadershi! $hich t$o are the most
im!ortant factors for any com!any to )ecome successful. *he com!any has recorded itself as the fastest
#ro$in# com!any $ith 600M of #ro$th rate.
;oo+in# at the indian scenario of Health insurance( $hich remained hi#hly underde"elo!ed and
a less si#nificant se#ment of the !roduct !ortfolios of the nationali/ed insurance com!anies in India(
*here $as need of such ty!e of com!any dealin# only in health insurance. *herefore there is
o"er$helmin# res!onse from the consumers. 5nly in na#!ur from last ' & 6 months o"er 600 !olicies
are sold $hich comes around 6 & 7 !olicies !er day.
Here comes the role of an under$riter as Health sector !olicy formulation( assessment and
im!lementation is an e%tremely com!le% tas+ es!ecially in a chan#in# e!idemiolo#ical( institutional(
technolo#ical( and !olitical scenario. >urther( #i"en the institutional com!le%ity of our health sector
!ro#rammes and the !luralistic character of health care !ro"iders.
*hou#h !olicy under$ritin# is done in the )ranch office for those not re@uirin# medical
e%amination as they are )elo$ 70 years of a#e( those !ro!osers $ho are a)o"e 70 years of a#e( their
medical under$ritin# is done at re#ional office !une.
*he $or+ load here is thou#h not much as the com!any is in its cradle !hase still the under$riter
confirms the !olicy under$ritin# in minimum time $hich "aries from half hour to 6 hours for !olicies
not re@uirin# medical under$ritin#( & those re@uirin# medical under$ritin# may "ary from 26 hours to
17 days. *he ma,or factor here of concern is delay from the !ro!oser in su)mittin# medical documents.
If time !hase is considered from the su)mission of medical re!orts to the issuin# of !olicy it comes to
around 12 hours to 6F hours.

UNDER7RITTING GUIDELINES FOR VARIOUS
(RODUCTS
03 Me'i-C$"ic In'i,i'#"$
;3 F"mi$y /e"$t% O)tim"
<3 Senio! CitiBenC Re' C"!)et
=3 Acci'ent C"!e
>3 O,e!e" /e"$t% In#!"nce

03 MEDI-CLASSIC INDIVIDUAL :-
1edi lassic Insurance from Star Health is a !olicy that aims to !ro"ide reim)ursement of
hos!italisation e%!enses incurred as a result of illnessOdiseaseOsic+ness andOor accidental in,uries.
Any !ersons a#ed )et$een 7 months and F0 years( residin# in India(can ta+e this insurance.
Premium <an#e )et$een :-
S#m
In#!e'
Din RE
> mont% - <>
y!
<? - => y! =? - >> y!
>? - ?>
y!
?? - @F y! @0 - @> y!
@? - AF
y!
70000 7:7 :00 1'20 ?A ?A ?A ?A
100000 1200 1'70 266: '000 676: 6F:2 8029
170000 1F00 2000 '600 6200 8:1: :2F6 92F6
200000 2'70 2800 67F' 7'00 F:8F 97:6 12620
270000 2F00 '170 776F :200 10898 11:66 176''

'00000 ''00 '870 81:0 F200 12827 1'916 1F669
'70000 ':70 6170 :60F 10198 166'6 17986 21'61
600000 6200 6700 F:00 11671 18262 1F017 262'8
700000 6900 7600 10:00 1'97F 19F79 2211' '002'
Hos!ital ash:Pro"ides for !ayment of <s.700 for each com!leted day of hos!italisation.
Premium ran#in# from <s.200 to <s. '70 !er !erson( de!endin# u!on the a#e.
Patient are:A"aila)le for !ersons a)o"e 87 years. It !ays for the attendant char#es after
dischar#e from the hos!ital S <s 600 !er day to a ma%imum of 7 days !er hos!itali/ation.
Premium <s '00 !er !erson.
?e$ .orn .a)y co"er:A"aila)le $ith >amily !ac+a#e !lan and !ro"ides for your ne$-)orn from
)irth u! to the e%!iry of the !olicy !eriod. *he sum insured is restricted to 10M of the sum
insured in res!ect of the mother. Premium 10M of !olicy !remium.
Hos!italisation o"er : In-!atient hos!italisation e%!enses for a minimum of 26 hours.Includes
room rent and )oardin# S2M of sum insured(su),ect to a ma%imum of <s.6000O- !er day.
?ursin# e%!enses.
Sur#eonAs fees(onsultantAs fees(AnaesthetistAs and S!ecialistAs fees.
ost of medicines and dru#s.
-mer#ency am)ulance char#es for trans!ortin# the insured !atient to the hos!ital u!to a sum of
<s :70O- !er hos!italisation and o"erall limit of <s 1700O- !er !olicy !eriod.

Pre-hos!italisation medical e%!enses u!to '0 days !rior to date of admission.
Post-hos!itali/ation - a lum!sum calculated at :M of the hos!italisation2e%cludin# room
char#es3su),ect to a ma%imum of <s.7000 is !aya)le
?on-allo!athic *reatments u!to <s.27(000O- !er occurence( su),ect to a ma%imum of 27M of sum
insured !er !olicy !eriod.
Hos!ital ash:Pro"ides for !ayment of <s.700 for each com!leted day of hos!italisation.
Premium ran#in# from <s.200 to <s. '70 !er !erson( de!endin# u!on the a#e.
Patient are:A"aila)le for !ersons a)o"e 87 years. It !ays for the attendant char#es after
dischar#e from the hos!ital S <s 600 !er day to a ma%imum of 7 days !er hos!itali/ation.
Premium <s '00 !er !erson.
?e$ .orn .a)y co"er:A"aila)le $ith >amily !ac+a#e !lan and !ro"ides for your ne$-)orn from
)irth u! to the e%!iry of the !olicy !eriod. *he sum insured is restricted to 10M of the sum
insured in res!ect of the mother. Premium 10M of !olicy !remium.
Premium !aid )y che@ue or credit card for this insurance is eli#i)le for relief under Sectin F0C
of the Income *a% Act.
"#clusions 6-
-%!enses for the treatment of any illnessOdiseaseOcondition($hich is !re-e%istin#
*reatment of illnessOdiseaseOsic+ness contracted )y the insured !erson durin# the first '0 days from
the commencement date of this !olicy
>irst *$o 9ears -%clusions: ataract(Hysterectomy for 1enorrha#ia or >i)romyoma(<e!lacement
sur#ery for +nee andOor ,oint2other than caused )y an accident3(Prola!se of inter"erti)ral disc 2other
than caused )y accident3( Jaricose Jeins and Jaricose Blcers

