Star Net Plus: Coverage, Claim & Renewal

Published: 07-03-2019 07:46:04 AM

Human Immunodeficiency Virus [HIV] is a three-staged virus that targets the immune system. It was estimated that India had an estimated HIV population of 2.1 million. However recent surveys have stated that HIV infections are decreasing in India over the last decade. However, HIV still poses a challenge to the developing Indian economy. Star Health Insurance provides Star Net Plus for HIV positive patients. It is the first policy in India which caters to the HIV positive individuals. This policy is eligible for all age groups suffering from this disease.

What is Star Net Policy?

This policy is meant for the HIV positive patients who are infected with Human Immuno Virus. It pays the sum insured as lump amount if the policy holder is declared as AIDS patient. In another case, it covers in-patient hospitalisation expenses.

Types of Star Net Plus policy

Section-1 HIV section: In the event of a valid claim, the insurance company will pay the sum Insured in lump sum that will help the policyholder to cover the future medical expenses related with this disease.

Section-2 Medical Section: Under this section, expenses such as room, boarding expenses, pre hospitalisation, and ambulance will be covered.

What Star Net Plus Covers?

Following coverage is provided under this policy:

• Lump sum amount will be given to the policyholder if S/he is declared AIDS patient
• Room, boarding expenses
• Consultants, specialist fees
• Anaesthesia, cost of pacemaker
• Emergency ambulance charges
• Pre/post hospitalisation

Eligibility Criteria Of This Policy

Criteria	Eligibility
Age	This policy is for anyone irrespective of their age provided they are infected with HIV but have not reached the state of AIDS and their CD4 count is over 350
Pre-Acceptance Medical Screenings	Yes so as to ensure that the insured person has not already reached the stage of AIDS.
Sum Insured	Option Sum insured under Section -1 [ Lump sum] Sum insured under Section-2 [Medical expenses] 1 5,000 15,000 2 5,000 10,000 3 15,000 15,000 4 30,000 30,000 5 50,000 50,000 6 0 10,000

Claim Process

• Call the 24-hour help-line for assistance.
• Inform the ID number for reference purposes.
• Inform the company in the given time and submit the required documents within 15 days from the date of discharge

Document Required To Make A Claim Under This Policy

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

• Claim form which is duly completed and signed.
• A copy of PAN card details of the Policyholder.
• All the original pre-admission treatment papers along with their investigations.
• Discharge summary in original documents from the hospital.
• Cash receipts of hospitals and chemists [Original]
• Reports of tests conducted along with the receipts in cash format.
• All original receipts from the anesthetist and surgeons are to be submitted.
• Certificate from the doctor who conducted to the patient regarding diagnosis.

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

• All the related prescriptions and receipts involved in the pre and post hospitalization process need to be provided under this claim procedure.

Cases Where One Can’t Claim Star Net Plus Policy (Exclusions)

Exclusions under Section-1

• Any payments under the policy concerning the treatment of HIV
• AIDS confirmed during the first 90 days at the initiation of Star Net Plus policy
• All medical conditions which may be pre-existing at the time of the inception of the policy and even includes the stage of AIDS except for HIV treatment

Exclusions under Section-2

• Naturopathy treatment
• Any injury or disease caused due to nuclear weapon/materials
• Dental treatment of any kind unless necessitated due to an accident or injury
• All pre-existing diseases which are covered until 48 consecutive months under continuous coverage have elapsed
• Cost of spectacles and lenses
• Exclusion of medical expenses for Tuberculosis and Gastro-Entirities
• Any disease contracted by the policyholder under 30 day’s period of starting the policy
• Expenses on the treatment of Cataract in the first two years under the condition that the policy has been in continuous operation.
• Hearing aids
• Walkers, Crutches, and Wheelchairs
• Expenses incurred on Lasik Laser
• Charges incurred on Hotel registration, records, telephones, and other similar fees
• Any treatments arising out of pregnancy, childbirth, miscarriage, abortion or any complications related to it are excluded

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 Net Plus Policy

Life time renewals are allowed 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 before his policy gets lapsed.

Advantages Of Buying Star Net Plus policy

 

• Provides lump sum payment to the insured so that he can plan out treatment
• No TPAs, only direct in-house claim settlement for faster claim settlement
• Cashless hospitalization is possible under the scheme of network hospitals.
• Free medical advice over the phone.

Critical Aspects

• This policy will be automatically terminate if the sum insured is exhausted or upon the death of the insured person
• Pre-existing medical conditions when the cover incepts for the first time including the stage of AIDS except HIV is excluded from this policy
• No claim of compensation would be payable to the insured if the illness, disease specified in the policy manifests during the first 90 days of the inception of the policy

Features of Star Net Plus policy

In-House or TPA)	In-house claim settlement
Pre-Hospitalization	Expenses to be incurred not exceeding 30 days before the date of Hospitalisation
Network Hospital Count	More than 6000 network hospitals are covered
Post-Hospitalization	Expenses to be incurred up to 7% subject to a maximum of RS 5000/- per hospitalization.
Room Eligibility	Room, Boarding Expenses at 2% of the sum insured
Share Claim Payments	NA
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	NA
Worldwide Coverage	NA
Maternity Cover	NA
Hospitalization at Home	NA
Day Care Treatment	NA
Non-Allopathic Treatment Coverage	25%of the sum insured
Emergency Ambulance	Emergency Ambulance up to a sum of RS 750/-and the overall limit of Rs 1500/- per policy period
Health Check-up	NA

FAQ’s

Q1- Is there any pre-medical test screening?

Yes, there is a pre-medical test screening so as to make sure that the policyholder does not have AIDS or has not reached the stage of AIDS.

Q2- Are expenses incurred on treatment of obesity or any surgical treatments related to weight control included in the respective policy?

No, any expenses incurred on weight control and its related aspects will be excluded under section-2 of Star Net Plus policy.