Star Health Insurance- Family Health Optima Insurance Plan:
Key features and exclusions of Star Health Insurance- Star Family Health Optima Plan
- Entry Age: 18 years to 65 years
- Exit Age: No
- Renewal: Lifelong renewal beyond 65 years
- Policy Type: Individual/ Floater
- Dependent Children Age: From 16 days from the child birth to 25 years of age
- Sum Insured: Rs.3 lacs to Rs.25 Lacs
- Pre- acceptance medical test: All persons above 50 years of age and those who declare adverse medical check history in the proposal form are required to undergo pre-acceptance medical screening at the company designated centres the cost of which would be borne by the insurance company.
- Day Star procedure: All day Star procedures are covered
- Mid-term inclusion: Newly married/ wedded spouse & New Born baby allowed.
- Room Rent: From Rs.2k per day up to Single standard A/C Room
- ICU Charges: Actual
- Road Ambulance: Covered up to Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period.
- Air Ambulance: Up to 10% of policy S.I per policy period. Available for Sum insured of Rs.5 lacs and above.
- Pre-Hospitalization: 60 days prior to the date of hospitalization
- Post hospitalization: 90 days from the date of discharge from hospital
- Coverage for modern treatments: Available
- Domiciliary Hospitalization: Covered for medical treatments (including AYUSH) for a period exceeding three days, for all illness/ disease/ injury
- Organ Donor expenses: Payable where the insured is the recipient, maximum payable under the head is 10% of the sum insured or Rs.1 Lacs whichever is less.
- Health Check up: Up to Rs.3500 once in a block of every claim free year provided the health insurance policy is in force
- Coverage for New Born Baby: Starts from 16th day after its birth till the expiry of the policy and is subject to a limit of 10% of the sum insured or Rs.50k whichever is less; subject to availability of the sum insured.
- Emergency Domestic Medical Evacuation: Up to Rs.10k would be reimbursed by the insurance company in case of expenses incurred towards transportation of the insured person from hospital where the insured person is currently undergoing treatment to another hospital for further treatment.
- Compassionate Travel: Provided in the event of the insured person being hospitalized for a life threatening emergency at a place away from his usual place of residence as recorded in the policy, up to Rs.5k would be reimbursed for one immediate family member for travel towards the place where the hospital is located.
- Repatriation of Mortal Remains: Up to Rs.5k per policy period would be reimbursed toward the cost of mortal remains of the insured person to the residence of the insured.
- Treatment in Valuable Service providers: in the event of medical emergency if the insured customer asks for advice of the insurance company regarding the hospital to undergo the treatment, insurance company would advice on a network hospital nearby for which the customer would be eligible for a lumpsum amount of Rs.5k or 1% of the sum insured.
- Shared Accommodation: If the insured person occupies a shared accommodation during in-patient treatment, then the insurance company would pay up to Rs.1k per day for such stay.
- Recharge Benefit: Up to Rs.1.5lacs during the policy period
- Cover for Accidental death and Permanent Total Disability: Up to Rs.1 Cr
- AYUSH Treatment: Up to Rs.20, 000/-
- Star Health Wellness program: Available
- Buy Back Pre-existing disease add-on: Available
- Second Medical opinion: Available
- Assisted Reproduction treatment: The Star insurance company will reimburse medical expenses incurred on assisted reproduction treatment up to a liability of Rs.2 Lacs after a waiting period of 36 months.
- Accidental Basic Sum insured for Road Traffic Accident (RTA): If the insured person meets with a Road traffic accident resulting in in-patient hospitalization, then the basic sum insured shall be increased by 25% subject to a maximum of Rs.10 Lacs subject to the terms and conditions mentioned under the policy.
- Cataract Surgery: Up to Rs.75k per policy period
- Cumulative Bonus: Up to 25% of the base policy sum insured for first claim free year and 10% from the second claim free year subject to the maximum allowable bonus not exceeding 100%.
- Co-payment: 20% co-pay for each and every claim for insured person whose age at the time of entry is 61 years and above.
- 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 are 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 on 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, wheelchairs, etc.