>irst9ear-%clusions:.eni#n Prostate Hy!ertro!hy(Hernia(Hydrocele(>istula in anus(Piles(Sinusitis
and related disorders(on#enital internal diseaseOdefect(remo"al of #allstones and renal stone
?aturo!athy treatment
-%!enses $hich are !urely dia#nostic in nature $ith no !ositi"e e%istence of any disease
*reatment of o#ential e%ternal diseaseOdefectsOanomalies
-%!enses $hich are mainly cosmetic in nature
;3 FAMILY /EALT/ O(TIMA :-
>amily Health 5!tima from Star Health is a health insurance !lan that #i"es !rotection for the
entire family on the !ayment of a sin#le !remium under a sin#le sum insured. *he sum insured
floats amon# the family mem)ers insured. It0s ,ust one more $ay to ti#hten the family )onds.
Any !erson a#ed )et$een 7 months and 80 years residin# in India can ta+e this insurance
A: Adult : hildren u!to 27 yrs. ?A: ?ot A"aila)le
S#m In#!e' : R3 08FF8FFF

> Mont% - => Y! =? Y!- >> Y! >? Y!- ?F Y!
2A 1:87 ?A ?A
1A R 1 1717 ?A ?A
1A R 2 1860 ?A ?A
1A R ' 1:F7 ?A ?A
2A R 1 1F90 ?A ?A
2A R 2 2027 ?A ?A
2A R ' 2187 ?A ?A

S#m In#!e' : R3 ;8FF8FFF
> Mont% - <> Y! <? Y!- => Y! =? Y!- >> Y! >? Y!- ?F Y!
2A 2F90 '160 77'7 8600
1A R 1 2:17 '007 7287 8120
1A R 2 2F'7 '0:7 7610 8227
1A R ' '0F7 '617 7:17 8867
2A R 1 '297 '777 7927 8987
2A R 2 '677 '8:7 8670 :'80

2A R ' '827 6080 8:97 :F20

S#m In#!e' : R3 <8FF8FFF
> Mont% - <> Y! <? Y!- => Y! =? Y!- >> Y! >? Y!- ?F Y!
2A '9F7 6'80 :807 100'0
1A R 1 ':10 '960 89'0 91F7
1A R 2 'F27 6110 :180 9:27
1A R ' 6127 6660 :8'0 10097
2A R 1 6190 6F'0 :F87 10827
2A R 2 6'10 7110 F600 11090
2A R ' 6817 7'20 F:10 11:77

S#m In#!e' : R3 =8FF8FFF
> Mont% - <> Y! <? Y!- => Y! =? Y!- >> Y! >? Y!- ?F Y!
2A 7197 7787 10710 1'717
1A R 1 6:70 70:0 9880 12:'0
1A R 2 6910 7270 10170 1'210
1A R ' 7'87 7:27 109F0 1':77
2A R 1 7297 7::7 112:0 16290
2A R 2 7867 8260 11F:0 16F90

2A R ' 8027 8760 127F7 17F17

S#m In#!e' : R3 >8FF8FFF
> Mont% - <> Y! <? Y!- => Y! =? Y!- >> Y! >? Y!- ?F Y!
2A 7920 8727 12010 17F77
1A R 1 7':0 7977 11770 17227
1A R 2 78'0 82F7 11F87 17867
1A R ' 80'7 8::0 12'90 182:7
2A R 1 8'67 :067 12F17 18:70
2A R 2 8F:7 :8:7 1'210 1:670
2A R ' :280 F197 1'F80 1F107
A#e of the oldest family mem)er co"ered should )e ta+en for !remium calculation
Ser"ice ta% e%tra
Hos!itali/ation o"er: Protects the insured !erson for in-!atient hos!itali/ation e%!enses for a
minimum of 26 hours. *hese e%!enses include room and )oardin# char#es as !er !olicy
conditions
?ursin# e%!enses
Sur#eonAs fees( onsultant0s fees( Anesthetist0s and S!ecialistAs fees

ost of medicines and dru#s
-mer#ency am)ulance char#es for trans!ortin# the insured !atient to the hos!ital u!to a sum of
<s.:70O- !er hos!itali/ation and o"erall limit of <s.1700O- !er !olicy !eriod.
Sin#le Sum Insured
o"era#e for entire family
Sin#le Premium
onsidera)le sa"in# in !remium as the family is co"ered under one !olicy
Pre-hos!itali/ation medical e%!enses u!to '0 days !rior to the date of admission
Post-hos!itali/ation calculated at :M of the hos!itali/ation e%!enses 2e%cludin# room
char#es3(su),ect to a ma%imum of <s.7000 is !aya)le.
Pro!oser( s!ouse( de!endent children u!to 27 years those $ho are economically de!endent on
their !arents.
A discount of 10M on Premium is allo$ed on rene$al of the !olicy if there is no claim in the
immediately !recedin# year of the !olicy. *his discount is not cumulati"e.
Payment )y che@ue for this insurance is eli#i)le for relief under Section F0C of the Income *a%
Act.
"#clusions$%
-%!enses for the treatment of any illnessO diseaseOcondition $hich is !re-e%istin#
*reatment of illnessOdiseaseOsic+ness contracted )y the insured !erson durin# the first '0 days
from the commencement date of the !olicy
>irst *$o 9ears -%clusions:ataract(Hysterectomy for 1enorrha#ia or
>i)romyoma(<e!lacement sur#ery for +nee andOor ,oint 2other than caused )y an

accident3(Prole!ses of inter"erte)ral disc2other than caused )y accident3("aricose "eins and
"aricose ulcers
>irst 9ear -%clusions:.eni#n Prostate Hy!ertro!hy(Hernia(Hydrocele(>istula in
anus(Piles(Sinusitis and related disorders(con#enital internal diseaseOdefects( remo"al of
#allstones and renal stone
?aturo!athy treatment
-%!enses $hich are !urely dia#nostic in nature $ith no !ositi"e e%istence of any disease
-%!enses incurred for non-allo!athic treatment
*reatment of e%ternal on#ential diseaseOdefectsOanomalies
-%!enses $hich are mainly cosmetic in nature
<3 SENIOR CITIGENSC RED CAR(ET :-
*urnin# si%ty is a ma,or milestone and for !eo!le(a time to start )ein# more careful a)out their
health.It is a matter of concern that insurance !olicies are hardly a"aila)le to address this critical
re@uirement.S*A< Health is !roud to introduce IndiaAs first health insurance !olicy aimed
s!ecifically at senior citi/ens.It !ro"ides co"er for anyone o"er the a#e of 80 and !ermits entry
ri#ht u! to the a#e of 89 $ith continuin# co"er after that. It is our $ay of carin# for a #eneration
that has done so much to )uild the country.

