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


It is a single policy with a wide coverage for whole family at an affordable premium. This plan offers extra sum insured (auto recharge) at no extra cost, up to 30% of the sum insured. It covers health checkup costs of upto Rs 3500/- for every claim free years and all day care procedures.

• Automatic restoration of entire Sum Insured by 300%.

• New-born baby cover from 16th day.

• Donor expenses for organ transplantation.

• Domiciliary Hospitalization Expenses for treatment exceeding 3 days



What does the plan cover?

The coverage is inclusive of the following:

• In-patient care: patient hospitalisation expenses for a minimum of 24 hrs including room rent, nursing and boarding charges.

• Ambulance costs: Ambulance charges for emergency transportation upto a sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period.

• Pre and post hospitalization: Pre Hospitalisation expenses 60 days prior to admission in the hospital. Post Hospitalisation expenses upto 90 days after discharge from the hospital.

• Daycare procedure: Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Anesthesia, Blood, Oxygen, Operation Theatre charges, Cost of Pacemaker, Cost of Medicine and drugs etc.

• Donor expenses: Donor expenses for organ transplantation.


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

• Tests and treatment referring to infertility and in vitro fertilization

• Some treatments like non-infective arthritis, joint replacement, etc., which can be covered only after the completion of two consecutive coverage years.

