Star Health Gain Insurance Policy: Coverage, Claim & Renewal

Updated: 25-08-2023 07:57:39 AM

In a world filled with uncertain situations, health insurance provides a financial backup for the insured against any uncertainties as far as health is concerned. Star Health Gain Insurance Policy covers the medical and health-related expenses of the insured.

What Is Star Health Gain Insurance Policy?

It is a health cover which provides regular hospitalization benefits on floater basis as well as on individual basis. Star Health Gain Insurance Policy caters to both Outpatient and Inpatient expenses and provides the policyholder with the freedom to choose the amount of sum insured and premium to be paid

Types Of Star Health Gain Insurance Policy

Star Health Gain Insurance Policy is provided to the policyholders in two ways

• Under Individual Basis
• Under Floater Basis

Eligibility Criteria For This Policy

Criteria	Eligibility
Entry Age	Adult (Min: 18 yrs- 65 Years) Dependent children (Min: 91 days-25 yrs)
Policy Tenure	One Year
Sum Insured	Rs 1 Lakhs to Rs 5 Lakhs
Premium	RS 15,000-RS 30,000
Policy Renewal Period	Lifelong Renewal Possible
Grace Period for Renewing the Policy	30 days
Maximum Permitted Members	Five members including two adults and three children

 Features Of This Policy

• Income Tax Benefits are availed under this policy as per Section 80D of the Income Tax Act, 1961
• This policy is covered under the network of more than 8800+ hospitals across India
• Free Look Period is available under this policy for 15 days for reviewing the terms and conditions of the policy and return the same if not found suitable
• Cashless hospitalization is supported under this Scheme
• This policy covers both outpatient and inpatient expenses

What All This Policy Includes?

Some of the claims which can be reimbursed under this policy are:

• Room, boarding, nursing expenses
• Consultant’s fees, medicines
• Emergency ambulance
• Day care procedures
• Pre and post hospitalization

How To Claim?

The claims procedure under Star Health Gain 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 to the insurance company or else, inform them within 24 hours of post hospitalization in case of emergency
• 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 Claim Process

1. Documents to be submitted under Reimbursement Claims:

• Duly completed claim form
• Original pre-admission treatment papers along with investigations
• Discharge summary
• Cash receipts of hospitals and chemists in original format
• Reports of tests conducted along with the receipts of doctors and surgeons
• Certificate from the doctor who attended the patient regarding diagnosis

2. Documents to be submitted under Cashless Treatment are

• On admission in the hospital, inform the ID number to the insurance company and fill up the pre-authorization form
• The treating doctor will fill up the treatment/hospitalization information in the form along with the expected cost of treatment
• This form will be submitted to the company and once all details are furnished, 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

Cases Where You Can’t Claim This Policy

• All self-intentional injuries are excluded under this Policy
• Intoxicating substances along with substance abuse
• Any injury which may be caused due to exposure to nuclear weapons and materials
• All hospitalizations which are not medically necessary

How Long Does It Take To Pay Out A Claim?

Upon receiving the required documents from the insured, Star Health will process the claim by first verifying the details and once they are satisfied, they will process the claim within 30 days from the receiving of the documents.

Renewal Process Of Star Health Gain Insurance Policy

In this policy, lifelong renewals are possible. Moreover, the policyholder gets 30 days grace period to make the payment. In case, the insured wish to reduce or increase the sum insured, S/he can do it at the time of renewal after the prior approval from the company.

Advantages Of Buying Star Health Gain Insurance

• Lifetime Renewal is possible under this policy
• No third party administrator and direct in-house claim settlement is provided
• Policyholder gets the complete flexibility in choosing sum insured they need, premium they wish to pay and family size one wish to opt for

Important Aspects

• The policyholder should know that the treatment for cataract is subject to the limit
• There is a waiting period of 2 years for specified illness/ treatments/disease and 4 years for any pre-existing period
• Free look period is not applicable at the time of the policy
• Star Health Gain Insurance policy does cover outpatient expenses, medical expenses incurred in network facility but there is no waiting period or co-pay applicable under this

 

Features	Particulars
Claim Type [In house or TPA]	In-house claim settlement
Pre-Hospitalization	Pre Hospitalization expenses to be incurred 30 days prior to the date of Hospitalization
Network Hospitals Count	More than 8800+ network hospitals are covered
Post-Hospitalization	Post Hospitalization expenses to be incurred 60 days prior to the date of discharge from the Hospital.
Room Eligibility	Room, Boarding and Nursing Expenses are inclusive as provided by the Hospital / Nursing Home up to 1% of the sum insured per day.
Share Claim Payments	Co-payment of 20%of each and every claim
Restoration of Cover	The cover will continue in case of Family Floater option
Ambulance Charges	Same as emergency ambulance section below
Worldwide Coverage	NA
Hospitalization at Home	NA
Day-Care Treatment	All day care procedures are covered
Non-Allopathic Treatment Charge	Excluded
Emergency Ambulance	Emergency Ambulance charges are covered up to a sum of RS 750/-per hospitalization and RS 1500/- per policy period.

 Also Read: Star Health Medi Classic Insurance Policy

FAQ’s

Q1-How to buy Star Health Gain Insurance Policy?

You can buy it online through Star Health insurance official website or contact their nearest branch.

Q2- Is there any exit age associated with this Policy?

There is no exit age under this policy and it can be renewed lifelong.

Q3- Are Vaccinations covered under this Policy?

All Vaccination or Inoculations are excluded under Star Health Gain Policy. However, post-bite treatment and medical treatment for therapeutic reasons can be claimed under this policy.