>or !eo!le a#ed )et$een 80 and 89 years
Euaranteed rene$als )eyond 89 years
?o !re-insurance medical test re@uired
*reatment at net$or+ hos!itals only
All !re-e%istin# diseases are co"ered from first year(e%ce!t those for $hich treatment or ad"ice
$as recommended )y or recei"ed durin# the immediately !recedin# 12 months from the date of
!ro!osal
Cisease for $hich treatment or ad"ice $as recommended )y or recei"ed durin# the immediately
!recedin# 12 months from the date of !ro!osal $ill )e co"ered from second year on$ards
Ce!e-!o V"c#$"!
Acci'ent 1 C"!'io
V"#$"! Die"e
100000 :7000
200000 170000
Ren"$
Com)$ic"tion
100000 :7000
200000 170000

A$$ Ot%e! m"6o!
S#!+e!ie
100000 80000
200000 120000
Policy Premium & Includin# ser"ice ta%
Hos!itali/ation o"er: In-!atient hos!itali/ation e%!enses for a minimum of 26 hours.Includes
room rent and )oardin# S1M of sum
IB e%!enses !er day S 2M of sum insured
?ursin# e%!enses
Sur#eonAs fees(consultantAs fees(AnesthetistAs and s!ecialistAs fees(!er illness S 27M of sum
insured
ost of )lood(o%y#en(!acema+er
ost of dru#s and dia#nostic tests S 70M of sum insured !er hos!itali/ation
*reatment for ardio"ascular Ciseases O ere)ro"ascular AccidentOancer and )rea+a#e of
.ones : u!to <s.:7(000O- $here the sum insured is <s.1(00(000O- and u!to <s.1(70(000O- $here
the sum insured is <s.2(00(000O-
ataract 2)oth eyes included3( u! to <s.17(000O-
<enal om!lications : u!to <s.:7(000O- $here the sum insured is <s.1(00(000O- and u!to
<s.1(70(000O- $here the sum insured is <s.2(00(000O-
All other 1a,or Sur#eries : u!to <s.80(000O- $here the sum insured is <s.1(00(000O- and u!to
<s.1(20(000O- $here the sum insured is <s.2(00(000O-
-mer#ency Am)ulance har#es for trans!ortin# thhe Insured Person to the Hos!ital S<s.800O-
!er Hos!italisation and <s.1200O- !er Policy !eriod

Post-hos!itali/ation - a lum!sum calculated at :M of the hos!itali/ation e%!enses2e%cludin#
room char#es3(su),ect to a ma%imum of <s 7(00o is !aya)le.
A discount of 10M of the a)o"e !remium $ill )e allo$ed if the Pro!oser !roduces the follo$in#
documents to the satisfaction of the om!any
Stress *hallium <e!ortT
.P re!ortT
Su#ar 2)lood & urine3T
.lood urea & creatinineT
Self-declaration or certification that sur#eries related to Heart O .rain O ancer has O ha"e not
)een done in the !ast T*he tests should ha"e )een ta+en not )efore 67 days from the date of
!ro!osal.
Premium !aid )y che@ue or credit card is eli#i)le for relief as !ro"ided under Section F0 C of the
Income *a% Act.
"#clusions$%
*reatments currently a"ailed or a"ailed durin# the !re"ious 12 months from date of !ro!osal
Any e%!enses incurred for treatment of illnessOdiseaseOsic+ness contracted )y the insured !erson
durin# the first '0 days from the commencement date of the !olicy
>irst *$o-year e%clusions : Hernia( Piles( Hydrocele( on#enital Internal diseaseOdefect(
Sinusitis( Eall StoneO<enal Stone remo"al and .eni#n Prostrate Hy!ertro!hy
*$o-9ear -%clusions:Hysterectomy(ataract(JointO=nee <e!lacement sur#ery2other than caused
)y an accident3(Prola!sed Inter"erte)ral Ciscs(Jaricose Jeins(Blcers
?aturo!athy treatement

-%!enses $hich are !urely dia#nostic in nature $ith no !ositi"e e%istence of any disease
-%!enses for treatments that are mainly cosemtic in nature
70M co-!ayment a!!lica)le for !re-e%istin# diseases conditions
'0M co-!aument a!!lica)le for all other claims.
03 ACCIDENT CARE :-
An accident can !ut anyone0s future at ris+. 4hile an accident can )e sudden( #uardin# a#ainst
them can )e a conscious deli)erate decision. S*A< Health Accident are Insurance !ro"ides
com!ensation in the e"ent of death( !ermanent disa)ility and in,uries suffered due to accidents
Accidental death
Permanent disa)ility & total or !artial & follo$in# an accident
*em!orary total disa)lement & the Insured Person is eli#i)le for a $ee+ly )enefit at 1M of
a!ital Sum Insured 2follo$in# an accident3 su),ect to ma%imum of <s.7000O- !er $ee+ for a for
100 $ee+s
-ducational #rant to children 21 hild & <s.7000O-( 2 hildren& <s.10(000O-3
*rans!ortation e%!enses of mortal remains 2<s.'000O-3
*ra"el e%!enses of one relati"e 2<s.1000O-3
umulati"e .onus of 7M accrues to the Insured Person for e"ery claim free year( su),ect to a
ma%imum of 70M
Fo! In'i,i'#"$ :-

Co,e!"+e 1 Ri& G!o#) G!o#) I G!o#) II G!o#) III
*a)le I 0.67 !er mille 0.80 !er mille 0.F0 !er mille
*a)le II 0.F0 !er mille 1.'0 !er mille 1.:7 !er mille
*a)le III 1.27 !er mille 1.:7 !er mille 2.00 !er mille
Fo! G!o#) :-
G!o#) SiBe
H of 'ico#nt on (!emi#m
De.c$#'in+ "''-on co,e! 2 e!,ice t".E
2 - 100 Persons 7M
101 - 1000 10M
1001 - 7000 12.7M
7001 - 10000 17M
U 10000 20M

