Star Cardiac Care Insurance Policy: Coverage, Claim & Renewal

Published: 06-03-2019 10:08:55 AM

Cardio Vascular Disease or Heart Diseases takes the lives of 32% of the global population as per the survey conducted in 2015. Since it drains most of the savings, it is essential to have the necessary financial backup for individuals who have undergone Cardiac surgery. Star Health Insurance provides Star Cardiac Care Insurance Policy for individuals who have undergone a surgery/correction/intervention for any cardiovascular disease for the first time.

What Is Star Cardiac Care Insurance Policy?

It is meant for those individuals who have undergone a surgery/correction/intervention for any cardiovascular disease for the first time. Individual aged between 10 years and 65 years can opt for this policy provided they have undergone any of the following surgeries:

1.  1.Percutaneous Transluminal Coronary Angioplasty (PTCA) / Coronary Artery Bypass Graft (CABG) within seven years period before the commencement of the first policy under this insurance or
2. Atrial Septal Defect (ASD) or Ventricular Septal Defect (VSD) that has been corrected
3. Patent Ductus Arteriosus (PDA) that has been treated
4. RF Ablation or RF Ablation done to correct the underlying cardiac condition
5. Had an Angiogram done but no intervention was medically found necessary

Types of Star Cardiac Care Insurance Policy

The Star Cardiac Care Insurance Policy is offered under two plans:

1. Gold Plan: It covers for both surgical intervention and medical management
2. Silver Plan: It only covers for surgical intervention

The Coverage included under this plan includes:

• Section 1 = Accident and Non-Cardiac ailments
• Section-2 = Cardiac ailments
• Section-3 = Out Patient benefits
• Section-4 = Personal Accidents which may or may not result in Death

Eligibility Criteria

Criteria	Eligibility
Entry Age	Min: 10 years Max: 65 years
Policy Tenure	One year
Sum Assured	RS 3,00,000/- – RS 4,00,000/- only as per sections 1 ,2 and 3 combined. Personal Accident Sum Insured [Section 4] shall be equal to Sum Insured opted by the insured

What Star Cardiac Care Insurance Policy Covers?

Following are some of the coverage provided under the policy:

• Room, boarding, nursing expenses
• Emergency Hospitalisation
• Pre/Post hospitalisation expenses
• Day care treatments
• Treatment of cataract

Claim Process

The claims procedure under Star Cardiac Care Insurance Policy is as follows:

• Contact the customer care 24 hour [TOLL-FREE] help-line for assistance – 1800 425 2255 / 1800 102 4477
• In a scenario when hospitalization is planned, inform 24 hours prior to admission
• In a scenario when hospitalization is done under an emergency, intimate the insurance company within 24 hours post-hospitalization
• All network hospitals are equipped with Cashless Facility
• In non-network hospitals, the payment needs to be made up front and submission of documents will be initiated to avail the reimbursement facility

Document Required For Making Claims

The documents and the procedure for making claims under Reimbursement Claims:

• Claim form which is duly completed and signed along with PAN card copy
• Original pre-admission papers with respect to treatment
• Investigations if applicable
• The discharge summary from hospitals in original format
• Cash receipts of hospitals and chemists in original format to be
• Reports of tests conducted along with their cash receipts
• All original receipts issued from the doctor, anaesthetist, and surgeons respectively
• Certificate from the doctor who attended the patient regarding diagnosis
• In case of a road traffic accident, first report incident(FIR) needs to be submitted too

The documents and the procedure for making claims under Cashless Treatment:

• The ID card issued by the insurance company respectively needs to be submitted to the hospital desk
• The pre-authorization form needs to be obtained from the hospital desk wherein the patient details will be filled and submitted to the health desk
• The treating doctor will fill up the treatment/hospitalization information in the form respectively along with the expected cost of treatment
• If all the details are legally binding, the company will process the request under the terms and conditions of the policy
• Pre and Post Hospitalization receipts and prescriptions are verified and accounted by the Insurance Company

For Section 4 [For the purpose of Accidental Death Claims]

