Star Family Health Optima Insurance Policy : Coverage, Claim & Renewal

Updated: 06-03-2019 08:54:22 AM

In this dynamic world of uncertainties, an Insurance plan provides financial security with respect to both individual and family aspects. Insurance acts as a financial reserve for the policyholder which in the near future may help them cater their financial needs. Star Health Insurance Company provides Star Family Health Optima Insurance Plan which caters to the needs of a growing family on a floater basis.

What Is Star Family Health Optima Insurance Policy?

It is a super saver plan which covers the entire family under single sum insured. This plan helps to save premium as the whole family is covered under one policy. Anyone between the age of 18 years and 65 years can get themselves covered under this policy.

Types of Star Family Health Optima Insurance policy

Star Family Health Optima Insurance Plan is provided under Floater basis to Self, Spouse and dependent children not exceeding three in number

Eligibility Criteria

Criteria	Eligibility
Entry Age	Min: 18 years Max: 65 years who is residing in India
Policy Tenure	One year
Sum Insured	Rs 1,00,000/- , Rs 2,00,000/- , Rs 3,00,000/- , Rs 4,00,000/- , Rs 5,00,000/- , Rs 10,00,000/- , Rs 15,00,000 /- , Rs 20,00,000/- and Rs 25,00,000/- only.
Dependent Children	Covered from the 16th day of Birth to the policy expiry date

 What Star Family Health Optima Insurance Policy Covers?

Below are some of the coverage provided by the Star health under this plan:

• Room, boarding and nursing expenses
• Consultants, specialist fees
• Anaesthesia, blood, cost of pacemaker
• Emergency ambulance and air ambulance
• Pre & Post hospitalisation
• Day Care procedures

Claim Process

The claims procedure under Star Family Health Optima Insurance Policy is as follows:

• Contact the customer care 24 hour [TOLL-FREE] help-line for assistance – 1800 425 2255 / 1800 102 4477
• In hospitalizations which are planned, inform 24 hours before admission.
• In hospitalizations for an emergency, information needs to be provided within 24 hours post-hospitalization.
• All the network hospitals are equipped with Cashless Facility under this plan.
• In non-network hospitals, reimbursement facility is provided to the policyholders.

Document Required To Make Claims Under This Policy

The documents to be submitted under Reimbursement Claims:

• Claim form [duly completed and signed]
• PAN card copy needs to be provided
• Pre-admission treatment papers along with investigations [In original format]
• Discharge summary with respect to original documents from the hospital
• The respective cash receipts of hospitals and chemists in original format
• Reports of all the medical tests conducted along with their cash receipts
• All original receipts from the doctor associated with the insured during the policy period
• Certificate from the doctor who attended the patient regarding the diagnosis period

The documents to be submitted under Cashless Treatment are:

• ID card issued by the insurance company
• Pre-authorization form filled with patient details both on the behalf of insured and treating doctor along with the expected cost of treatment
• If all the details are legally binding and verified, the insurance 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 of the Insured

Cases Where You Can’t Claim This Policy (Exclusions)

Insurance company won’t be liable to pay if the claim arises due to the following cases:

• Intentional self-injuries
• Plastic surgery unless absolutely necessary due to an accident or an injury
• Oral Chemotherapy
• All medical and surgical treatments related to Sleep Apnea
• All generic and endocrine disorders
• All unconventional, untested and experimental treatments are excluded under this policy
• Erectile dysfunction and Change of Sex.
• All injuries contributed via war or due to a foreign enemy.
• Circumcision
• All hospital surcharges, administration charges along any such charges are excluded under this policy.
• All psychiatric, mental and behavioral disorders.

