Star Criticare Plus Insurance Policy: Coverage, Claim & Renewal

Updated: 28-08-2023 07:26:32 AM

With increasing medical expenses, health insurance has become necessary more than a choice. Star health presents Star Criticare Plus Insurance policy which protection against critical diseases.

What is Star Criticare Plus Insurance policy?

This health insurance policy reimburses hospitalisation expenses incurred due to illness, disease, sickness or accidental injuries. Along with that, it also provides lump sum amount to the insured if he is diagnosed with a major illness listen in the policy for the first time during the policy period. The major diseases covered under this policy are:

• First diagnosis of cancer, chronic kidney disease, brain tumor
• Undergoing major organ transplant for first time
• Cerebro Vascular Stroke causing Hemiplegia, Acute Myocardial Infarction when it occurs for the first time
• Established irreversible, irreversible Paraplegia, irreversible Quadriplegia coma occurring for the first time

Types of Star Criticare Plus Insurance Policy

This policy is per individual members covered. This policy covers two sections:

Section-1 deals with all illness except the major ones

Section-2 deals with all the nine major/critical illness that the policy covers for.

Eligibility Criteria

Criteria	Eligibility
Entry Age	Min: 18 years Max: 65 Years Residing in India
Sum Insured	Rs 2 lakh, Rs 3 lakh, Rs 4 lakh, Rs 5 lakh, Rs 10 lakh

What Star Criticare Plus Insurance policy Covers?

Following coverage is provided under this policy:

• In-patient hospitalisation expenses for a minimum of 24 hours including room rent
• Consultant’s fees
• Cost of medicine and drugs
• Emergency ambulance
• Non allopathic treatment

Claim Process

The claims procedure under this 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 prior to admission [24 hours]
• In a scenario when hospitalization is done under an emergency, intimation should be sent to the hospital within 24 hours
• All network hospitals can avail Cashless Facility for filing the claim
• In non-network hospitals, the payment needs to be made up front, and reimbursement claims can be generated after the submission of the relevant documents.

Document Required For Claim Process

The documents to be submitted under Reimbursement Claims,

• Claim form which is duly completed along with a copy of PAN card
• Original pre-admission treatment papers along with investigations
• Discharge summary in original documents from the hospital
• Receipts [cash] of hospitals and chemists in original format
• Test re conducted along with their cash receipts
• All original receipts from the doctor, anaesthetist, and surgeons
• Certificate from the doctor who attended the patient regarding diagnosis

The documents to be submitted under Cashless Treatment are,

• The ID card issued by the insurance company needs to be forwarded to the hospital desk to initiate cashless treatment
• The pre-authorization form needs to be obtained from the hospital desk and further submitted to the insurance company after the treating doctor will fill up the treatment/hospitalization information along with the expected cost of treatment
• If all the details are legally binding, the company will follow through on the request under the terms and conditions of the policy in place
• Pre and Post Hospitalization receipts and prescriptions are verified and accounted by the Insurance Company

Cases Where You Can’t Claim Under Star Criticare Plus Insurance Policy (Exclusions)

• Naturopathy treatment
• All expenses incurred on Lasik Laser treatment
• All expenses incurred on Refractive Error Correction treatment
• Any diseases which may be contracted during the first 30 days of the policy after the commencement dates
• Any injuries or diseases which have been contributed from War
• Any injuries or diseases which have occurred due to involvement in nuclear materials/machine
• Use of intoxicating drugs or alcohol
• Intentional self-injury
• All internal and external congenital diseases or defect

How Long Does It Take To Pay Out A Claim?

The claims need to be intimated within the duration of 24 hours [under 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 Criticare Plus Insurance policy

There is no exit age under this policy. If the insured wants to increase the sum insured, he can do so only at the time of renewal. 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 before his policy gets lapsed.

Advantages Of Buying Star Criticare plus Insurance Policy

• Lump sum compensation expenses in addition to payment of hospitalization expenses. These expenses would be paid only till the date of diagnosis of the major illness
• Free look period of 15 days is provided under this policy
• 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
• Non allopathic treatments are covered

Critical Aspects

• Only one lump sum payment can be made during the life time irrespective of the number of the major illness suffered by the insured person
• There is no survival period, only waiting period of 90 days from the date of inception of policy
• Pre-existing disease are covered after 48 months of continuous insurance

Features of Star Criticare Plus Insurance Policy

 

Features
Claim Type (In-House or TPA)	In-house claim settlement
Pre-Hospitalization	Expenses to be incurred 30 days before the date of Hospitalisation
Network Hospital Count	More than 8800+ network hospitals are covered
Post-Hospitalization	Expenses paid as lump sum [7% of hospitalization expenses] up to the limit specified
Room Eligibility	Room, Boarding and Nursing Expenses are inclusive as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to a maximum of Rs 4,000 per day
Share Claim Payments	30% of each and every claim
Restoration of Cover	NA
No Claim Bonus	NA
Worldwide Coverage	NA
Maternity Cover	Covered
Hospitalization at Home	NA
Day Care Treatment	Specific day care procedures are covered under Section-1
Non-Allopathic Treatment Coverage	Covered up to 25%of sum Insured subject to a maximum of Rs 25,000/- per policy period
Emergency Ambulance	Expenses covered up to a sum of RS 750/-per hospitalization and Rs 1500/- per policy period
Health Check-up	NA

Also Read: Star Net Plus

FAQ’s

Q1-Is family discount provided under this policy?

Yes, it is provided up to two members at 5% and for more than two members at a 10% discount.

Q2-Does this respective policy provide tax benefits?

Yes, it does under the provision of section 80D of Income Tax Act, 1961.

Q3- Does this particular policy cover for Non-Allopathic treatments?

Yes, it covers for Non-Allopathic treatment. They are restricted up to 25% of the sum insured which is subject to a maximum of Rs 25,000/- in the entire policy period.