Policy can )e e%tended to co"er 1edical -%!enses on !ayment of Additional Premium
>or !ur!ose of ratin#( !ersons !ro!osed for insurance are classified under three ris+ #rou!s
<is+ Erou! I & Persons en#a#ed !rimarily in administrati"e functions
<is+ Erou! II & Persons en#a#ed in manual $or+ other than $hat is s!ecifically !ro"ided for
under Erou! III
<is+ Erou! III & Persons $or+in# in e%!losi"es industry( mines $or+ers( hi#h tension electric
su!!ly( horse racin# includin# ,oc+eys( athletes and occu!ations of similar ha/ards
*he Insurance may )e rene$ed under mutual consent
E.c$#ion
-%!enses incurred on e"ents occurrin# )efore the commencement of the co"er or other$ise
outside the Period of Insurance
Any claim in res!ect of Pre-e%istin# condition
Any claim if the insured acts a#ainst the ad"ice of a !hysician
Any claim arisin# out of Accidents that the Insured Person has caused intentionally or )y
committin# a crime or as a result of drun+enness or addiction 2dru#s( alcohol( etc3
Any claim arisin# out of mental disorder( suicide or attem!ted suicide self inflicted in,uries( or
se%ually transmitted conditions( an%iety( etc
Partici!ation in Ha/ardous S!ortOHa/ardous acti"ities
Persons $ho are !hysically and mentally challen#ed unless s!ecifically a#reed and endorsed in
the !olicy

;3 O,e!e" /e"$t% In#!"nce :-
Star Corporate travel Protect
Star Family Travel Protect
Star Student Travel Protect
Star individual Travel Protect

St"! Co!)o!"te t!",e$ (!otect :-
Elo)ali/ation and )usiness e%!ansion ha"e increased the need for tra"elin# )et$een countries.
Peo!le $ho tra"el also hold !ositions of hi#h res!onsi)ility in their or#ani/ations. 4hile all ris+s
cannot )e a"oided( S*A< Health !rotects cor!orate e%ecuti"es durin# their tra"el )y co"erin#
them a#ainst most ris+s arisin# out of tra"el so they can focus on the ,o) at hand and accom!lish
their o),ecti"es.
Fe"t#!e
-mer#ency medical e%!enses $hilst you tra"elOstay a)road
-mer#ency medical trans!ortation to India
<e!atriation of mortal remains
Any dental emer#ency e%!enses follo$in# an accident
om!ensation follo$in# accidental in,uries
ost of loss of tra"elerAs chec+ed-in )a##a#e
<easona)le e%!enses incurred for o)tainin# ne$ !ass!ort
-%!enses on emer#ency !urchase of consuma)les due to any delay in handin# o"er tra"ellerAs
chec+ed in )a##a#e )y the carrier for more than 12 hours
Celay in fli#ht
-%!enses relatin# to tra"el and accommodation incurred due to missed de!artureOconnection
Hi,ac+ distress
Any le#al lia)ility that may )e fastened u!on the tra"ellers( if heOshe causes any )odily in,ury or
!ro!erty dama#e to any third !arty $hilst on an insured tri!

Any tra"el e%!enses incurred in sendin# a su)stitute em!loyee follo$in# the co"ered
sic+nessOaccidental in,uries of the insured em!loyee
E$i+i-i$ity
All or!orate -%ecuti"es residin# in India a#ed )et$een 1F and :0 years tra"elin# a)road on
)usiness !ur!oses can ta+e this insurance
I it nece"!y to #n'e!+o me'ic"$ tetI
Eenerally not re@uired. Ho$e"er any !ro!osal $ith ad"erse medical history( irres!ecti"e of the
a#e should )e accom!anied )y an -E( >astin# and Post!randial .lood Su#ar( Brine Stri! *est
and holesterol Profile re!orts duly certified )y a cardiolo#ist.
($"n "n' T!i) o)tion
*he insurance is a"aila)le for *ra"el $orld$ide includin# BSA and A?ACA( for sum insured
limits of BSC 1(00(000( BSC 2(70(000 and BSC 7(00(000.
STAR STUDENT TRAVEL (ROTECT :-
Students tra"elin# a)road are already on their o$n and need hel! if they are e"er laid lo$ )y an illness.
S*A< Health has a s!ecially desi#ned Student *ra"el Protect Insurance that !rotects them durin# a
crucial !hase )ecause medical treatment a)road can )e !rohi)iti"ely e%!ensi"e in most cases.

Me'ic"$ Benefit
-mer#ency medical e%!enses
-mer#ency trans!ortation )ac+ to India
<e!atriation of mortal remains
Cental emer#ency e%!enses follo$in# an accident
T!",e$ Re$"te' Benefit
>or in,uries caused )y accidents
>or chec+ed in )a##a#e
Com)"ion"te Benefit
Jisit of one immediate family mem)er( in case of hos!italisation
<e!atriation due to medical reasons or death of family mem)er( resultin# in interru!tion in study
<eim)ursement of tuition fee for the )alance !eriod in the e"ent of death of the s!onsor
Le+"$ C$"im
>or )odily in,ury to third !arties or dama#e to their !ro!erty( if you ha!!en to )e the cause
ost of )ail )ond follo$in# false arrest or $ron#ful detention.
STAR STUDENT TRAVEL (ROTECT:-

*hese days a lot more families "acation a)road. 4hile this is the !erfect o!!ortunity for en,oyment(
there is a clear need to !rotect the family from ris+s that may )e merely incon"enience( li+e the loss of a
!ass!ort or somethin# more serious li+e a mem)er of the family fallin# ill and needin# hos!itali/ation.
*o )e !re!ared for any crisis S*A< Health offers financial !rotection under >amily *ra"el Protect
Insurance Policy
E$i+i-i$ity
All Indian ?ationals and their families - a#ed )et$een 8 months and 80 years( tra"elin# a)road
on holiday can a"ail this insurance
>amily consists of insured !erson( s!ouse and t$o de!endent children 2hildren )elo$ 1F years3
Additional children can )e co"ered on !ayment of e%tra !remium at 27M additional !remium !er
child u! to a ma%imum of t$o additional children

C$"im (!oce'#!e
#nform the #) number for easy reference
on toll free number
#n case of emergency hospitali*ation+
information to be gien within ,- hours after
hospitali*ation
#n non!network hospitals+ payment must be
made upfront and then reimbursement will be
e.ected on the submission of documents.
#n case of planned hospitali*ation+ it should
be informed ,- hours prior to admission into
hospital
$fter checking of the full documents / feld
isit report the claim settlement department
settles the claim.
0he Medical O(cer will personally isit the
hospital for oerlooking / taking proper follow
up of the claim / flls the feld isit report