• Death certificate
• Post-mortem certificate, if conducted
• FIR [as per the situations requirement]
• Police investigation report as per the situations requirement]
• Viscera sample report as per the situations requirement]
• Legal heir certificate
• Forensics report as per the situations requirement]
• Succession certificate as per the situations requirement]

Cases Where You Can’t Claim Star Cardiac Care Insurance Policy (Exclusions)

Below are some of the cases where the insurance company is not liable to pay:

• Any plastic surgery [other than those deemed necessary due to accidents or illness]
• Psychiatric, Mental or Behavioural disorders are excluded under this policy
• All Sexually Transmitted Diseases are excluded under this policy
• All procedures which involve the use of Platelet Rich Plasma
• All cochlear implants and related procedures along with their expenses.[Not applicable to Section-3]
• All injuries caused due to involvement in nuclear materials.
• Stem cell therapy.
• All injuries caused during training or competition in professional and semi-professional tournaments.
• Being involved in damage of property under or by order of a local authority or a government body.
• Any loss arising due to the policyholder being involved in any violation of the law.

How Long Does It Take To Pay Out A Claim?

All claims need to be intimated within the duration of 24 hours from hospitalization. Upon getting all the required documents, the insurance company will assess and evaluate them and accordingly settle the claim within 30 days.

Renewal Process Of Star Cardiac Care Insurance Policy

Lifelong renewals are allowed under this policy. Under this policy, the policyholder will get 30 days as a grace period from the date of expiry to renew his policy. It is recommended for an insured to pay timely premium from letting it get lapsed.

Advantages Of Buying Star Cardiac Care Insurance Policy

Following are some of the benefits of buying this policy:

• No need of undergoing Pre-acceptance medical screening
• This policy is portable that means if the insured wants to port this policy, S/he needs to intimate the insurance company 45 days before but not earlier than 60 days from the date of renewal is due
• Free look of 15 days are provided under this policy that lets the policyholder to review the terms and conditions of the policy and return the same if not found suitable
• Premium paid under Star Special Care is eligible for tax benefits under Section 80D of the income tax act 1961

Features Of The Policy

Features	Particulars
Claim Type [In house or TPA]	In-house claim settlement
Pre-Hospitalization	Expenses Incurred for 30 days prior to the date of Hospitalisation
Network Hospitals Count	More than 8800+ network hospitals are covered
Post-Hospitalization	Post Hospitalisation expenses to be incurred up to 7% of the hospitalization expenses subject to a maximum of Rs 5000/- per hospitalization. This cannot be availed for a period exceeding 60 days.
Room Eligibility	Room [Single A/C standard], Boarding and Nursing expenses subject to a maximum of RS 5000/- per day.
Restoration of Cover	–
Share Claim Payments	10% of each and every claim for insured persons beyond 60 years of age at entry level
No Claim Bonus
Ambulance Charges	As per pre and post hospitalization charges
Worldwide Coverage	Applicable under the policy[Under Section 4]
Maternity Cover	Not covered
Hospitalization at Home	Not covered
Day-Care Treatment	Covered
Non-Allopathic Treatment Charge	Not covered
Emergency Ambulance	Covered up to maximum of Rs 750/- per hospitalisation and Rs 1500/- per policy period
Health Check up	Not applicable

FAQ’s

Q1- Are outpatient expenses covered under this policy?

Yes, outpatient medical expenses are covered provided they have been incurred in Network Hospitals. The limit of this benefit is Rs 500/-per event and Rs 1500/- per policy period.

Q2 – Is there any waiting period under this policy?

Yes, it has and varies from different section under which the insured is covered under

Section 1

30 days waiting period for illness/disease/treatment

24 months for specified illness/disease/treatment

48 months for Pre-existing disease

Section 2

90 days waiting period irrespective of whether it is pre-existing or not

Section 3&4: No waiting period

Q3- What is the co-payment under the policy?

The co-payment under the policy is 10% of each and every claim amount for policyholders that are 60 years or more at either entry level or at the time of renewals.

Q4-Are injuries being sustained in war excluded under this policy?

All injuries contracted in war are excluded under this policy.