How Long Does It Take To Settle The 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 Family Health Optima Insurance Policy

There is no exit age and lifelong renewals are allowed under this policy. Beyond 65 years, this family health optima insurance plan can be renewed for life time. Under this policy, the policyholder will get 120 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 Family Health Optima Insurance Plan

• Provides a wider coverage for the whole family under a single premium
• Provides cover for assisted reproductive treatment
• Child above 16 days of age can be covered as part of the family
• Organ Donor expenses are covered up to 10% of the Sum insured or Rs 1 lakh whichever is less under this policy
• The company reimburses all expenses with respect to the transportation of the policyholder from the treating hospitals to another up to the limits mentioned in the clause
• AYUSH treatment is provided under this policy subject to certain limits
• Second Medical Opinion feature is available under this policy with respect to the insurance company’s network
• The company will even reimburse the transportation expenses incurred for one immediate family member subject to Rs 5000/- towards the place where the hospital is located.
• Reimbursement up to Rs 5,000/- towards the cost of repatriation of mortal remains of the insured person
• 1% of the basic sum Insured subject to a maximum of Rs 5,000/- will be payable in case of a medical contingency requiring hospitalisation and admitted in the network hospital
• Premium paid under Star Family health Optima Insurance Plan is eligible for tax benefits under Section 80D of the income tax act 1961

Critical Aspects

• There is a 30 days waiting period under this plan. Apart from this, there are 2 and 3 years of waiting period for specified illness and assisted reproduction treatment to cover
• It is mandatory for all policyholders beyond 50 years having a history of adverse medical records are required to undergo Pre-Acceptance Medical Screenings at the respective company designated centres
• Coverage for new born starts from the 16^th day after the child birth provided the mother is insured under the policy for a continuous period of 12 months without break
• This policy will be automatically terminated upon the exhaustion of the sum Insured or death of the insured person
• Revision in Sum Insured is only allowed at the time of renewal

Features of This Plan

 

Features	Particulars
Claim Type [In house or TPA]	In-house claim settlement
Pre-Hospitalization	Expenses to be incurred up to 60 days
Network Hospitals Count	More than 8800+ network hospitals are covered
Post-Hospitalization	Expenses can be incurred up to a period of 90 days.
Room Eligibility	Rs 2000/- Single standard A/C room as per the chosen Sum Insured
Share Claim Payments	Co-payment of 20% of each and every claim amount
Restoration of Cover	Covered
No Claim Bonus	25% of the expiring Basic Sum Insured in the second year and additional 10% of the expiring Basic sum Insured for the subsequent years
Ambulance Charges	Rs 1500/-per policy period.  Air Ambulance as per policy limits which is up to 10% of the Basic sum insured if the opted Sum Insured is above Rs 5 lakh
Worldwide Coverage	Not provided
Maternity Cover	NA
Hospitalization at Home	Treatment at home/Domiciliary Hospital provided for a period exceeding three days
Day-Care Treatment	Covered
Non-Allopathic Treatment Charge	AYUSH Covered under this policy
Emergency Ambulance	Emergency Ambulance charges are covered maximum up to Rs 750/- per hospitalization and of RS 1500/-per policy period.
Health Check-up	Subject to a maximum of Rs 3500 for every claim free year

FAQ’s

Q1- What is the room eligibility criteria under this policy?

The Room, Boarding and Nursing expenses are subject to the following requirements-

Sum Insured	Limit mentioned [ Rs]
1,00,000/- and 2,00,000/-	Up to 2,000/- per day
3,00,000/- and 4,00,000/-	Up to 5,000/- per day
5,00,000/- – 25,00,000/-	Single Standard A/C room

Q2- Are pre-existing diseases covered under this policy?

Yes, they are covered under this Plan after a waiting period of 48 months.

Q3- What is the cost of health check-ups under Star Family Health Optima Insurance Plan?

The cost of health check-up is subject to the following sub limits given below:

Sum Insured [ Rs]	Limit mentioned per day [ Rs]
1,00,000/- and 2,00,000/-	Up to 10,000
3,00,000/- and 4,00,000/-	Up to 15,000
5,00,000/- – 25,00,000/-	Up to 20,000

Q4-Does this policy support AYUSH treatment?

Yes, this plan supports AYUSH [Ayurveda, Unani, Sidha and Homeopathy system of medicines] treatment. The sub-limits are mentioned as

Sum insured [ Rs]	Limit mentioned per policy period [ Rs]
1,00,000/- to 4,00,000/-	Up to 10,000
5,00,000/- to 15,00,000/-	Up to 15,000
20,00,000/- to 25,00,000/-	Up to 20,000