5EY INTER(RETATIONS
*here is still much sco!e to e%!lore the mar+et as the city !o!ulation is a)o"e '0(00(000 &
only 2 & 7M of !o!ulation is co"ered under any +ind of health insurance co"era#e.
Jarious mar+etin# acti"ities are done to !romote the com!any.
Bnder$ritin# !rocedures are done cautiously for o"erall ris+ assessment & if found out of the
)o% full efforts are ta+en to co"er that !erson under some different !lan.
Personal freedom is #i"en to the Sales 1ana#ers to e%!lore his O her talent and #enerate )usiness
)y his O her inno"ati"e ideas.
Bnder$ritin# #uidelines are user friendly and fitted into the soft$are called (REMIA3
*he soft$are sometimes )ecomes trou)le creator due to inefficiency of either internet
connecti"ity or continuous !o$er su!!ly.
1edical under$ritin# is ta+en care )y @ualified doctors at Pune due to under load of $or+.
om!any !ossesses reminder soft$are $hich #enerates alerts )efore e%!iry of the !olicy after
one year for rene$al.
*here is a fi%ed !rototy!e of !olicy under$ritin# due to soft$are in $hich chan#es can only
occur throu#h hi#her centers.
*his )ranch u! till no$ has under$ritten 620 !olicies in 6 months
*herefore :- 6'2 O 6 Q 10F
*herefore :- 10F O 28 Q 6 & 7 !olicies O day
-"ery !olicy ta+es on an a"era#e 7 & 8hrs. *o )e under$ritten.

*he ma,or time is ta+en )y the !olicies re@uirin# medical under$ritin# i.e. !ro!osers
a)o"e 70 yrs. 5f a#e. As it re@uires !rom!t action from the !ro!oser side after #i"in#
ad"anced recei!t.
5ther$ise !olicies not re@uirin# medical under$ritin# are #ettin# under$ritten e"en in
1:00 & 1:'0 hrs.

SOME SUGGESTIONS FOR CONSIDERATIONS:-
Still ri#orous mar+etin# acti"ities can )e underta+en for #ra)in# attention of the mar+et.
As the $or+ load #oes u! unedr$rittin# !rocedures should )e more cautiously done for not
acce!tin# dou)tful cases so the re!udiation rate of the claims can also )e reduced there)y
reducin# disa!!ointment for the !olicy holders.
1edical under$riter can )e a!!ointed after the $or+load e%ceeds limit of around 12 -17 cases
!er day reduce the turn around time re@uired for !olicy issuin#.
?on-net$or+ hos!itals should )e em!anelled as soon as !ossi)le after confirmin# their #enuiness
to reduce incidences of moral ha/ards.
*he com!any totally de!ends on $e) ser"ices for their under$ritin#( there should )e some
)ac+u! if the system fails to continue the $or+.
4e) ser"ices and alerts can )e more ri#orously used for !ost !olicy ser"ices )y #i"in# additional
features as follo$s :-
*o #ather and enlist the data )ase of all !olicy holders.
*hose ha"in# mo).no. can )e !ro"ided $ith either $ee+ly O e"ery fortni#ht.
Health ti!s( Health Alerts for social out)rea+s.
Alerts a)out ne$ health care schemes and )enefits.
5ne can ma+e !eo!le a$are a)out e%tra )enefits li+e ta% e%em!tions etc.

S7OT - An"$yi
STRENGT/S 7EA5NESSES
Stand alone health insurance com!any in
the field.
-%!erience( e%!ertise and su!!ort of
.i# financial #rou!.
;atest *echnolo#y and Infrastructure to
su!!ort & fasten the ser"ices.
All the ran#e of health !roducts under one
roof.
ashless ser"ice $ithout *PA inter"ention
i.e. in-house claim settlement.
26 hours Eeneral PractitionerAs ad"ice and
medical counselin#
26%: in-house all enter
*oll free tele!hone assistance
om!lete +no$led#e )ac+ed $e)site to offer
medical information( includin# health
ti!s.
;ar#e ran#e of !remiums throu#h different
!roducts for e"ery class of !eo!le.
Cirect discount on !remium for no claim
)enefit
4elcome discount for the !ro!osers shiftin#
from other com!any $ith all the
continuation )enefits.
Inno"ati"e !roducts e"en for chronic non-
cura)le diseases li+e dia)etes( AICS etc.
B!comin# !ri"ate health com!anies
offerin# health insurance.
4ell esta)lished !u)lic sector
com!anies.
;ac+ esta)lished infrastructure at
)ranch offices.

A"aila)ility of tailor made !olicies.
O((ORTUNITIES T/REATS
A)ility of local !eo!le to !ay for #ood
ser"ices.
?on-a"aila)ility of any ma,or health
insurance ser"ice !ro"ider.
4illin#ness of or!orates to ha"e a tie-u!
$ith the com!any.
;ar#e sector of the !o!ulation not co"ered
under health insurance & e"en is una$are of
the )enefits.
Increasin# !o!ulation #oin# a)road and
hence a"ailin# 5"erseas !olicies.
Inceasin# num)er of road side accidents &
increased cost of healthcare facilities
.
-sta)lished #eneral insurance
com!anies ha"in# )rand name.
>rom the mal!ractices )ein# re#ularly
done in this form of insurance !ractices.
Bn$illin#ness of !eo!le to )uy health
insurance thin+in# of $asta#e of money.
1ore no. 5f !ro!osals from senior a#e
#rou!.$ho are in real need of health care
e%!enses.
<esistance amon# !eo!le as they ha"e
mindset of a"ailin# !olicies from !u)lic
sector com!anies.


=ey >indin#s durin# study in
?e$ India Assurance om!any
sta)lished )y Sir Cora) *ata in 1919( ?e$ India is the first fully Indian o$ned insurance
com!any in India.
4ith a $ide ran#e of !olicies ?e$ India has )ecome one of the lar#est non-life insurance
com!anies( not only in India( )ut also in the Afro-Asian re#ion.
?e$ India $as a !ioneer amon# the Indian om!anies on "arious fronts( ri#ht from insurin#
the first domestic airlines in 1968 to satellite insurance in 19F0. *he latest addition to the list of firsts
is the insurance of the I?SA*-2-.
5ur 1ission :-
*o de"elo! #eneral insurance )usiness in the )est interest of the community.
*o !ro"ide financial security to indi"iduals( trade( commerce and all other se#ments of the
society )y offerin# insurance !roducts and ser"ices of hi#h @uality at afforda)le cost
5ur Jalues :-
Hi#hest !riority to customer needs.
Hi#h standards of !u)lic conduct.

