National Insurance Company Ltd.

Star National Swasthya Bima Policy

1. Salient Feature
2. Scope of Cover
3. Additional Features
4. Exclusions
5. Premium Payable

Star National Swasthya Bima policy is a unique Health Policy designed especially for the Account

holders of Bank of India.  The entire family consisting of the account holder, spouse and two

dependent children upto the age of 21 years can be covered under this policy.

This policy covers Hospitalization expenses for account holder and family.  In case of Hospitalization

Expenses, the entire family is covered for the Floater Sum Insured as opted for, i.e., either one or all

members of the family, as stated above, can utilize the Sum Insured during the policy period.

Age: 3 months to 65 years.  However, renewals are allowed upto 80 years at a premium to be fixed

by the Company.

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2. Scope Of Cover

1) Room, Boarding expenses as provided by the Hospital/Nursing Home.

2) Nursing expenses.

3) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

4) Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines &

Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker,

Artificial Limbs and cost of organs and similar expenses.

5) Coverage options – 8 Slabs ranging from Rs.50,000/- to Rs.5,00,000/-, is available.

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3. Additional Features

Additional Covers:

1) Ambulance Charges - In case of emergencies, reasonable amount can be reimbursed not

exceeding Rs.1000/- (Rupees one thousand only) per Policy period.

2)  In case of Hospitalisation of children below 12 years, a lump sum amount of Rs.1000/- (Rupees

one thousand only) per policy period towards the out-of-pocket expenses. The payment will be made

on the basis of a declaration from the parent without insisting on any supporting bill/cash memo.

3) Cost of Health Check-up allowed @ 1% of the Sum Insured after completion of three continuous

claim free years of policy.

4) Pre & Post Hospitalisation Expenses for first 30 days and 60 days respectively.

5) Pre-existing diseases are not covered.  However, Pre-existing diseases will be covered after three

consecutive continuous claims free policy years which include policies taken from other Insurance

Companies.

6) Maternity Benefit and Baby Care Expenses are also reimbursed upto 5% of the sum insured.

7) Treatment of NRIs in Indian Hospitals is allowed.

8) Treatment in Hospitals in Nepal and Bhutan are also covered in Indian Currency.

9) In case of death in hospital, funeral expenses are reimbursed upto Rs.1,000/- over and above the

sum insured subject to original illness/accident claim admitted under the policy.

Children aged between 3 months and 5 years can also be covered, provided that one or both

parents are covered concurrently.

Other Features:

1.                   Hospitalisation expenses, the entire family is covered for the Floater Sum Insured as

             opted, i.e. either any one or all of the entire family, as stated above, can avail of the Sum

             Insured opted.

2.                   Tax benefit available under Section 80D of IT Act.

3.                   Premium will be paid through the Bank.

4.                   Period of Insurance one year.

5.                   The claims will be serviced by TPAs.

6.                   Minimum hospitalisation for 24 hours.

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4. Exclusions

1. All diseases/injuries, which are pre-existing when the cover incepts for the first

time. This exclusion will be deleted after three consecutive continuous claims free

policy years in respect of all diseases provided, there was no hospitalisation for pre-

existing ailment during such three years of insurance.For this purpose policy/policies

issued by other insurance companies for last three continuous consecutive years will be

considered,provided there was no hospitalisation for pre-existing ailment during such

three years of insurance.

2. Any hospitalization expenses incurred in the first 30 days from the commencement

date of Insurance cover except in case of Injury arising out of accident.

3. During the 1^styear of operation of insurance cover the expenses on treatment of

diseases such as Cataract, Benign, Prostatic Hypertrophy, and Hysterectomy for

Hemorrhagic, or Fibromyoma, Hernia, Hydrocele, congenital internal disease, Fistula in

anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre

existing it will be covered after three consecutive continuous claims free policy years.

4. Circumcision, vaccination or inoculation or change of life or cosmetic or aesthetic

treatment of any description, plastic surgery other than as may be necessitated due to

an accident or as apart of any illness.

5. Cost of spectacles and contact lenses, hearing aids.

6. Dental treatment or surgery of any kind unless requiring hospitalization.

7. Convalescence, general debility, run-down condition or rest cure, congenital

external disease or defects or anomalies, Sterility, Infertility, Venereal disease,

intentional self injury and use of intoxication drugs/alcohol, AIDS.

8. Charges incurred at Hospital or Nursing Home primarily for diagnosis purpose.

9. Expenses on vitamins and tonics unless forming part of treatment for injury or

diseases as certified by the attending physician.

10.Expenses in excess of 5% of the Sum Insured as mentioned in the schedule due to

treatment arising from or traceable to pregnancy (including voluntary termination of

pregnancy) and child birth (including Caesarean Section) and allied maternity

benefits.No expenses will be payable for any treatment arising from or traceable to

Voluntary Termination of Pregnancy.

11. Naturopathy Treatment.

12. The benefits like Cumulative Bonus and Cost of Health Check up,enjoyed under the

previous Policy/Policies, issued by any other Insurance Company shall not be available

under this Policy.

(N.B. Company's Liability in respect of all claims admitted during the period of

Insurance shall not exceed the Floater Sum Insured per family as mentioned in the

schedule).

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5. Premium Payable

Floater Sum Insured (Rs.) Premium including Service Tax at 12.24% (Rs.)

50,000 930/-

1.0 lac 1,746/-

1.5 Lac 2,635/-

2.0 lacs 3,390/-

2.5 Lacs 4,059/-

3.0 lacs 4,729/-

4.0 lacs 5,899/-

5.0 lacs 7,071/-

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6. Claims Procedure

Hospilisation Claims will be settled by the Third Party Administrators (TPA).

The details of the claims procedure for emergency/planned hospitalization and the

contact phone nos. of TPA’s are given in the TPA Guidebook. Insured as well as the

Family is eligible for both cashless treatment and reimbursement of claims.

Name of the Third Party Administrator:

(To be selected from the Approved list of TPAs)

Documents to be submitted:

A)For Cashless Claim(If treatment is taken in the panel hospital of TPA):

“Pre Authorization Form” given in the TPA Guide Book.

B)Reimbursement (If treatment is taken in hospital not in panel of TPA)

1.Claim form

2.Discharge Summary

3.Prescription with bills

4.Test Reports

5.Any other documents required by NICL/TPA.

NICL office will take decision on the basis of documents submitted and the terms,

conditions, exceptions and exclusions of the policy.

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7. General Instructions

The Prospectus contains the details of the policy.
The Proposal Form attached to this Prospectus should be duly filled and

submitted to the Bank of India Branch, where the a/c. holder has an a/c.

2 stamp size photographs of insured and covered family members to be

affixed/attached in the Proposal form for making ID cards by TPA.

The premium will be deducted from the a/c.by the bank and paid to National

Insurance Co. Ltd.,

Effective date of cover will be from the date of receipt of premium by NICL

DO/BO.

A Receipt, Policy & IT Certificate will be issued by NICL.
The TPA will send Guide Book & ID Cards to the insured.
Details of the policy will be available with Bank of India, National Insurance

Company Ltd., Third Party Administrators.

Premium paid is eligible for IT benefit.

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