Star health family health optima insurance

Star Family Health Optima insurance review

• Key features of Star Family Health Optima Insurance

  • Room Rent: Capped at ₹2,000 / ₹5,000 / Single Standard A/c based on Plan SI
  • Co-pay: NIL for insurance < 60 yrs/ 30% co-pay for ages > 60 yrs
  • Restoration Benefit: Thrice upto 100% of Base SI for plans with SI > 3 lacs
  Highlights of Family Health Optima insurance

  This is one of the largest selling plans under the Star Health umbrella of products. The unique features of this plan include:

  • Single policy, broader coverage at an affordable premium for the entire family
  • Eligibility for Coverage
    • Adults: 18 to 65
    • Dependent children: 16 days old to 25 years (can cover upto 3 children)
  • 7 Sum Insured options - 3 lacs, 4 lacs, 5 lacs, 10 lacs, 15 lacs, 20 lacs, 25 lacs
  • With Auto Recharge option additional coverage at no additional cost
  • Automatic Restoration of Sum insured by 100% upon complete exhaustion available 3 times.
  • Free Look Period - 15 days
  • 60 days of Pre-hospitalization & 90 days of Post-hospitalization Expenses Covered on actual cost
  • Additional Sum Insuredupto 25% of Sum Insured - Max 5Lac for Two Wheeler Road Accidents
  • Health Check-up Benefit for every claim free year.
  • Domiciliary Hospitalization Expenses for treatment exceeding 3 days.
  • CoversAll Day Care procedures - Cataract with enhanced coverage limits
  • Assisted Reproduction (Infertility) Treatment Coverage - up to Rs. 2 Lac - Every block of 3 years
  • Free Medical Second Opinion

• Family Health Optima Insurance Plan Benefits (All Amounts in ? INR)

  3 lac	4 lac	5 lac	10 lac	15 lac	20 lac	25 lac
  Policy Period
  1 year	1 year	1 year	1 year	1 year	1 year	1 year
  Family Definition
  Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children	Upto Primary Insured + Spouse + 3 children
  Hospitalisation - Room Rent limit per day
  Upto 5,000	Upto 5,000	Single Standard A/C	Single Standard A/C	Single Standard A/C	Single Standard A/C	Single Standard A/C
  ICU / Operation Theatre Charges
  Actual	Actual	Actual	Actual	Actual	Actual	Actual
  No. of Daycare Treatments / Procedures Covered
  All Daycare Procedures covered	All Daycare Procedures covered	All Daycare Procedures covered	All Daycare Procedures covered	All Daycare Procedures covered	All Daycare Procedures covered	All Daycare Procedures covered
  Sub Limits for Treatment of Cataract as Daycare (per episode / per policy period)
  25,000 / 35,000	30,000 / 45,000	40,000 / 60,000	50,000 / 75,000	50,000 / 75,000	50,000 / 75,000	50,000 / 75,000
  Ambulance Charges by Road (per policy period)
  Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period	Upto 750 per hospitalisation and maximum of 1,500 per policy period
  Air Ambulance (per policy period)
  -	-	Upto 10% of Sum Insured	Upto 10% of Sum Insured	Upto 10% of Sum Insured	Upto 10% of Sum Insured	Upto 10% of Sum Insured
  Pre Hospitalisation Expenses incurred
  Upto 60 days	Upto 60 days	Upto 60 days	Upto 60 days	Upto 60 days	Upto 60 days	Upto 60 days
  Post Hospitalisation Expenses incurred
  Upto 90 days	Upto 90 days	Upto 90 days	Upto 90 days	Upto 90 days	Upto 90 days	Upto 90 days
  Domiliciary Hospitalisation - for period exceeding 3 days
  Covered	Covered	Covered	Covered	Covered	Covered	Covered
  Organ Donor
  Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000	Upto 10% of Sum Insured and maximum of 1,00,000
  Free Annual Health Check Up (available after every claim free year on the policy)
  750	1,000	1,500	2,000	2,500	3,000	3,500
  New Born Baby Cover (provided mother is insured for 12 months without a break)
  Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth	Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth
  Emergency Domestic Medical Evacuation (per Hospitalisation)
  Upto 5,000	Upto 5,000	Upto 7,500	Upto 7,500	Upto 7,500	Upto 10,000	Upto 10,000
  Compassionate Visit (Travel)
  -	-	-	Upto 5,000 per Hospitalisation	Upto 5,000 per Hospitalisation	Upto 5,000 per Hospitalisation	Upto 5,000 per Hospitalisation
  Repatriation of Remains
  Upto 5,000 per policy period	Upto 5,000 per policy period	Upto 5,000 per policy period	Upto 5,000 per policy period	Upto 5,000 per policy period	Upto 5,000 per policy period	Upto 5,000 per policy period
  Treatment in Preferred Network Hospitals (payable as lump sum)
  Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period	Upto 1% of Sum Insured subject to maximum of 5,000 per policy period
  Shared Accomodation (benefit per day)
  800	800	800	800	800	1,000	1,000
  AYUSH Treatment
  Upto 10,000	Upto 10,000	Upto 15,000	Upto 15,000	Upto 15,000	Upto 20,000	Upto 20,000
  Second Medical Opinion
  Covered	Covered	Covered	Covered	Covered	Covered	Covered
  Assisted Reproduction Treatment (after a waiting period of 36 months)
  -	-	Upto 1,00,000	Upto 2,00,000	Upto 2,00,000	Upto 2,00,000	Upto 2,00,000
  Automatic Restoration of Basic Sum Insured (3 times during the policy period, 100% each time)
  Covered	Covered	Covered	Covered	Covered	Covered	Covered
  Recharge Benefit (Provided once during the policy period)
  75,000	1,00,000	1,50,000	1,50,000	1,50,000	1,50,000	1,50,000
  Waiting Period
  30 days - for fresh proposals excluding Accidental Hospitalisation
  Covered	Covered	Covered	Covered	Covered	Covered	Covered
  24 months - for specified illness / diseases
  Covered	Covered	Covered	Covered	Covered	Covered	Covered
  48 months - for Pre Existing Diseases )
  Covered	Covered	Covered	Covered	Covered	Covered	Covered

