Star Special Care Policy: Coverage, Claim & Renewal

Published: 06-03-2019 08:00:52 AM

Autism or Autism Spectrum Disorder [ASD] is a development disorder having the main symptoms like difficulty in communication and social interaction. It affects the nervous system and cognitive ability that further affects the emotional, social as well as physical behaviour of an individual. Star Health Insurance provides Star Special Care policy which acts as a medical cover to support children with Autism Disorder.

What Is Star Special Care Policy?

It is an indemnity-oriented health insurance policy meant for children diagnosed with Autism Spectrum. Any child aged between 3 years to 25 years can be covered under this policy without the need of pre-acceptance medical screening

Types of Star Care Special Care Policy

Star Care Special Care policy is only offered under Individual basis to its respective policyholders.

Eligibility Criteria

Star Health Star Special Care Policy is designed for people who are diagnosed with Autism Spectrum disorder.

Criteria	Eligibility
Entry Age	Min: 3 years Max: 25 years
Pre-Acceptance Medical Screening	No Pre-Acceptance Medical Screening is required under this policy
Policy Tenure	One year
Sum Insured	RS 3 lakhs

What Star Health Star Special Care Covers?

Following are some of the coverage provided under the policy:

• Room, boarding, nursing expenses
• Surgeon, consultants, specialist’s fees
• Emergency Hospitalisation
• Post hospitalisation expenses
• Day care treatments

Claim Process

The claims procedure under Star Special Care 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 before admission
• In a scenario when hospitalization is due to an emergency situation, intimate the insurance company within 24 hours after the admission
• All network hospitals have Cashless Facility available for the policyholders under this scheme
• For non-network hospitals, the payment needs to be made up front and the respective documents need to be submitted for reimbursement

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
• Pre-admission treatment papers
• Discharge summary in original documents from the hospital
• Cash receipts in the original format [ Hospital and Chemist]
• Reports of tests conducted along with receipts to be submitted
• All original receipts from the doctor 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 respectively needs to be submitted to the hospital desk
• The pre-authorization form needs to be obtained from the hospital desk wherein the patient details will be filled and submitted to the health desk
• The treating doctor will fill up the treatment/hospitalization information in the form respectively along with the expected cost of treatment
• If all the details are legally binding, 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 Star Special Care (Exclusions)

Star Health won’t be liable to pay if the claim arises due to the following cases:

• Substance abuse or intoxicating substances
• STD and HIV/AIDS are also excluded under this policy
• Any admission in the hospital which was only done for a diagnostic purpose
• All injuries or diseases which may be directly or indirectly contributed via nuclear weapons/materials
• Naturopathy treatments
• Cerebral palsy

How Long Does It Take To Pay Out A 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 Special Care Policy

The policyholder can renew this policy up to the age of 25 years. Beyond 25 years, the insured will be offered an alternate product with continuity benefits. 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 Special Care 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
• Free look of 15 days are provided under this policy that lets the policyholder to review the terms and conditions of the policy and return the same if not found suitable
• Premium paid under Star Special Care is eligible for tax benefits under Section 80D of the income tax act 1961
• This policy allows for the emergency ambulance facility.
• Hassle free claim-settlement process

Important Aspects Of This Policy

• There is a 30 days waiting period under this policy. Apart from this, to cover specified illness and pre-existing disease, policyholder has to wait for 24 months and 48 months respectively.
• Under this policy, Autism shall not be considered as pre-existing disease

Features Of This Policy

Features
Claim Type (In-House or TPA)	In-house claim settlement
Pre-Hospitalization	NA
Network Hospital Count	More than 8800+ network hospitals are covered
Post-Hospitalization	Post-Hospitalization expenses incurred up to a period of 60 days [at 7% or a sum equivalent to the hospital charges] after discharge from a hospital
Room Eligibility	Room [Single A/C standard], Boarding and Nursing expense up to Rs 5000/- per day.
Share Claim Payments	20% of each and every claim
Restoration of Cover	Not provided
No Claim Bonus	Not allowed under the policy
Ambulance Charges	–
Worldwide Coverage	Excluded under the policy
Maternity Cover	NA
Hospitalization at Home	–
Day Care Treatment	Covered
Non-Allopathic Treatment Coverage	NA
Emergency Ambulance	Emergency Ambulance charges are covered maximum up to Rs 750/- per hospitalization and of RS 1500/-per policy period
Health Check-up	NA

FAQ’S

Q1- Does this policy offer Grace Period?

Yes, it offers Grace Period of 30 days after the expiry of the policy during which renewal is possible.

Q2- Are outpatient expenses covered under this policy?

No, outpatient medical expenses are subject to exclusions under Star Special Care Policy. However, they are provided for behavioral therapy, Physiotherapy, Occupational therapy, and Speech therapy.

Q3-What is the eligibility requirement in case of shared accommodation for Rooms?

In case of shared accommodation, then the expenses will be subject to Rs 500/- per day which is subject to a maximum of Rs 2000/- per hospitalization and Rs 10,000/- per policy period. In a scenario, where the insured stays in the Intensive Care Unit [ICU] or High Dependency Units/Wards, their eligibility requirement will be treated under shared accommodation.