Key Features of Star Health Insurance Company
Star Health insurance plan offers comprehensive health insurance plans which make the best choice for you and your family and senior citizens, etc. Some of the exclusive features and tax benefits offered by Star health insurance company are
Star Wellness Program:
This program intends to promote, incentivize and reward the insured person’s healthy lifestyle through various wellness activities. The wellness activities are designed to help the insured person earn wellness reward points which will be tracked and monitored by the insurance company. These wellness points can be utilized by the insured to claim discounts on the renewal premium. The following table shows the discount on premium available under the wellness program:
|Wellness points earned
||Discount on premium
Star Health In-House Claim Settlement:
Star Health & Allied insurance company has no Third-party administrators to settle the claim. All the reimbursement and cashless claims are settled through the in-house claim settlement team of Star insurance company. This is an advantage to the customer as the in-house claim settlement would be available round the clock.
The customer’s reimbursement claim would also be settled within a few days as there would be no involvement of a third party in the claim settlement process. The in-house claim settlement process was proved to reduce the claim settlement time and has also improved customer satisfaction.
Faster & Hassle-free claim settlement:
The main purpose of taking a health insurance policy is to avail cashless/ reimbursement facility at the time of hospitalization and to reduce the chance of going bankrupt due to the hospitalization expenses which may involve in disposing of the assets such as Gold or other properties.
If the claim settlement is not faster and hassle-free the insured customer would suffer a lot and the use of insurance policy would be limited. Star Health Insurance Company provides faster claim settlement service to their customers, in case of cashless claim settlement 90% of the claims are settled within 2 hours, and in case of reimbursement claim settlement would be done within 7 days from the receipt of all the required documents and it gives 24 hours service to their customers.
All the claims settled by Star Health Insurance Company are hassle-free as the claim settlement process is made simpler and faster. The duly filled claim settlement form should be filled by the insured customer and submitted to the insurance company along with the discharge summary and other bills for the claim to be processed within the time limit mentioned in the policy document.
Star Health Insurance Company has tied up with more than 10, 000 hospitals and diagnostic centers to provide cashless claim settlement service to its customers. The cashless claim settlement facility can be availed by the customers in any of the network hospitals or tie-up hospitals pan India.
Most customers prefer to avail of cashless service at the time of hospitalization due to the comfort it offers to the customers. Almost 90% of the cashless claims are approved and settled within 2 hours of notifying the insurance company. All the major hospitals in India are tied up with Star Health and Allied insurance company.
Automatic Restoration of Sum Insured:
Automatic restoration of the sum insured is the restoration of the sum insured upon complete exhaustion during the policy period. The sum insured would be restored up to 3 times during the policy period without any extra premium to be paid. The sum insured restored under the policy can be used only for the new illness or a new family member for the same illness. It is to be noted that the restoration happens only after the complete exhaustion of the sum insured available in the policy.
Super Restoration of Sum Insured:
If the limit of coverage under this policy is exhausted during the policy period, an additional basic sum insured of 100% would be provided once, for the remaining policy period for subsequent hospitalization. Under the Super Restoration plan, the sum insured would be restored up to 100% of the basic sum insured and the same can be utilized for the same ailment in subsequent hospitalization.
The difference between the Automatic restoration of the sum insured and Super restoration of the sum insured is that the reinstated sum insured can be used for the same illness in the latter while the former doesn’t have this option. Super restoration of the sum insured is like an additional sum insured given to the insured for treatment of existing or new illnesses.
The unutilized additional basic sum insured cannot be carried forward at the end of the policy period during the renewal. The super restoration of the sum insured is not available for modern treatments. The super restoration of the sum insured is done only once during the policy period.
Star Health Insurance Company provides customers with installment options for the health insurance premiums. The health insurance premium can be paid in installments for long-term health insurance policy periods. Installment options help the customers to pay the health insurance premium more than once during the policy period. This way customers can save money by opting for higher coverage and paying later.
No pre-acceptance medical screening:
Most of the health insurance plans in Star Health Insurance Company do not require pre-acceptance medical screening for the policy issuance. The pre-acceptance medical screening would be required only in few cases such as Higher sum insured selection, adverse health conditions declared in the proposal form, etc. The pre-acceptance medical screening would be done at the company network diagnostic centers where the cost of screening would be borne by the Star health insurance company. For more details please refer to our website