Premium Chart for Zone 1 (Excluding Tax)
Zone 1 : Mumbai, Thane, Delhi including Faridabad, Gurgaon, Ghaziabad and Noida, Ahmedabad, Baroda Surat
25 LACS 20 LACS 15 LACS 10 LACS 5 LACS 4 LACS 3 LACS 2 LACS 1 LAC Age in years / S.I. (in Rs.) Plan
18,540 16,770 14,895 12,620 9,895 9,075 8,015 7,135 6,505 16days-35 2A
21,625 19,575 17,400 14,740 11,585 10,740 9,500 8,535 7,765 36-45
30,330 27,485 24,460 20,730 16,345 15,435 13,695 12,485 11,320 46-50
37,505 34,070 30,405 25,580 20,890 19,290 17,055 15,450 13,990 51-55
46,615 42,355 37,805 31,845 26,065 24,210 21,445 19,590 17,710 56-60
57,330 52,095 46,500 39,215 32,145 29,995 26,610 24,450 22,090 61-65
66,975 60,860 54,325 45,850 37,620 35,200 31,255 28,830 26,030 66-70
74,560 67,755 60,485 51,065 41,930 39,295 34,915 32,275 29,130 71-75
80,220 72,905 65,080 54,965 45,145 42,350 37,645 34,845 31,445 76-80
86,340 78,465 70,045 59,170 48,615 45,655 40,590 37,620 33,940 Above 80
22,230 20,125 17,885 15,155 11,915 11,065 9,790 8,810 8,010 16days-35 2A+1C
25,215 22,835 20,310 17,210 13,545 12,675 11,230 10,165 9,230 36-45
34,050 30,870 27,485 23,290 18,380 17,445 15,490 14,175 12,845 46-50
41,815 37,985 33,905 28,540 23,335 21,615 19,130 17,405 15,750 51-55
51,705 46,980 41,935 35,350 28,955 26,960 23,900 21,900 19,795 56-60
61,295 55,700 49,720 41,945 34,400 32,135 28,520 26,250 23,710 61-65
69,930 63,545 56,725 47,880 39,300 36,795 32,680 30,170 27,235 66-70
77,870 70,765 63,170 53,345 43,805 41,080 36,510 33,775 30,480 71-75
85,280 77,500 69,185 58,440 48,015 45,080 40,080 37,140 33,510 76-80
91,800 83,430 74,480 62,925 51,715 48,600 43,225 40,100 36,175 Above 80
26,880 24,355 21,660 18,355 14,460 13,575 12,030 10,920 9,915 16days-35 2A+2C
29,520 26,755 23,805 20,175 15,905 15,000 13,305 12,120 10,990 36-45
38,765 35,155 31,305 26,530 20,960 19,990 17,760 16,315 14,770 46-50
47,075 42,770 38,175 32,160 26,325 24,455 21,665 19,795 17,900 51-55
57,255 52,025 46,435 39,160 32,105 29,950 26,570 24,415 22,060 56-60
67,950 61,750 55,120 46,520 38,175 35,725 31,730 29,275 26,430 61-65
77,580 70,500 62,935 53,145 43,645 40,925 36,370 33,645 30,365 66-70
86,440 78,555 70,125 59,240 48,675 45,705 40,640 37,665 33,985 71-75
94,705 86,070 76,835 64,925 53,365 50,170 44,625 41,420 37,360 76-80
101,985 92,685 82,745 69,930 57,500 54,100 48,130 44,725 40,335 Above 80
34,885 31,630 28,160 23,865 18,840 17,895 15,890 14,555 13,185 16days-35 2A+3C
38,415 34,840 31,025 26,290 20,770 19,805 17,595 16,160 14,625 36-45
50,770 46,070 41,055 34,790 27,530 26,475 23,550 21,765 19,675 46-50
61,665 56,035 50,015 42,195 34,605 32,335 28,700 26,420 23,860 51-55
75,270 68,405 61,060 51,555 42,335 39,680 35,255 32,595 29,420 56-60
89,575 81,405 72,670 61,395 50,455 47,400 42,150 39,090 35,265 61-65
102,445 93,110 83,120 70,250 57,760 54,350 48,355 44,935 40,525 66-70
114,290 103,875 92,730 78,395 64,485 60,740 54,065 50,310 45,360 71-75
125,340 113,920 101,705 86,000 70,760 66,710 59,390 55,325 49,880 76-80
135,070 122,765 109,600 92,690 76,280 71,960 64,080 59,745 53,850 Above 80
16,875 15,260 13,540 11,475 8,985 8,175 7,210 6,380 5,825 16days-35 1A+1C
18,360 16,610 14,750 12,495 9,795 8,975 7,925 7,055 6,430 36-45
25,390 22,995 20,450 17,330 13,640 12,770 11,315 10,245 9,305 46-50
30,395 27,610 24,640 20,690 16,855 15,455 13,630 12,225 11,085 51-55
38,520 34,995 31,235 26,280 21,470 19,840 17,545 15,915 14,405 56-60
48,350 43,930 39,210 33,040 27,050 25,145 22,280 20,375 18,420 61-65
60,000 54,520 48,670 41,055 33,665 31,435 27,895 25,665 23,180 66-70
66,750 60,660 54,145 45,695 37,495 35,080 31,150 28,730 25,940 71-75
73,050 66,385 59,260 50,030 41,070 38,480 34,185 31,590 28,515 76-80
78,595 71,425 63,760 53,845 44,220 41,470 36,860 34,105 30,780 Above 80
21,415 19,385 17,225 14,595 11,465 10,625 9,400 8,440 7,680 16days-35 1A+2C
22,920 20,750 18,445 15,630 12,290 11,435 10,125 9,125 8,295 36-45
29,850 27,055 24,075 20,400 16,085 15,180 13,465 12,270 11,125 46-50
35,810 32,530 29,035 24,415 19,930 18,375 16,240 14,685 13,300 51-55
43,345 39,380 35,145 29,595 24,205 22,445 19,870 18,100 16,375 56-60
55,115 50,075 44,700 37,690 30,890 28,795 25,540 23,445 21,185 61-65
66,505 60,435 53,950 45,530 37,355 34,945 31,030 28,620 25,840 66-70
74,035 67,280 60,060 50,710 41,630 39,010 34,660 32,035 28,915 71-75
81,065 73,670 65,765 55,540 45,620 42,805 38,050 35,225 31,785 76-80
87,250 79,290 70,785 59,795 49,135 46,145 41,030 38,035 34,315 Above 80
28,530 25,855 23,000 19,490 15,360 14,465 12,830 11,670 10,585 16days-35 1A+3C
31,355 28,420 25,295 21,435 16,905 15,990 14,190 12,955 11,740 36-45
41,240 37,405 33,320 28,235 22,315 21,330 18,955 17,440 15,780 46-50
50,085 45,505 40,615 34,230 28,030 26,080 23,115 21,160 19,130 51-55
60,970 55,400 49,455 41,720 34,215 31,960 28,365 26,105 23,575 56-60
76,700 69,705 62,225 52,540 43,145 40,450 35,945 33,245 30,005 61-65
87,645 79,650 71,105 60,065 49,355 46,355 41,220 38,215 34,475 66-70
97,710 88,800 79,275 66,990 55,070 51,790 46,070 42,785 38,590 71-75
107,105 97,340 86,900 73,455 60,405 56,865 50,600 47,050 42,425 76-80
115,370 104,860 93,610 79,140 65,100 61,325 54,585 50,800 45,805 Above 80

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


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.

Q2. 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..

Q3. 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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