*rans!arency in o!erations.
*he com!any has many )ranch offices in ?a#!ur for different re#ions of ?a#!ur. *he focus
of the com!any is more on "ehicle( fire etc. ty!e of insurances. Health insurance thou#h
ha"in# all ty!e of !ortfolios under the um)rella of the com!any is still a less concerned issue
for them.
*here is common under$riter for all ty!e of insurance !olicies. 1edical under$ritin# is done
on ad"ice of the authori/ed dia#nostic centers in the city. *hey don0t ha"e in-house claim
settlement de!artment. 5n their )ehalf third !arty administrators do the ,o) for them for
$hich they #et 8M of the !remium amount.
*he team of their sales mana#ers are also ne#lectin# health care !ortfolio.
5ther !ri"ate insurance com!anies are !ro"idin# them $ith more )enefits and much more
u!#raded ser"ices.
*here is much sco!e for either im!ro"in# or im!lementin# the under$ritin# #uidelines.
*here is much difference in !remium char#ed for the said co"era#e in !ri"ate com!anies and
?e$ India Assurance om!any.
5ther )enefits li+e no claim )enefit( cumulati"e )onus( continuation )enefits should )e more
em!hasi/ed on $hile e%!lainin# to the !ro!oser.
*he com!any has di"ided $hole India in three /ones accordin# to the health costs of those
!articular areas for reim)ursements.

mediclaim policy 6-
*his insurance is a"aila)le to !ersons )et$een the a#e of 1F years to 80 years. hildren )et$een
the a#e of ' months to 1F years can )e co"ered !ro"ided !arents are co"ered simultaneously. *he
!ersons )eyond 80 years can continue their insurance !ro"ided they are insured under 1ediclaim
!olicy $ith our om!any $ithout any )rea+.
*he !olicy co"ers hos!italisation e%!enses for the treatment of illnessOin,ury !ro"ided
hos!italisation is more than 26 hours. Pre-hos!italisation e%!enses for '0 days and !ost
hos!italisation e%!enses for 80 days are also !aya)le.
Cay-care treatment - *he 1edical e%!ense to$ards s!ecific technolo#ically ad"anced day-care
treatments O sur#eries $here 26 hour hos!italisation is not re@uired.
Am)ulance har#es for shiftin# the insured from residence to hos!ital are co"ered u! to the
limits s!ecified in the !olicy.
Ayur"edic O Homeo!athic and Bnani system of medicine are co"ered to the e%tent of 27M of
Sum Insured !ro"ided the treatment is ta+en in the Eo"ernment Hos!ital.
Pre-e%istin# diseases are co"ered only after 6 continuous and claim free rene$als $ith our
om!any.
Pre-e%istin# conditions li+e Hy!ertension( Cia)etes( and their com!lications are co"ered after
t$o years of continuous insurance on !ayment of additional !remium.
"#clusions$%

1. Ciseases contracted $ithin '0 days of insurance
2. Cental treatment e%ce!t arisin# out of accident.
'. Ce)ility and Eeneral <un Co$n onditions.
6. Se%ually transmitted diseases and HIJ 2AICS3
7. ircumcision( osmetic sur#ery( Plastic sur#ery unless re@uired to treat in,ury or illness
8. Jaccination and Inoculation
:. Pre#nancy and child )irth
F. 4ar( Act of forei#n enemy( ionisin# radiation and nuclear $ea!on.
9. *reatment outside India
10. ?aturo!athy
11. Comiciliary *reatment
12. -%!erimental or un!ro"en treatment
1'. All e%ternal e@ui!ments such as contact lenses( cochlear im!lants etc

>ollo$in# is the chart for their mediclaim !olicy :-
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0FFFFF 1'17 1270 16F0 1F70 2700 2F10 '280 '870 6110
0;>FFF 1897 1817 1F80 22F0 2990 '7'0 6010 6710 7080
0>FFFF 2017 1920 2210 2:17 '::0 6260 6F60 7670 8080
0@>FFF 2'07 2197 27'0 '100 6'60 6FF0 7880 8'80 :090
;FFFFF 2797 26:0 2F67 '690 6910 7880 8620 :'10 F210
;;>FFF 2F70 2:17 '1'0 'F'0 7660 82:0 :110 F280 91F0
;>FFFF '107 2977 '607 61:7 7980 8FF0 :F10 90:0 10120
;@>FFF ''80 '200 '8F7 6720 86F0 :690 F700 9F60 10920
<FFFFF '817 '667 '9:0 6F87 8990 F090 9200 10760 11F20

<>FFFF 6087 'F:0 6680 76:0 :970 9210 106F0 120'0 1'660
=FFFFF 6710 6297 6970 80:0 F910 10'60 11:F0 1'7'0 170'0
=>FFFF 6980 6:27 76:0 8:'7 9F80 11680 1'0:0 17060 18:90
>FFFFF 7610 7170 79'7 :2:7 10F20 127F0 16'70 18720 1F680
2pecial 7eatures 6-
1. Ciscount in !remium for family co"er
2. ;oyalty Ciscount
'. Eood Health Ciscount
6. umulati"e .onus
7. ost of Health hec+ u!
8. Income *a% .enefit under Section F0C of I* Act.
laims are administered throu#h *hird Party Administrators 2*PA3 $hose contact !articulars
a!!ear on the !olicy document. Insured can o!t for cashless or reim)ursement facility for their
claims. *he !ro!oser has the o!tion to a"ail *PA ser"ices( $hich is cashless or direct ser"ice )y
Policy issuin# 5ffice( $hich is on reim)ursement )asis.

(e!on"$ Acci'ent (o$icy:-
*his !olicy offers com!ensation in case of death or )odily in,ury to the insured !erson( directly
and solely as a result of an accident( )y e%ternal( "isi)le and "iolent means.
*he !olicy o!erates $orld$ide and is a 26 hours co"er.
Cifferent co"era#es are a"aila)le ran#in# from a restricted co"er of Ceath only( to a
com!rehensi"e co"er co"erin# death( !ermanent disa)lements and tem!orary total disa)lements.
>amily Pac+a#e co"er is a"aila)le to Indi"iduals under Personal Accident Policy $here)y the
!ro!oser( s!ouse and de!endent children can )e co"ered under a sin#le !olicy $ith a 10M
discount in !remium.
Erou! !ersonal accident !olicies are also a"aila)le for s!ecified #rou!s $ith a discount in
!remium de!endin# u!on the si/e of the #rou!.

