Key features and exclusions of Star Health Gain Insurance Plan
- Entry Age: 18 years to 65 years
- Dependent Children: 91 days to 25 years
- Exit Age: No
- Renewal: Lifelong renewal beyond 65 years
- Sum Insured: Rs.1 Lac & Rs.5 Lacs
- Policy Type: Individual & Floater
- Policy Term: 1 year
- Day Star procedure: All day Star procedures are covered
- Room Rent: 1% of Sum insured
- ICU Charges: As per the limits
- Modern Treatments: Covered up to the limits mentioned in the policy
- Emergency Ambulance: For transporting the insured customer to the hospital up to a sum of Rs.750/- per hospitalization and overall limit of Rs.1500 per policy
- Pre Hospitalization expenses: 30 days prior to the date of admission are payable
- Post Hospitalization expenses: 60 days after the date of discharge from hospital are payable.
- Co-payment: This policy is subject to a co-payment of 20% for each and every claim for insured customers whose age is above 61 years.
- Cataract: Up to Rs.40k per eye and up to Rs.60k per policy period
- Pre Existing waiting period: 48 months
- Specific Waiting period: 24 months
- Initial Waiting period: 30 days except for accidents
- Moratorium Period: After completion of 8 continuous years under the policy no look back to be applied. After the completion of the moratorium period, no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.
- Revision of Sum Insured: Reduction or enhancement of sum insured is permissible only at the time of renewal. The acceptance or rejection of such a request would depend on the discretion of the company.
- Obesity and weight control treatments are not covered
- Gender change treatments
- Cosmetic or plastic surgery
- Engagement in Hazardous or Adventure sports
- Claims resulting from Breach of law
- Treatment for Alcoholism, drug or substance abuse or any addictive condition thereof
- Dietary supplements and substances that can be purchased without prescription including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner s part of hospitalization expense.
- Refractive Error less than 7.5d
- Expenses incurred towards Sterility and Infertility
- Congenital external conditions
- Intentional self injury etc
- War, nuclear, chemical or biological attack or weapon
- Expenses incurred on Investigation & Evaluation primarily for diagnosis.
- Expenses for treatments arising directly from or consequent upon any insured person committing a breach of law with criminal intent
- Expenses incurred towards treatment in any hospital or by any medical practitioner or any other service provider specifically excluded by the insurer and disclosed in its website and notified to the policyholders are not admissible.
- Medical or surgical treatment of Endocrine disorders
- Cost of spectacles and contact lens, hearing aids, cochlear implants and procedure related hospitalization expenses, walkers and crutches, wheel chairs etc.
Star Health Insurance Add-ons/Riders
Add-ons or Riders are a form of extra coverage available to the insured customer on payment of additional premiums which are to opted at the time of policy purchase. There are different add-ons with Star Health insurance companies to cover your specific needs at different points in time.There are certain add-ons which are available in the Star health insurance policies on payment of extra premium. They are:
Buy Back Pre-Existing Diseases:
Under this add-on or Rider the pre existing disease waiting period reduces from 36 months to 12 months. The pre existing disease waiting period is the time during which the insurance coverage would not be applicable for the diseases or illnesses or conditions that exist prior to the inception of the policy. If the customer purchases this add-on or rider the pre existing disease waiting period would be reduced from 3 years to 1 year and after the completion of 1 year policy period the customer can avail the benefits of pre existing disease cover from the next year policy period. The add-on is to be purchased at the time of taking the policy and the waiting period is one year from the purchase of first policy date.
Hospital Daily Cash:
Star Health Insurance Company will pay cash benefit of Rs.1000 per day for each completed day of hospitalization subject to a maximum of 7 days per hospitalization and 14 days per policy period. For the purpose of this optional cover, the days of admission and discharge will not be taken into account. The hospital daily cash benefit is available on payment of additional premium by the insured customer at the time of policy purchase. The hospital cash benefit option enables the customer to get his/her petty expenses covered during their stay in the hospital. The hospital daily cash should be reimbursed from the insurance company and doesn’t require any bills to be submitted for the reimbursement to happen. It is important to note that the hospital daily cash benefit is payable only in case of in-patient treatment and not for other treatments.
Star Health Insurance Company will pay the cost of engaging an attendant at the residence of the insured person immediately after discharge from the hospital provided the same is recommended by the physician. Such expenses are payable up to Rs.400 per day for each completed day in the hospital for 5 days per occurrence and a total of 14 days during the policy period. 1 day deductible will be applied for this add-on at the time of claim settlement. This benefit is applicable only for insured persons above 60 years of age and becomes payable only upon a valid claim for hospitalization. The add-on should be purchased at the time of policy start or renewal since the midterm addition of add-on would not be possible.
Star Health Insurance Company pays the Maternity related claim expenses as an add-on to the existing health insurance plan. The maternity cover includes maternity-related expenses such as Child delivery, Abortion, or Miscarriage. In addition to the maternity expenses, the Star health insurance policy also covers the newborn baby expenses. Few of the health insurance plans offer the maternity cover inbuilt while the other plans offer maternity as a rider on payment of additional premium. The maternity add-on has to be purchased at the time of policy issuance or at the time of renewal as the midterm addition is not possible.