Star Health Family Health Optima Plan

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About Star Health Company

Established in 2006 with a vision to become the largest and most preferred health insurance company in India, Star Health and Allied Insurance Co Ltd is a joint venture between ICICI Ventures Fund Management, TATA Capital Growth Fund, Oman Insurance Company, UAE and Alpha TC Holdings Pte. Ltd., Singapore. Today, it is India's first standalone company in the health insurance industry. There are 3 major sections: Health Insurance, Overseas Mediclaim Policy and Personal Accident plans that are available with the company which has its presence with more than 290 branch offices pan India.

With a belief in using the resources to focus on providing excellence in service, design products and use core competency of innovation to deliver the best to their customers, Star Health has become one of India's most trusted specialist company for health insurance. The company offers wide range of plans and insurance policies single-mindedly dedicated to the health sector. Also, health insurance policies, medi-claim and overseas travel insurances plans are a part of company's offerings keeping in mind the comfort and suitability of its nation-wide clients and customers.

Family Health Optima Insurance Plan

Single policy, wider coverage for whole family at an affordable premium. Get extra sum insured (auto recharge) at no extra cost. Health Checkup benefit for every claim free year. 3 times Automatic restoration of Sum insured by 100% each time upon complete exhaustion. Cover for Assisted Reproductive Treatment. New-born baby cover from 16th day. Donor expenses for organ transplantation. Domiciliary Hospitalization Expenses for treatment exceeding 3 days.Cover for all day care procedures. A grace period of 120 days from the date of expiry of the policy is available for renewal.

Plan Benefits

Room, boarding and nursing expenses all inclusive as per the limits. 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 pacemaker.

  • Ambulance charges for emergency transportation to hospital as per specified limits.
  • Air Ambulance charges upto 10% of the Basic Sum Insured during the entire policy period.
  • Pre-Hospitalization expenses up to 60 days prior to admission in the hospital.
  • Post-hospitalisation expenses incurred up to 90 days after discharge from the hospital.
  • Domiciliary hospitalisation: Cover for medical treatment for a period exceeding three days.
  • Organ Donor Expenses: Cover upto 10% of the Sum Insured or Rupees One lakh, whichever is less.
  • Cost of Health Checkup: Expenses incurred towards cost of health check-up up to the limits
  • New Born Baby cover: Cover starts from 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less
  • New Born Baby cover: Cover starts from 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less

New Benefits:

  • Emergency Domestic Medical Evacuation: Company reimburse the expenses incurred towards transportation of the insured person from the treating hospital to another one upto the limits.
  • Compassionate Travel: The Company will reimburse the transportation expenses by air incurred upto Rs5000/- for one immediate family member (other than the travel companion) for travel towards the place where hospital is located.
  • Repatriation of Mortal Remains: The Company shall reimburse up to Rs.5,000/- towards the cost of repatriation of mortal remains of the insured person to the residence of the insured.
  • Lump-sum for Treatment in Preferred Network Hospital: In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, the Company may suggest an appropriate hospital from the network for treatment upto 1% of Basic Sum Insured subject to maximum of Rs.5000/- per policy is payable as lumpsum.
  • Shared Accommodation: Upto the limits.
  • AYUSH treatment: Upto the limits.
  • Second Medical Opinion: The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company's network of Medical Practitioners
  • Assisted Reproductive Treatment: The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertilityWaiting period of 36 months from the date of first inception of this policy.Maximum liability of the Company for such treatment shall be limited to Rs.1 lakh for sum insured of Rs.5 lakh and Rs.2 lakhs for sum insured of Rs.10 lakhs and above for every block of 36 months.
  • Additional Sum Insured for RTA(Road Traffic Accident): If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of Rs.5,00,000/- .This benefit is payable if the insured person was wearing a helmet and travelling in a two wheeler either as a rider or as a pillion rider.
  • Automatic Restoration of Sum Insured: Available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one.
  • Recharge Benefit: Available up to the limits.
  • Bonus: Following a claim free year bonus of 25% of the expiring basic sum insured in the second year and additional 10% for subsequent years (max.100%) would be allowed. Where there is a claim the Bonus would be reversed in the same order in which it was given.

What is not covered?

The coverage has the following exclusions:

  • Any pre-existing ailment/disease that will only be covered after 4 consecutive years of completion of the policy
  • Any illnesses/ surgery/ diagnosis within the first 30 days of the policy start date besides those arising out of injuries
  • Damage because of self-inflicted harm (resulting from suicide, attempted suicide)
  • Fee of spectacles/contact lenses, dental treatment
  • Medical charges incurred for treatment of AIDS
  • Congenital disease
  • Some treatments like non-infective arthritis, joint replacement, etc., which can be covered only after the completion of two consecutive coverage years.

Claim Process

Cashless Claim Process:

  • Approach the insurance desk of hospital and show the ID card for identification purpose.
  • Network hospital would verify your identity and submit pre authorization form to us.
  • The doctor will assess the documents and process the claim as per terms of the policy.
  • A field doctor will be assigned to make the hospitalisation simple for you.

Reimbursement

Reimbursement process for pre and post hospitalisation expenses:

  • The Mediclaim Policy allows reimbursement of medical expenses incurred towards the ailment for which hospitalisation was necessitated prior to hospitalisation and up to a certain number of days after discharge.
  • To claim pre hospitalisation expenses: Any expenses incurred on Out Patient treatment which leads to In-Patient hospitalization 30 days prior to the date of hospitalization is settled as Pre hospitalization. All original bills have to be produced.
  • Pre & Post hospitalization expenses will be settled on Actual Basis.

Reimbursements in case of treatment in non-network hospitals:

Star Health should be contacted within 24 hours from the time of admission with following details:

  • Star Health id card number,
  • Nature of illness
  • Name & address of the Hospital/Nursing Home/Clinic, Room Number

The claim will be registered by customer care and a claim number will be provided to the Policyholder. This claim form must be filled fully and sent to Star Health office along with the necessary documents.

Documents Required:

  • Completely filled claim form
  • Original bills, receipts and discharge certificate/card from the hospital.
  • Original bills from chemists supported by proper prescription.
  • Receipt and investigation test reports from a pathologist supported by the note from attending medical practitioner/ surgeon prescribing the test.
  • Nature of operation performed and surgeon's bill and receipt.
  • Self-declaration/MLC/FIR in case of accident cases.
  • Treating doctor's certificate

FAQs

1
Q1. What is a Health Card?

It is a card that comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital. Remember, health card is not a debit or credit card that can be used to make payments.

2
Is a medical checkup necessary before buying a Health policy?

A medical checkup is necessary for a new health insurance policy for customers above the age of 50 years. Medical checkup is not required only for Senior Citizen's red carpet Policy offered to people between 60 years to 75 years.

3
Does any health policy cover the treatment for existing disease also?

Normally health plans exclude treatment of any pre existing disease / condition. At Star the treatment of any such pre existing disease/ condition is covered after 48 months of continuous renewals with Star.

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