*his !olicy is )asically desi#ned to offer some sort of com!ensation to the insured !erson $ho
suffers )odily in,ury solely as a result of an accident $hich is e%ternal( "iolent and "isi)le. Hence
death or in,ury due to any illness or disease is not co"ered )y the !olicy.
*he follo$in# ty!es of co"era#e0s are offered under a Personal Accident !olicy:-
T"-$e D
1. Ceath co"er $herein 100M of the ca!ital sum insured is !aya)le.
T"-$e C
1. o"era#e under *a)le C
2. ;oss of t$o lim)s O )oth eyes O one lim) and one eye $herein 100M of the ca!ital sum insured is
!aya)le.
'. ;oss of one lim) or one eye $herein 70M of the ca!ital sum insured is !aya)le.
6. Permanent *otal Cisa)lement other than a)o"e e.#. !aralysis due to an accident( $herein 100M
of the ca!ital sum insured is !aya)le.
T"-$e B
1. o"era#e under *a)le
2. Permanent Partial Cisa)lement i.e. $here a !art of the )ody )ecomes !ermanently disa)led due
to an accident( e.#. total and irre"oca)le loss of use of a fin#er due to an accident. In such cases(
a !ercenta#e of the ca!ital sum insured as s!ecified in the !olicy is !aid.
T"-$e A
1. o"era#e under *a)le .
2. *em!orary *otal Cisa)lement i.e. $here the insured !erson )ecomes tem!orarily disa)led from
underta+in# any $or+ as a result of an accident for e.#. fracture of le#s. In such cases( a $ee+ly

!ayment of 1M of the ca!ital sum insured su),ect to a ma%imum limit( is !aid for the num)er of
$ee+s or !art thereof 2ma%imum 100 $ee+s3( durin# $hich the insured !erson is totally disa)led.
*he insured can claim only under any one of these sections as a result of any one accident.
*he !olicy also co"ers e%!enses incurred for carria#e of dead )ody from !lace of accident to the
residence su),ect to a limit of 2M of the ca!ital sum insured or <s.2(700 $hiche"er is less. Bnder
an Indi"idual Personal Accident !olicy or >amily Pac+a#e Policy( an education fund is !aya)le
for a ma%imum of 2 de!endent school #oin# children( in case of death or !ermanent total
disa)lement of the insured !erson.
*he com!any issue se"eral ty!es of !ersonal accident !olicies such as :-
Indi"idual Personal Accident !olicy.
Erou! Personal Accident !olicy.
Passen#er >li#ht ou!on - o"erin# !ersonal accident ris+ $hilst tra"elin# as a !assen#er on a
scheduled fli#ht.
Eramin Personal Accident Policy - for !ersons residin# in rural areas $here )enefits as !er *a)le
mentioned a)o"e are co"ered for a ca!ital sum insured of <s.10(000O-.
Janata Personal Accident !olicy - $here )enefits as !er *a)le mentioned a)o"e are co"ered for
a ma%imum sum insured of <s.1(00(000O-. ;on# *erm Policies can also )e issued u!to 7yrs.
Student Safety Insurance - for schools and colle#es( co"erin# students a#ainst Personal Accident
)enefits as !er *a)le . mentioned a)o"e for a ca!ital sum insured of <s.10(000O-.
<a, <a,esh$ari 1ahila =alyan 9o,na - for $omen in the a#e #rou! of 10 to :7 years. $here
)enefits as !er *a)le mentioned a)o"e are co"ered for a ca!ital sum insured for <s.27(000O-. In
case of death of an unmarried $oman due to an accident( <s.27(000O- is !aya)le to the nominee
or le#al heir. In case of a married $oman( if the hus)and dies due to an accident( <s.27(000O- is
!aya)le to the $ife )ut if the $ife or insured dies no com!ensation is !aya)le.

.ha#yashree hild 4elfare Policy - for #irl child in the a#e #rou! of 0 to 1F years. $hose
!arents a#e does not e%ceed 80yrs. In case of death of either or )oth !arents due to an accident( a
sum of <s.27(000O- is de!osited in the name of the #irl child $ith a financial institution named in
the !olicy $hich $ill dis)urse amounts as s!ecified for the )enefit of the #irl child to the li"in#
!arent or to the nominated #uardian. Erou! !olicies can also )e issued.
&election of &um Insured$%
It is "ery difficult to !ut a "alue to a human life. Hence the !rinci!le of indemnity cannot )e
a!!lied in this !olicy. Ho$e"er it )ecomes necessary to a!!ly some yardstic+ for fi%in# the sum
insured so that human li"es are not o"er"alued for ulterior moti"es.
Hence the ca!ital sum insured is restricted to :2months income from #ainful em!loyment. *his
means that income from !ro!erty( shares etc. $ill not )e ta+en into account. >or non $or+in#
s!ouse( the sum insured is restricted to 70M of the sum insured of earnin# s!ouse su),ect to a
ma%imum of <s.1(00(000O- and for de!endent children to 27M of the sum insured of earnin#
!arents su),ect to a ma%imum of <s.70(000O-. In case of Eramin Personal Accident( Student
Safety( <a, <a,esh$ari( .ha#yashree !olicies the sum insured is fi%ed.
In Indi"idual Personal Accident !olicy( facility of cumulati"e )onus is #i"en $here)y the ca!ital
sum insured is increased )y 7M e"ery year on claim free rene$als su),ect to a ma%imum of 70M.
*his cumulati"e )onus is a"aila)le only under ta)les A(. & .
In t%e e,ent of "n "cci'ent +i,in+ !ie to " c$"im t%e fo$$o*in+ te) %o#$' -e
t"&en:-
In case of death claim :-
1. Assi#nee under the !olicy should immediately notify the !olicy issuin# office.
2. Su)mit the claim form alon#$ith death certificate( !ost mortem re!ort( !olice re!ort and ori#inal
!olicy.

In case of in,ury claim :-
1. ?otify the !olicy issuin# office immediately.
2. Su)mit Police re!ort if any.
'. Su)mit claim form alon#$ith medical certificate certifyin# the disa)lement.
6. In case medical e%!enses e%tension has )een ta+en( then the !rescri!tion alon#$ith )ills are to )e
su)mitted.
)'erseas 8ediclaim Policy
/i+%$i+%t :-
Premium !aya)le in <u!ees and laims settled a)road in forei#n urrency.

