- Policy Name
- Star Comrehensive Insurance Policy
- Company Name
- Star Health And Allied Insurance Company Limited
- Customer Care Number
- 18004252255
- Loss Amount
- 79467
- Ratings
- Opposite Party Address
- First Floor,White House,
MC Road,
Nalanchira P.O
Thiruvananthapuram Taluk Kerala 695015
The total Hospitalization expenses incurred was Rs.1,00,018 out of which only Rs.20,000/- is allowed
a. As per the FAQ available in the website of IRDA ( attached herewith).As per the same " Cumulative Bonus means any increase or addition in the sum Insured granted by the insurer without an associated increase in premium". In case of our policy ( whose details are already submitted the sum insured including cumulative Bonus is Rs.10 Laksh for which admissible Delivery Charges – Caesarean Section is Rs.50,000/- against which only 20,000/- is admitted. As per the policy document the Basic sum assured is Rs.5,00,000/- and cumulative bonus is Rs.5,00,000/-. The order of the Insurance ombudsman ( differentiating the terms as " Basic Sum Insured " and " Sum Insured") against this claim made is in favour of the insurance company which does not seem fair. The table of benefits in the Brouchure of the Insurance company uses the term " Sum Insured" and Not " Basic sum Insured"). This aspect and the direction of IRDA is not seen considered by the Insurance Ombudsman
b. Kind attention is invited to the Table ( Schedule of Benefits) in the Stare Health Comprehensive Insurance Policy Brouchre. In the brochure separate amount/ amount limit is provided for delivery charges ( Caesarean Section), Room Rent, Boarding and Nursing charges, ICU/Operation theatre charges). From the schedule of Benefits it is clear that the limit of Rs.50,000/- is only for the expense for conducting the C-Section and not for others. From the Bill given from hospital it is clear that only the C-Section delivery charges is covered under the head of Surgical Services and other Services the total of which amounts to Rs.50551.32/- ( This is already covered under the Rs.50,000/- mentioned in Point a). The other expenses for which claim is admissible is included in the hospital Services (Rs.45,566.99) and Clinical Services ( Rs.3910) which total to Rs.49,466.99. Thsi part of the grievance is not seen addressed by the Insurance Ombudsman
a. As per the FAQ available in the website of IRDA ( attached herewith).As per the same " Cumulative Bonus means any increase or addition in the sum Insured granted by the insurer without an associated increase in premium". In case of our policy ( whose details are already submitted the sum insured including cumulative Bonus is Rs.10 Laksh for which admissible Delivery Charges – Caesarean Section is Rs.50,000/- against which only 20,000/- is admitted. As per the policy document the Basic sum assured is Rs.5,00,000/- and cumulative bonus is Rs.5,00,000/-. The order of the Insurance ombudsman ( differentiating the terms as " Basic Sum Insured " and " Sum Insured") against this claim made is in favour of the insurance company which does not seem fair. The table of benefits in the Brouchure of the Insurance company uses the term " Sum Insured" and Not " Basic sum Insured"). This aspect and the direction of IRDA is not seen considered by the Insurance Ombudsman
b. Kind attention is invited to the Table ( Schedule of Benefits) in the Stare Health Comprehensive Insurance Policy Brouchre. In the brochure separate amount/ amount limit is provided for delivery charges ( Caesarean Section), Room Rent, Boarding and Nursing charges, ICU/Operation theatre charges). From the schedule of Benefits it is clear that the limit of Rs.50,000/- is only for the expense for conducting the C-Section and not for others. From the Bill given from hospital it is clear that only the C-Section delivery charges is covered under the head of Surgical Services and other Services the total of which amounts to Rs.50551.32/- ( This is already covered under the Rs.50,000/- mentioned in Point a). The other expenses for which claim is admissible is included in the hospital Services (Rs.45,566.99) and Clinical Services ( Rs.3910) which total to Rs.49,466.99. Thsi part of the grievance is not seen addressed by the Insurance Ombudsman