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.
Family Health Optima Insurance Plan addresses several health insurance needs. Read along to know about the benefits that this plan offers to its policyholders:
The insured person will get coverage against the following-
The plan covers pre & post-hospitalization expenses incurred up to 60 & 90 days respectively.
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.
If the insured suffers an injury/illness/disease and requires medical treatment for a period exceeding three days, the plan will cover its 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).
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.
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.
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.
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).
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.
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.
The expenses associated with shared accommodation are also liable to get the coverage up to certain limits, provided 24 hours of stay is completed.
The policyholder is liable to avail of a medical second opinion from a doctor in the insurer's network of medical practitioners.
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.
Amount paid towards the premium of this plan is eligible for tax relief under Section 80D of the Income Tax Act, 1961.
| 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
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
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
There is a list of conditions that the plan doesn't cover. A few of them are listed below-
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
Star Health Insurance Buying Process
We, at PolicyX.com can provide a dedicated agent by your side during the claim settlement process. Below is its buying process.
To avoid any issues, you can file a claim via two means. Let's take a look at them.
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October, 2021
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October, 2021
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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.
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July 31, 2021
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Last updated on July, 2021
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