• Eligibility of Family Health Optima health Plan

  • Anyone between the ages of 18 and 65 who lives in India can take this insurance.
  • Only renewals after 65 years.
  • It is possible to cover children from the age of 16 as part of the family.

• Claims Settlement Process for Star Health Insurance

  Cashless Claim Procedure during hospitalization
  Cashless Claim: a six step process

  • Step 1 - Approach the insurance desk at a network hospital. Intimation can be given either through contacting us at 1800 425 2255 / 1800 102 4477 or e-mail us at support@starhealth.in
  • Step 2 - Show your Star Health ID card for identification purpose at the hospital reception.
  • Step 3 - Submit to the hospital Pre admission investigations and Doctor’s consultation papers.
  • Step 4 - Network hospitals will verify your identity and submit duly filled pre - authorization form with Star Health.
  • Step 5 - Our doctors verifies all the submitted documents before processing the claim as per terms and conditions. An assigned field doctor may visit the patient at the hospital if required.
  • Step 6 - After discharge, the hospital will send the claim documents to the company and the authorized amount will be settled directly to the hospital.

  (Note: Non-Payable items would be at the insured's own cost)
  a) In case of planned hospitalization:

  • Please contact the toll-free help line: 1800 425 2255 / 1800 102 4477
  • The hospital will send the duly filled pre-authorization from through hospital portal (or) at the below number (or) Email ID
    • Call : Toll-free FAX: 1800 425 5522 (or)
    • Call : Non Toll-free FAX: 044 -28302200
    • Email : cashless.network@starhealth.in
  • Please carry your ID card.

  b) Procedures to be followed in case of emergency hospitalization:In case of Emergency like accident or sudden bout of illness may that requires immediate admission to the hospital

  • Upon receiving intimation from the insured/insured’s attender, they are contacted by the network hospital
  • Customer Care will verify the validity and coverage of the policy
  • A field visit doctor is deputed to visit the patient at the hospital if required.
  • Our medical team will process the cashless request for the insured person subject to policy terms and conditions.

  c) Cashless claim authorization process

  • Upon receiving intimation from the insured/insured’s attender, they are contacted by the network hospital.
  • Customer Care will verify the validity and coverage of the policy
  • A field visit doctor is deputed to visit the patient at the hospital if required
  • Our medical team will process the cashless request for the insured person subject to policy terms and conditions.

  d) Documents required for cashless claim submission by Hospital

  • Health card
  • Doctor's consultation papers
  • Discharge summary
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  • KYC documents of the insured if claimed amount exceed Rs.1, 00,000/-

  (Note: Documents other than the Health Card should be submitted in original)
  

  When the Insured gives prior intimation about the treatment and the insured pays the expenses himself with the hospital and then claims for a reimbursement of those expenses within 15 days from the date of discharge.

