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Family Health Optima plan by Star Health insurance company is one of the gem products of the health insurance industry. It is a classic health insurance plan which is designed perfectly to cover all the members of the family under a single health insurance policy. The benefit of insuring your family under this effective form of the health insurance policy is that you have to pay a single premium for all members. It will be a very affordable policy as compared to the options that you explore under the Individual health insurance plan.
The plan offers coverage against a wide range of diseases and comes out with several additional benefits. The policy also allows its customers to maintain personal health records in electronic format. The company is catering with this product for a long time.
Family Health Optima Insurance Plan is a one stop for all your health insurance needs. We all are aware of the fact that a health insurance plan has become a necessity and insuring your family is always a priority. We all want a trustworthy company to secure the future of our family and with such hope, there is nothing better than the star health insurance company. The plan comes out with a wide range of benefits that will help you in dealing with unwanted medical emergencies and their expenses as well. The plan comes out with valuable benefits that include 405 Day-care Procedures, Domiciliary Hospitalization, Donor Expenses for Organ Transplantation, Coverage for Newborn Baby, and so on.
It is basically a flagship product in the market. To make it affordable, the company comes out with Room Rent capping of 1-2% of sum insured depending on the customer's location. In the case of Sum Insured opted of Rs. 5,00,000 in Mumbai/Thane, Delhi/NCR, and Gujarat, one will be eligible for Single AC Room.
Basic Cover
Under the basic cover, insured members will be liable to get coverage against Room, boarding and nursing expenses all inclusive as per the limits. The cost of the Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Oxygen, Operation Theatre, Diagnostics, imaging modalities, and Medicines and Drugs, Oxygen, Blood, Operation theatre, Diagnostic and Cost of the pacemaker are also included in the same. Moreover, transportation charges such as Ambulance charges for emergency transportation to hospital, Air Ambulance charges will be liable to get coverage under this effective family health insurance policy.
Pre-Hospitalization Expenses
Pre-hospitalization cover is an effective benefit that allows the insured to get the needful financial cover up to 60 days prior to admission in the hospital. There are several charges associated with this tenure that we call pre-hospitalization and with this plan you don't have to worry about the same.
Post-hospitalization
Just like the pre-hospitalization, there are several expenses that take place after the hospitalization as well and the list of the same is quite long. So with this effective health insurance policy, you will be liable to get cover against post hospitalization charges and that up to 90 days after your discharge from the hospital.
Domiciliary hospitalization
There are many diseases and stages in which an insured may require the treatment at his/her home only. In such situations an effective health insurance policy like Family Health Insurance Optima, the insured will be liable to get cover for such treatment as well. This plan will cover for medical treatment for a period exceeding three days.
Organ Donor Expenses
Like other needful covers, it is also an important benefit and star family health optima offers the same. Under this, the insured will get the cover up to 10% of the Sum Insured or Rupees One lakh, whichever is less.
Cost of Health Checkup
With this effective health insurance policy, the insured with be liable to get the required cover against health checkup expenses up to a certain limit.
New Born Baby cover
There are many plans that do not offer the needful new born baby cover. With this health insurance policy, you will be liable to receive the cover for your child from the 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less.
Emergency Domestic Medical Evacuation
The plan will reimburse the amount that occurs because of transportation of the insured person from the treating hospital to another one up to the limits.
Compassionate Travel
Under the Health Optima Plan, the insured has the authority to claim for
transportation expenses by air incurred up to Rs 5000/- for one immediate family member (other than the travel companion) for travel towards the hospital.
Repatriation of Mortal Remains
The plan is liable to reimburse up to Rs.5,000/- towards the cost of repatriation of mortal remains of the insured person to the residence of the policyholder.
Lump-sum for Treatment in Preferred Network Hospital
In case of any medical emergency, if the policyholder takes advice from the insurer, the insurer may suggest a hospital from the network for treatment up to 1% of Basic Sum Insured subject to a maximum of Rs.5000/- per policy is payable as the lump sum.
Shared Accommodation
The expenses associated with shared accommodation are also liable to get the cover up to certain limits.
AYUSH treatment
Plan is there to cover such treatment as well as up to the limits.
Second Medical Opinion
The policyholder is liable to avail a Medical Second Opinion from a Doctor in the insurer’s network of Medical Practitioners.
Assisted Reproductive Treatment
The insurance company will also pay for all expenses that occurred on Assisted Reproduction Treatment, where indicated, for the sub-fertility Waiting period of 36 months from the date of the first inception of this policy.
Additional Sum Insured for RTA(Road Traffic Accident)
If the policyholder meets with traffic during resulting in in-patient hospitalization, then the Basic sum insured will increase by 25% subject to a maximum of Rs.5,00,000/-.This benefit is payable only if the insured person was wearing a helmet and traveling in a two-wheeler either as a rider or as a pillion rider
Automatic Restoration of Sum Insured
This benefit is available 3 times at 100% each time, during the policy tenure. Each restoration will start only after the exhaustion of the earlier one.
Recharge Benefit
It is also liable to get the cover but up to the limits.
Bonus
For every claimless year, a bonus of 25% of the expiring basic sum insured in the second year and an additional 10% for subsequent years (max.100%) would be allowed.
| Family Health Optima | Minimum | Maximum |
| Coverage Amount (in Rs.) | 1,00,000 | 5,00,000 |
| Policy Term (in years) | 1 | 1 |
| Entry Age (in years) | 5 months | 60 years |
| Renewable till Age (in years) | - | 60 years |
Tax Benefits
Amount paid toward the premium of this insurance is eligible for relief under Section 80D of the Income Tax Act.
Free Look Period
A free look period of around 15 days from the date of receipt of the policy is there under which you can review the policy terms and conditions. In case, if you are not satisfied then you can even go for cancellation and the insurance company will refund the premium amount. The company will refund the amount adjusting the cost of pre-acceptance of medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Freelook cancellation is not applicable at the time of renewal.
Guaranteed Lifetime Renewals
Life-long renewals beyond 65 years are offered under this policy.
Co-Payment
20% of each and every claim for persons above 60 years at entry level and their subsequent renewals.
Pre-Acceptance Medical Screening
Persons who are of above 50 years will have to undergo pre-acceptance medical screening at the company nominated centers. The cost of screening is borne by the company.
Pre-Existing Diseases/Illness
Are covered after 48 months of continuous Insurance without break with any Indian Insurance Company.
| Age | Sum Assured | Zone 1 | Zone 1a | Zone 2 | Zone 3 |
| 16 days to 35 years | Upto 10 lacs | Rs.11700 | Rs.10030 | Rs.9393 | Rs.8413 |
| 36-45 | Upto 10 lacs | Rs.12968 | Rs.11122 | Rs.10408 | Rs.9316 |
| 46-50 | Upto 10 lacs | Rs.17429 | Rs.14927 | Rs.13965 | Rs.12496 |
| 51-55 | Upto 10 lacs | Rs.21122 | Rs.18089 | Rs.16921 | Rs.15143 |
( Zone 1 :Mumbai, Thane, Delhi including Faridabad, Gurgaon, Ghaziabad and Noida, Ahmedabad, Baroda Surat.
Zone 1a: Chennai, Bangalore, Pune, Nasik, Ernakulam, Trivandrum and Rest of Gujarat.
Zone 2: Coimbatore, Indore City, and Rest of Kerala
Zone 3: Rest of India) ( Premium amount includes taxes as well)
The Plan will not be liable to cover any liabilities in a few cases such as-
Claim process of this star insurance company is really amazing. The company carries a good claim settlement ratio and customers for a long time. Under this process, you got two options of claim settlement cashless and reimbursement.
Cashless- Under the cashless form of the claim settlement, you don't have to pay any single penny from your pocket for the treatment. Under the same you have to connect with the insurer[‘s representative at the network hospital and inform them about the whole scenario and then he/she will take care of the rest. The insurance company will settle all expenses associated with your treatment. You can completely focus on your treatment to get the required cover. The company carries a wide range of network hospitals where you can get the cashless treatment easily.
Reimbursement- Under the reimbursement procedure of claim settlement, once you get hospitalized you have to take care of all your treatment-related expenses and then the insurance company will reimburse later. Before filing the claim, it is essential to make sure that you filing the claim for the disease which is liable to get the cover.
Star Health and Allied Insurance Co Ltd was established in 2006. The company caters into Health Insurance, Overseas Mediclaim Policy, and Personal Accident. With no other insurance category to focus and divide our attention, the company fully focus on excellence, design products and use core competency of innovation to deliver the best to customers.
The company is offering a wide range of health insurance products at affordable prices to make health insurance every human being’s right. And as a company, single-mindedly dedicated to health insurance.
1. Does it carry the benefit of cumulative bonus?
Yes, under this plan, you are liable to get the cumulative bonus for every claimless year. It can be any percent of your sum assured.
2. Does the premium vary state wise?
Yes, the premium amount of the policy according to the state wise and health condition of the customer.
3. Where to file the claim?
You can visit directly to the office for filing the claim or can call on the toll-free number of the insurance company for the same.
4. Does this policy charge extra fees for a medical checkup?
No, the company will take care of the same. The policy will offer yearly health checkup for free of cost.
5. How would I know that the hospital does cover under the network hospital?
Along with the documents of this policy, you will receive a list of network hospitals in which you can check for the same.
6. Does my pre-existing disease is liable for the cover?
Yes, for the same you have to submit all documents related to pre-existing diseases.
7. I am 34, should I have to go through the pre-screening test to buy this policy?
Persons above 50 years will be required to undergo pre-acceptance medical screening at the Company nominated centers. Cost of screening is currently borne by the company.
8. What is the best thing about the policy?
A complete cover for family and No Third Party Administrator, direct in-house claim settlement.
