How to use Star Health Claim Form for Health Insurance Claims

The company provides a wide variety of plans in the health insurance category. These plans are all designed to meet the needs of different customer segments. For a better understanding of the claim process, it is good to know the list of plans the company provides to avoid any confusion at the time of the claim. The list of 14 plans provided by the company are:

1. Star Special Care Insurance Policy
2. Star Cancer Care Gold
3. Star Family Delite Insurance Policy
4. Star Criticare Plus Insurance Policy
5. Star Care Micro Insurance Policy
6. Star Net Plus Insurance Policy
7. Star Cardiac Care Insurance Policy
8. Star Diabetes Safe Insurance Policy
9. Star Super Surplus Insurance Policy
10. Star Health Gain Insurance Policy
11. Star Mediclassic Insurance Policy
12. Star Senior Citizen Red Carpet Insurance Policy
13. Star Family Health Optima Insurance Policy
14. Star Comprehensive Insurance Policy

The claims of all these policies are to be done as per the terms and conditions involved in the policy. The procedures related to policies can be carried out online. The feature of star health insurance online payment option is also available for smooth payment of premiums. The claim procedure, on the other hand, requires the submission of hard copies of the documents and is hence, carried out on an offline basis.

The incurred claim ratio is the major indicator of the star health claim status of settlements. It also suggests the efficiency of the company along with their financial capabilities. The ratio also suggests how strict the insurer is in terms of claims. Incurred claim ratio of Star Health for the year 2014-15 was 63.96%, and for the year 2015-16, it was 53.81%. The claim ratios that are above 50% are considered fairly good when it comes to insurance agencies. These ratios suggest that the claims that are fairly as strong are also considered for the claims. The company has good funding for meeting the claims according to the ratios and is capable of meeting its insurance claims financially.

The claims can be filed for both situations, cashless treatments as well as reimbursements of treatments. The procedures to be followed in both the scenarios are explained as follows:

Also Read: Star Care Micro Insurance Policy

Reimbursement for Medical Expenses

The cashless treatments are ensured for the treatments that are carried out in the network hospitals. but for the treatments that are carried out in hospitals or nursing homes that do not fall under the network of hospitals are to be filed for reimbursement. The reimbursement procedure and documentation is explained as follows:

1. Documents Required:

• Filled claim form (Downloaded from star Health Insurance Website)
• Valid Identity proof approved by the Government of India
• Letter of referral by the practicing medical professional consulted for treatment
• Details of medical practices, tests, and medications authorized by medical practitioner
• Original copy of discharge card from the hospital or nursing home
• Original copies of receipts and bills from the hospital
• Original copies of receipts and bills from the medicine store/ druggist
• Original copies of bills and reports related to the diagnostic tests involved
• Indoor Case papers
• FIR Report copy of police complaint, if any
• Original copy of the post-mortem report, if any

The document requirements mentioned above is the mandatory requirement. These requirements are constant, but there can be additional requirements based on the policy or the claim scenario.

2. Filing Process

The basic details required to file a claim successfully are:

• Name of the Insured
• Customer ID
• Name of the Claimant
• Hospital Details
• Treatment and diagnostic details
• Claim amount approximate value
• Date of admission in Hospital

Collect all the required documents from the hospital and submit them to the third-party administrator along with the above details to file a claim.

3. Claim Reimbursement Process

After the claim is filed successfully and all due documentation is submitted, the below process follows:

• The case and documents are sent to the nearest branch office of the company and their specialized medical team reviews them thoroughly.
• In case of approval by the medical team, the fund processing and related formalities will be carried out within 15 days. The claimant will be informed regarding the same.
• If the information or the documents provided by the claimant is insufficient, he/she will be informed, and the asked to get the remaining documents. This process will be carried out quickly to ensure that the claim is resolved on time.

The cashless treatments can be carried out at the hospitals that fall under the network of Star Health & Allied Insurance Co. Ltd. Under this claim, the medical bills of the insured are sent directly to the company, and the insured does not have to pay anything in exchange for the treatment.

Also Read: Star Cardiac Care Insurance Policy

Claim Filing Process (For both Planned and Emergency Hospitalization)

• The insured and/or claimant has to carry the member card to the hospital. In the absence of a member card, the policy number and member ID are to be provided to the network hospital.
• Star Health Insurance can be contacted by telephone or fax to inform about the hospitalization.
• The pre-authorization form is to be filled by the insured in the customers’ section along with the provision of personal details and policy ID or member ID.
• The pre-authorization will be faxed to Star after balance details get filled by hospital staffs
• The in-house medical team of Star will review the documents and the case to decide whether the claim is approved or not.
• The claimant will be then informed regarding the star health claim status.
• If the approval is pending, the company will ask the hospital to provide further details.
• If the claim gets rejected the claimant has to apply for reimbursement.

Claim Process for Cashless Treatment

• The first step is the filling up of pre-authorization form.
• The details provided by the claimant will be verified by the third-party Administrator and the hospital.
• The policyholder will be assigned with a field doctor to carry out the treatment.
• Once the claim filing formalities are done, and the claim is approved, the bill is settled by Star with the hospital itself.
• There are some cases under which some treatments are not covered by the policy. The insured and claimant will be informed regarding the same at the time of payment.

Making claims in the insurance sector is considered a big hassle and a roadblock in accessing the services of insurance providers at the time of actual claims. To ensure that there are no disappointments at the time of claims it is important that the customers study the terms and conditions of the policy thoroughly at the time of purchase. The inclusions and exclusions of policies are clearly mentioned in the policy documents. The claim procedure is very simplified provided that the claimant is aware of the procedure and ensures that there are no mistakes in the filing of the claim. The major reasons for pending approvals are incomplete or incorrect documentation. The Star Health claim form is to be duly filled without any errors to ensure a smooth claim approval.

Also Check: Star Criticare Plus Insurance Policy

Q1. How to get access to the Star Health claim form?

The claim form of Star Health Insurance can be downloaded online on the company website.

Q2. What are the channels of payment for paying the premium?

Star Health Insurance online payment and offline payment options are both available. The online payment modes involve debit card, credit card, and net banking.

Q3. How to check Star Health claim status?

The process of claims starts as soon as you submit the claim form. The cashless claims are approved as early as two hours.

Q4. Are there any tax benefits involved in Star Health Insurance Policies?

Yes, tax benefits are involved under section 80D of Income Tax Act, 1961. These benefits are involved in all the plans by the company.

Q5. Are the number of claims limited in Star Health Insurance Plans?

Insured can make any number of claims in a given policy year. However, the sum assured limits are there for every policy year.