Star Health Mediclassic Plan

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About Star Health and Allied Insurance Company Ltd:


Incepted in the year 2006, the Star Health and Allied Insurance Company have an umbrella incorporating the Overseas Mediclaim Policy, Personal Accident and Health Insurance. The focused line of approach enables the company to have a better vision of the tasks and targeted customers who are aimed to be treated with best of the insurance aids.

Without expanding too much of the product range category the company aims to put quality to the existing products only. Star Health and Allied Insurance Company is based out of India and is functioning towards offering better products at a much affordable price.

Situated in Chennai, the nerve centre of the Company oversees the functionality of the entire network. The company has a total working capital of Rs. 985 crores. The company boasts of being the first and the only health insurance company in India that offers services pertaining to personal accidents, medi-claim, and overseas travel insurance.

The many policies of Star Health Care Company offer the best cover to the individual as well as the family members. The terms of policies are moulded as per the requirements. With a commitment of never compromising on your healthcare need the company presents a host of policies to choose from.

Mediclassic Insurance plan (Individual)

The Mediclassic Insurance plan provided by the Star Health Insurance Company is different from other insurance plans as it provides coverage for non- allopathic treatments as well up to certain limits. Apart from this it provides coverage for pre-existing diseases, and much more. It is available in family package as well. The sum insured under this plan is disbursed equally among the family members covered. This plan covers a child from an age group of 5 months to an adult of 65 years. The person who buys this plan will get add on covers as well as an automatic restoration service. A free look period is provided to the customer for checking the plan’s terms & conditions. If the customer is not satisfied, then he/she can cancel the plan and the company will refund the amount after deducting the pre-acceptance fees of medical screening.


Highlights of Star Health Mediclassic Insurance Plan:

1. No claim bonus of 5% for every claim free year up to 25%.

2. Health Checkup costs up to Rs.5,000/- for every block of 4 claim free years.

3. Automatic restoration of entire Sum insured by 200%.

4. Optional Covers : Hospital cash and patient care cover.

5. 101 day-care procedures covered.


What does the plan cover?

Hospitalisation Cover:

1. Protects the insured for in patient hospitalisation expenses for a minimum of 24 hrs.These expenses include room rent,nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees,Cost of Medicines and Drugs.

2. Ambulance charges for emergency transportation to hospital as per specified limits.

3. Pre-Hospitalization expenses up to 30 days prior to admission in the hospital.

4. Post-hospitalisation paid as lump-sum upto the limit specified.

5. 101 Day-care treatments covered.

6. Non-Allopathic Treatments.

7. Covered up-to specified limits.

Pre-Existing Diseases / Illness:

Are covered after 48 months of continuous Insurance without break with any Indian Insurance Company.

Add-on covers (subject to payment of additional premium):

Patient Care:Available for persons above 60 years. Pays for attendant charges after discharge from hospital for maximum 5 days per hospitalisation and 14 days per policy period.

Hospital Cash: Hospital cash benefit for each completed day of hospitalization.

Family Package:

Available for persons from 5 months to 45 years. The sum insured is apportioned equally among insured family members. Health Checkup benefit will be calculated on the policy sum insured and equally divided among all the insured persons.

Health Check-up benefits: Cost of Health Check-up once after a block of every four claim-free years.This benefit is available for sum insured of Rs.2,00,000/- and above only.

Automatic Restoration of Sum Insured (not appilcable for Family Package):In the event of a claim, during the currency of the policy, if the entire sum insured is exhausted and the policy has not yet expired then the automatic restoration of Sum Insured will operate and the sum insured will be restored to the original amount i.e. 200% only once. This restored sum insured can be utilized, during the remaining policy period, for any other illness / diseases unrelated to the ones for which claim/s has /have been made.

HIV Persons Coverage:

This policy can be taken by HIV positive persons provided the CD 4 count at the time of entry is above 350 (proof to be produced). However, hospitalization for any opportunistic infections is not covered.

Bonus:

Bonus calculated at 5% of the basic sum insured for every claim-free year subject to a maximum of 25% is allowable.In the event of the claim the bonus will reduced by 5%.


What is not covered under the plan-

1. Any pre-existing disease that is not covered under any other insurance policy by an Indian Insurer for 48 consecutive months.

2. Any disease that occur within the first 30 days of the commencement of policy.

3. Circumcision, Plastic Surgery, Vaccination (preventive and child care), aesthetic treatment, Inoculation, etc.

4. During first two years of the insurance, Cataract, degenerative diseases, Hepatobiliary Gallbladder and pancreatic stones, Arthroscopic repair, Uterine Prolapse, Genitourinary Calculi, etc. treatments are not covered.

5. The cost of lenses and spectacles, hearing aids, walkers, crutches or any such aid are not included.


Claim Procedure:

Planned: When the concerned persons are aware of the hospitalization.

1. One must call and get the case registered at the toll-free helpline 1800-425-2255.

2. The pre-authorization form needs to be filled and faxed to: 1800-425-5522 (toll-free), 044 28302200 (non-toll free)

3. The claimant needs to carry the ID and the policy schedule together.

4. In Case of Emergencies, the same procedure must be followed within 24 hours of admission.


Cashless:

1. Approach the insurance desk of the hospital.

2. Show Id number or card for reference.

3. Identification of ID number and submission of the pre-authorization form.

4. Assessment and further processing of the claim as per terms and policy.

5. Assignment of field doctor for hassle free functioning.

6. Final settlement.


Reimbursement:

1. Assignment of a field doctor for effective functioning.

2. When discharged, payment of bills is done by the claimant.

3. Claim form duly filled with all the original claim supporting documents submitted to nearest Star office.

4. Settlement as per terms & conditions.


Documents Required:

1. Pre-authorization form duly filled.

2. Original bill for hospitalization/chemists/pathologist/surgeon, discharge certificate and all the receipts.

3. FIR/Self-declaration/MLC in the case of accidents.

4. Certificate of the treating doctor.

5. Hospital registration certificate, if it has less than 15 beds,.

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