  Reimbursement Claims Procedure following hospitalization

  Procedure for Reimbursement of Claim

  • All claims need to be intimated within 24 hours of hospitalization. Reimbursement facility is available at network hospitals as well as at non-network hospitals
  • Avail treatment, settle all bills and file a claim for reimbursement.
  • Submit the claim documents to the company within 15 days from the date of discharge.
  • To receive Star Health Insurance claim form, cite your policy number and intimate Star Health about hospitalization.

  Reimbursement Claim Procedure

  • Upon discharge, pay all hospital bills and collect all original documents of treatment undergone and expenses incurred.
  • Star Health Claim form has to be filled in and along with, all the relevant original documents have to be submitted at the nearest Star Office
  • We settle the claim in subject to policy terms and conditions.
  • Non-Payable items would be at the insured's own cost.

  Documents required for reimbursement claim submission

  • Copy of Health card
  • Duly filled claim form
  • Pre admission investigations and Doctor's consultation papers
  • Discharge summary from hospital in Original.
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • Case receipts from hospital, chemist
  • In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  • Copy of the KYC documents - NEFT details, Contact number and E-mail ID

• How can one Buy a Star Health Insurance cover?

  Today in the India market, it is not very difficult to purchase an appropriate Health insurance plan, on the contrary it is relatively simple if one follows the defined steps below:

  • Step 1- Visit a product comparison website like eindiainsurance to review and compare policy benefits, coverage and premium details online
  • Step 2 - Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy
  • Step 3 - Fill the online Star Health Insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate
  • Step 4 – Star Health will then process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy medical examination at Star Health’s network diagnostic centers.
  • Step 5 - Depending on Star Health team’s evaluation, if the proposal is accepted, then they will issue the policy subject to receipt of annual single premium as published on the website and remitted online through the payment gateway
  • Step 6 - Please note that the proposer will have to pay the necessary amount for undergoing the specified medical examination and such tests shall be valid for a maximum period of 30days only…however, if the policy is issued we will refund you 100% of the cost of the pre-policy medical examination
  • Step 7 - The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form

• Exclusions under the Star Health Policy

  Some of the major exclusions under the policy are listed below, kindly go through the entire list of exclusion in the policy kit which accompanies the insurance policy:

  • Congenital External Condition / Defects / Anomalies (except to the extent provided under Section specific to a New Born infant).
  • Intentional self injury.
  • Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing.
  • Venereal Disease and Sexually Transmitted Diseases,
  • Injury/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, warlike operations (whether war be declared or not)
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials
  • Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity (except to the extent provided as per “Coverage” of the opted policy variant)
  • Expenses incurred on High Intensity Focused Ultra Sound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain Stimulation, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low level laser therapy, Photodynamic therapy and such other therapies similar to those mentioned under this exclusion
  • Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home. Admission primarily for diagnostic purpose with no positive existence of sickness / disease / ailment / injury and no further treatment is indicated
  • Unconventional, Untested, Unproven, Experimental therapies
  • Stem cell Therapy, Autologous derived Stromal vascular fraction, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy
  • All types of Cosmetic, Aesthetic treatment of any description, all treatment for Priapism and erectile dysfunctions, Change of Sex
  • Plastic surgery (other than as necessitated due to an accident or as a part of any illness)
  • Inoculation or Vaccination (except for post–bite treatment and for medical treatment for therapeutic reasons)
  • Dental treatment or surgery (in excess of what is specifically provided) unless necessitated due to accidental injuries and requiring hospitalization
  • Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these (other than ectopic pregnancy and to the extent covered under polic variant)
  • Medical and / or surgical treatment of Sleep apnea, treatment for genetic and endocrine disorders. Expenses incurred on Lasik Laser or other procedures Refractive Error Correction and its complications, all treatment for disorders of eye requiring intra-vitreal injections
  • Cochlear implants and procedure related hospitalization expenses
  • Cost of spectacles and contact lens (in excess of what is specifically provided), hearing aids, Cochlear implants and procedures, walkers and crutches, wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar aids.