Star Family Health Optima Insurance Plan
Family Health Optima plan by Star Health is one of the best sellers of the company. It is a classic Family Health Insurance plan, which is perfectly designed to cover all the members of the family (proposer, spouse, dependent children from 16 days to 25 years) under a single policy.
Apart from being an affordable plan, it shells out a wide range of coverage options against multiple diseases and comes out with useful additional benefits. The policy also allows its customers to maintain personal health records in an electronic format.
Let's understand of Star Health Optima Plan with an Example
Vinay, a 30-year-old IT professional, lives in Delhi with his wife and kid. Looking at the rising medical expenses, he decides to cover his entire family under single health insurance.
He chooses Star Family Health Optima with a cover of Rs.20 lakhs. His overall premium comes out to be Rs.22,560 (yearly), after a 5% discount. After 8 months, his wife meets with an accident and is hospitalized because of minor injuries. As far as treatment expenses are concerned, Health Optima works its magic and covers all the expenses, without troubling Vinay's wallet.
Eligibility Criteria
Minimum age of entry | 18 years |
Maximum age of entry | 65 years |
Sum Insured | Rs.1 lakh to Rs.25 lakhs |
**Last Updated on 14-01-2021
Coverage of Star Family Health Optima Insurance Plan
The plan offers complete coverage to you and your family in the time of medical emergencies. Let's take a look at it:
Parameters | Coverage |
Day Care Procedures | Covered |
Pre Hospitalization Expenses | Covered, up to 60 days |
Post-Hospitalization Expenses | Covered, up to 90 days |
Air Ambulance | Up to 10% of the Basic Sum Insured during the entire policy period. |
Ambulance Cover | Up to Rs.750/hospitalization and an overall limit of Rs.1500/policy period. |
New Born Baby Cover | Available from 16th day of baby's birth |
Automatic Restoration of Sum Insured | Available |
Domiciliary Treatment Expenses | Yes |
Organ Donor Expenses | Covered |
Ayush Treatment Expenses | Covered |
Maternity Expenses | Not covered, except ectopic pregnancy |
Modern Treatments | Covered |
Waiting Period | Initial period- 30 days
Specified diseases- 24 hours of coverage
Pre-existing diseases- 48 months of coverage |
**Last Updated on 14-01-2021
Key Benefits of the Star Family Health Optima Plan
Family Health Optima Insurance Plan is a one-stop for all your health insurance needs. Read along to know several benefits that this plan offers to its policyholders:
- 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.
- Pre and Post Hospitalization Expenses: The plan covers pre & post hospitalization expenses incurred up to 60 & 90 days respectively.
- 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.
- 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.
- Organ Donor Expenses: In case the insured requires an organ transplant, the plan looks after its expenses (cover up to 10% of the sum insured or Rs.1 lakh, whichever is less).
- 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.
- 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.
- 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.
- Compassionate Travel: If the insured is undergoing treatment for a life-threatening emergency far away from his/her home, the plan will reimburse the air transportation expenses (up to Rs.5,000) for one immediate family member (other than travel companion).
- 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 his/her residence.
- Treatment in Preferred Network Hospital: If the insured undergo treatment in one of the suggested network hospitals of the company, 1% of basic SI (up to Rs.5000) is paid in lump-sum per policy year. This is only applicable if you choose the sum insured of Rs.3 lakhs and above.
- 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.
- 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.
- 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.
- Tax Benefits: Amount paid towards the premium of this plan is eligible for tax relief under Section 80D of the Income Tax Act, 1961.
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.
Why Should I choose Family Health Optima Plan rather than Star Family Delite Insurance?
Looking at the rise in healthcare expenses, it's of the dire need to buy a health insurance plan that offers vast coverage. With Star Health Optima, you can secure your family with a coverage of up to Rs.25 lakhs. On the other hand, the Star Family Delite plan only covers up to Rs.3 lakhs.
Therefore, to avail yourself a wide coverage and protect your family from uncertain medical emergencies, it is advisable to invest in the Star Health Optima plan.
How To Buy Star Family Health Optima Insurance Plan?
Just follow the below steps and buy your policy right away:
- Visit the official website of Star Health Insurance company and click on the 'Plans'. Select 'View All Plans' from the drop-down menu.
- Select 'Star Family Health Optima Insurance Plan'.
- Fill in all the necessary details such as your name, date of birth, number of family members you want to add, contact information, etc.
- Choose the coverage amount, and you will get the premium amount.
- Pay the premium online and the policy will be mailed to your registered email address.
You can also buy this plan from PolicyX.com. Just connect with our experts via call (1800-4200-269) and they will guide you through the buying process.
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 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 requested by the company.