Policy a"aila)le for fre@uent cor!orate tra"elers
1edical e%!enses incurred )y the insured !ersons( outside India as a direct result of )odily
in,uries caused or sic+ness or disease contracted are co"ered.
-i#ht Plans a"aila)le under the !olicy:
(LAN A-0E >or tra"el to countries e%cludin# BSA & anada for )usiness and holiday limited to
BSC 70(000.
(LAN-A-;E Same as 2A-13 a)o"e e%ce!t that )enefits stand increased to BSC 270000.
(LAN B-0E >or tra"el $orld$ide includin# BSA & anada for )usiness and holiday limited to
BSC 1(00(000.
(LAN B-;E Same as 2.-13 a)o"e e%ce!t that )enefits stand increased to BSC 7(00(000.
(LAN CE >or tra"el to countries e%cludin# BSA & anada for em!loyment and studies limited
to BSC 170(000.
(LAN DE >or tra"el $orld$ide includin# BSA & anada for em!loyment and studies limited to
BSC 170(000.
(LAN E-0E >or tra"el $orld$ide includin# BSA & anada for cor!orate fre@uent tra"elers
limited to BSC 1(00(000.
(LAN-E-;E Same as 2--13 a)o"e e%ce!t that )enefits stand increased to BSC 7(00(000.
>* o"er is a"aila)le for -%ecuti"es 5f or!orate clients and Partners of re#istered firms
annually su),ect to the duration of any one tri! not e%ceedin# 80 days.
ACCI*I5?A; Add-on )enefits:-.esides the a)o"e additional add-on )enefits are a"aila)le
under .usiness & Holiday and >* co"er2-%ce!t Plan and Plan C3

1. Personal Accident
2. ;oss of chec+ed in .a##a#e
'. Celay of chec+ed in .a##a#e
6. ;oss of !ass!ort
7. Personal ;ia)ility
(!emi#m: Ce!ends on A#e-)and( *ri!-)and and ountry of "isits.o"era#e: Initially co"er u!to 1F0
days is !ro"ided under .usiness & Holiday Plan ..-%tension allo$ed on ori#inal !olicy for further
!eriod of 1F0 days su),ect to declaration of #ood health
A#e ;imit: 8 months and a)o"e u!to :0 years.
Policy is to )e ta+en !rior to de!arture from India.
*ra"elers o"er 80 years of a#e and for those tra"elin# to BSA & anada o"er 60 years the
follo$in# 1edical re!orts 2from an 1C ardiolo#ist3 need to )e su)mitted alon# $ith the
!ro!osal form:
-E
>astin# .lood Su#ar or Brine Stri! test
*hese re!orts are re@uired if the tra"el !eriod e%ceeds 80 days and a)o"e.
In case of tra"ellers una)le to su)mit the a)o"e 1edical re!orts co"er stands restricted to BSC
10(000.
8a9or 4xclusions6-
All !re-e%istin# diseaseOillnesses are not co"ered 2+no$n and un+no$n3.
*ra"elin# a#ainst 1edical ad"ice or for 1edical treatment includin# routine chec+-u!.

>irst BSC 100 of all claims are to )e )orne )y the tra"eller.
Please refer to Policy for further details.
S7OT - An"$yi
STRENGT/S 7EA5NESSES
5ne of the )i##est #eneral insurance
com!any
;atest *echnolo#y and Infrastructure to
su!!ort & fasten the ser"ices.
26 hours Eeneral PractitionerAs ad"ice
and medical counselin#
*oll free tele!hone assistance
om!lete +no$led#e )ac+ed $e)site to
offer medical information( includin#
health ti!s..
-ffecti"e Pan India Presence.
first fully Indian o$ned insurance
com!any in India.
Already esta)lished )rand name.
;ar#e amount of s+illed and
e%!erienced man!o$er.
Jery stron# financial )ac+ u!.
All the ran#e of #eneral insurance
!roducts under one roof.
ashless ser"ice $ith *PA inter"ention
hence loose !ersonal touch $ith the
consumer.
;ac+ of @ualitati"e and result oriented
leadershi! in health insurance.
Bnder-utilisation of all the reources li+e
man!o$er( technolo#y(
infrastructure etc.
Bna"aila)ility of ri#orous trainin#
sessions for +no$led#e u!#radation.
Bna"aila)ility of cross chec+in#
mechanism for claim settlement.

O((ORTUNITIES T/REATS
A)ility of local !eo!le to !ay for #ood
ser"ices.
4illin#ness of or!orates to ha"e a tie-
u! $ith the com!any.
;ar#e sector of the !o!ulation not
co"ered under health insurance & e"en is
una$are of the )enefits.
Increasin# !o!ulation #oin# a)road and
hence a"ailin# 5"erseas !olicies.
an !ro"ide all sort of #eneral insurance
!ortfoiio under one roof as a
com!rehensi"e ser"ice !ro"ider.
.
>rom the mal!ractices )ein# re#ularly
done in this form of insurance !ractices.
Bn$illin#ness of !eo!le to )uy health
insurance thin+in# of $asta#e of
money.
1ore no. 5f !ro!osals from senior a#e
#rou!.$ho are in real need of health
care e%!enses.
>raud claims #ettin# a!!ro"ed.
>rom fastly #ro$in# !ri"ate sector
com!anies !ro"idin# #ood ser"ices.
.


'nne#ure 1
(uistionnaire for &ales )anagers
?ame :- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hy you chose to )e a Star0s Sales 1ana#erW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o Ho$ do you a!!roach a !ros!ecti"e consumer W for e%.
Pre"ious contacts or relati"es
Cirectly to un+no$n !erson
Any other 2Please s!ecify3
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hich !olicy you stress more on & for ho$ much of co"era#eW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hat do you mean )y )!e-e.itin+ 'ie"e !lease defineW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hat is the )!oce'#!e fo! c$"im !lease #i"e detailsW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hat are our to$$ f!e no3 >or our re#ion W
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o 4hat are the J#e!ie customer raises $hile you e%!lain them the !ro!osalsW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hat is the m".im#m $imit of time fo! !ene*"$ of the !olicy W
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o In totality ho$ many forms of !olicies S*A< ha"e in it0s !ortfolioW
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
o 4hat do you e%!lain to customer $hile e%!lainin# the !olicies li+e P-C( e%clusions(
)enefits( rene$als etc.W
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VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
Please e%ce!t my sincere than+s for co-o!eratin# me in my !ro,ect $or+.

JUISTIONNAIRE FOR (OLICY /OLDERS
1. >rom $here you #ot the information a)out Star Health & Allied Insurance com!anyW
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2. Ho$ you find !ost !olicy ser"ices of the com!anyW
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'. Ha"e you e"er claimed for your healthcare ser"icesW
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6. If yes ho$ $as the e%!erienceW
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7. Are you satisfied )y the !remium amount this com!any char#e forW
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VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV