Star Family Health Optima
  • Secure Your Family’s Medical Needs
  • Understand the Key Benefits & Features
  • Check Your Eligibility Criteria

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Star Family Health Optima Insurance Plan

Family Health Optima plan by Star Health is a classic Family Health Insurance plan, which is designed to cover all the members of the family (proposer, spouse, dependent children from 16 days to 25 years) under a single policy.

It shells out a range of coverage options against multiple diseases and comes out with additional benefits. The policy also allows its customers to maintain personal health records in an electronic format.

What Are The Key Benefits Of The Star Family Health Optima Plan?

Family Health Optima Insurance Plan addresses several health insurance needs. Read along to know about the benefits that this plan offers to its policyholders:

  1. In-Patient Coverage

    The insured person will get coverage against the following-

    • Boarding expenses
    • Nursing
    • Cost of the surgeon
    • Intensive care unit
    • Medical practitioners & consultants fees
    • Anesthesia, oxygen, operation theatre charges, surgical appliances, blood, etc.
    • Medicines, drugs, and consumables
    • Diagnostic procedures
  2. Pre and Post Hospitalization Expenses

    The plan covers pre & post-hospitalization expenses incurred up to 60 & 90 days respectively.

  3. 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.

  4. Domiciliary hospitalization

    If the insured suffers an injury/illness/disease and requires medical treatment for a period exceeding three days, the plan will cover its expenses.

  5. Organ Donor Expenses

    In case the insured requires an organ transplant, the plan looks after their expenses (cover up to 10% of the sum insured or Rs. 1 lakh, whichever is less).

  6. Cost of Health Checkup

    For every claim-free year, the insured can undergo health check-ups and its costs are covered by the plan (according to its TnCs). Such check-ups should only be done at the network hospitals associated with the company.

  7. New Born Baby cover

    Get the cover for your child from the 16th day after birth and subject to a limit of 10% of SI or Rs. 50,000, whichever is less. For this, the mother should be covered under the policy for a continuous period of 12 months.

  8. Emergency Domestic Medical Evacuation

    The plan will reimburse the amount (up to the policy limits) incurred against the transportation of the insured person from the treating hospital to another hospital for further treatment.

  9. Compassionate Travel

    If the insured is undergoing treatment for a life-threatening emergency far away from their home, the plan will reimburse the air transportation expenses (up to Rs. 5,000) for one immediate family member (other than a travel companion).

  10. Repatriation of Mortal Remains

    The plan is liable to reimburse up to Rs. 5,000 towards the cost of repatriation of the mortal remains of the insured person to their residence.

  11. Treatment in Preferred Network Hospital

    If the insured undergoes treatment in one of the suggested network hospitals of the company, 1% of basic SI (up to Rs. 5,000) is paid lump-sum per policy year. This is only applicable if you choose the sum insured of Rs. 3 lakhs and above.

  12. Shared Accommodation

    The expenses associated with shared accommodation are also liable to get the coverage up to certain limits, provided 24 hours of stay is completed.

  13. Second Medical Opinion

    The policyholder is liable to avail of a medical second opinion from a doctor in the insurer's network of medical practitioners.

  14. Bonus

    A bonus of 25% of the expiring basic sum insured in the second year and an additional 10% for subsequent years (maximum 100%) are allowed for every claim-free year. This is only applicable if you choose the sum insured of Rs. 3 lakhs and above.

  15. Tax Benefits

    Amount paid towards the premium of this plan is eligible for tax relief under Section 80D of the Income Tax Act, 1961.

Eligibility Criteria Of Star Family Health Optima

Minimum age of entry 18 years
Maximum age of entry 65 years
Sum Insured Rs. 3 lakhs to Rs. 25 lakhs

**Last Updated on July, 2021

Sample Rates Of Premium

Star Family Health Optima

This table illustrates the premium payable by an individual with different age groups and different sum insured options. We have assumed that the policyholder wants to insure his parents who are aged 65 years and 55 years.

Age Sum Insured Options (in Rs.)
3 Lakhs 4 Lakhs 5 Lakhs 10 Lakhs 15 Lakhs 20 Lakhs 25 Lakhs
30 Years 11,552 13,057 14,060 17,883 21,104 23,748 26,231
40 Years 13,251 14,957 15,983 20,308 23,966 26,945 29,754
50 Years 18,278 20,585 21,688 27,482 32,432 36,427 40,179

**Last Updated on July, 2021

For a better understanding, refer to the graph below that will help you understand how the premiums vary with the sum insured.

Sample Illustration of Premium Amount for Different Sum Insured

Sample Illustration Of The Premium Amount

What Does Star Family Health Optima Insurance Plan Covers?

Star Family Health Optima offers coverage, ensuring that your medical needs are looked after in the time of medical emergencies. Let's take a look at it:

Coverage Table of Star Health Family Optima
Sum Insured (In Lakhs) 3 4 5 10 15 20 25
Hospitalization Benefits Up to Rs. 5, 000 Single Standard A/C Room
No. of Day Care Treatments/Procedures covered All daycare procedures are covered
Ambulance Charges - By Road Up to Rs. 750/- per hospitalization and overall limit of Rs. 1,500/- per policy period
Air Ambulance (per policy period) NA Up to 10% of the Sum Insured
Pre-Hospitalization Expenses Covered, up to 60 days
Post-Hospitalization Expenses Covered, up to 90 days
Domiciliary Hospitalization - for a period exceeding three days Available
Organ Donor Expenses Up to 10% of SI or a maximum of Rs. 1,00,000/-
Cost of Health Check-up (in Rs.) 750 1,000 1,500 2,000 2,500 3,000 3,500
Coverage for New Born Baby Up to 10% of SI or a maximum of Rs. 50,000/- subject to availability of the SI (from 16th day to till the expiry of the policy), provided if the mother is insured for 12 months without a break
Maternity Benefit Not covered, except ectopic pregnancy
Emergency Domestic Medical Evacuation (per Hospitalization) Rs. 5,000/- Rs. 7,500/- Rs. 10,000/-
AYUSH Treatment (per policy period) Up to Rs. 10,000/- Up to Rs. 15,000/- Up to Rs. 25,000/-
Second Medical Opinion Available
Automatic Restoration of Basic Sum Insured 3 times during the policy period, 100% each time Available
Assisted Reproduction Treatment (payable after a waiting period of 36 months) NA Rs. 1,00,000 Rs. 2,00,000
Additional Sum Insured for Road Traffic Accident (RTA) Up to 25% of Sum Insured subject to a maximum of Rs. 5,00,000/- (once in a policy period)
Bonus - Maximum allowable bonus is 100% 25% of Sum Insured after the first year if claim-free and an additional 10% for the subsequent years
Waiting Period of Star Family Optima Insurance Plan
Waiting Period Initial period- 30 days
Specified diseases- 24 hours of coverage
Pre-existing diseases- 48 months of coverage

**Last Updated on July, 2021

What's Not Covered Under The Star Family Health Optima Insurance Plan?

There is a list of conditions that the plan doesn't cover. A few of them are listed below-

  • Intentional self-injury
  • Mental illness
  • Cosmetic & aesthetic treatment
  • Dental surgery
  • AIDS
  • Pregnancy, childbirth, miscarriage, and abortion
  • Congenital disease
  • Infertility and in vitro fertilization
  • Hospitalization out of war, riot, strike, and nuclear weapons

How is Star Family Health Optima Different From Star Comprehensive Plan?

Both Star Family Health Optima and Star Comprehensive plans offer complete medical coverage during medical emergencies. The only difference between these two plans is their premiums.

Let's get a clearer picture with the below table & chart.

Sum Insured Options (In Rs.) Premium of Star Family Health Optima (in Rs.) Premium of Star Comprehensive Plan (in Rs.)
10 Lakh 17,883 22,550
20 Lakh 23,748 31,577
25 Lakh 26,231 34,527

**Last Updated on July, 2021

Premium of Star Family Health Optima Vs. Star Comprehensive Plan

Premium Amount Of Star Family Health Optima Vs Star Comprehensive

Buying Process

Star Health Insurance Buying Process

  • Visit the official website of the company and click on the 'Buy Now' tab.
  • Fill in all the necessary details.
  • Once you have selected the plan of your choice, make the premium payment.
  • Your policy document will be mailed to you at your registered email address.

We, at PolicyX.com can provide a dedicated agent by your side during the claim settlement process. Below is its buying process.

  • Fill in the details in the 'Calculate Premium' form.
  • The next page will show all the available plans. Choose the best Star health plan and click on 'Buy Now'.
  • Pay the premium and your policy document will be shared with you on your registered email.

What Is the Claim Process of Star Family Health Optima Insurance Plan?

To avoid any issues, you can file a claim via two means. Let's take a look at them.

Cashless Claim Settlement Process

  • Get admitted to one of the network hospitals of Star Health and inform the company (1800 425 2255/1800 102 4477 or e-mail us at support@starhealth.in).
  • Reach out to the hospital reception and show your Star Health ID card for identification.
  • Download and submit the pre-authorization form.
  • The form will then be processed further for verification by the company's assigned doctors. If required, an assigned field doctor may visit the patient at the hospital.
  • After discharge, the claim document will be sent to the company by the hospital and the amount will be settled (on approval).

Documents required

  • Copy of health card
  • Doctor's consultation papers
  • Discharge summary
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • In cases of accidents, Medico Legal Certificate (MLC) and/or FIR
  • KYC documents of the insured if the claimed amount exceed Rs. 1 lakh
  • Others as requested by the company

Reimbursement Claim Settlement Process

  • All claims need to be intimated within 24 hours of hospitalization. Treatment can be taken at a non-network or network hospital of the company.
  • Avail treatment, settle all the bills, and file a claim for reimbursement.
  • Submit all the required documents like hospital bills, pharmacy bills, together with all the original documents of treatment and the claim form to the company within 15 days of the discharge.
  • After successful verification, the company will process the claim, and you will receive the amount in your registered bank account.

Documents required

  • Copy of health card
  • Duly filled claim form
  • Pre-admission investigations and doctor's consultation papers
  • Discharge summary from the hospital in original
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • Case receipts from hospital & chemist
  • In cases of accidents, Medico Legal Certificate (MLC) and/or FIR
  • Copy of the KYC documents
  • Others as requested by the company

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FAQ's

1. Does Star Family Health Optima offer any discounts at the time of policy purchase?

Yes, one can avail of a 5% discount while buying the policy online. This is only available for the first purchase

2. Can I pay my Family Health Optima premiums in installments?

Yes. The plan offers an installment facility where one can pay the premiums monthly, quarterly, half-yearly, and annually.

3. How would I know that the respective network hospital is associated with Star Health?

You can check the list of network hospitals from Star Health’s website.

4. I am 34 years old. Do I need to go through a pre-policy medical check-up?

People above 50 years are required to undergo pre-acceptance medical check-ups only at the company-nominated centers. The cost of screening is currently borne by the company.

5. Does the plan offer a co-payment benefit to the policyholders?

Yes. If the age of the applicant is 61 years and above, then 20% of the co-pay applies to every claim.

Find Out What PolicyX.com Customers Are Saying

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1 days ago

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Indore

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July 26, 2021

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Mumbai

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Mumbai

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Last updated on July, 2021

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