Star Health and Allied Insurance Co Ltd was established in 2006 as a joint venture between ICICI Ventures Fund Management, TATA Capital Growth Fund, Oman Insurance Company, UAE and Alpha TC Holdings Pte. Ltd., Singapore. The company deals in 3 major sections: Health Insurance, Overseas Mediclaim Policy and Personal Accident plans and has progressed by leaps and bounds in just under a decade.
Raising a benchmark in the health insurance sector, Star Health has become one of Indias most trusted specialist company for health insurance. It has its presence with more than 290 branch offices across pan India working dedicatedly towards providing the best of policies to their valuable customers. With a vision to become the largest and most preferred health insurance company in India, it provides help and assistance to its customers through help lines, call centres and through internet.
Star Health believes 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. Being Indias first standalone company in the health insurance industry, it deals in various kinds of health insurance policies, medi-claim and overseas travel insurances plans keeping in mind the comfort and suitability of its nation-wide clients and customers.
Senior citizen Plan
As the name suggests, Senior citizen plan is a plan for senior citizens aged between 60 to 75 years. The plan covers pre-existing diseases from the second year onwards and doesn't require any pre-insurance medical test. It gives a high sum insurance coverage upto Rs.10 Lakhs and guaranteed lifetime renewals.
As one enters the golden age and retires, medical expenses become the most difficult part to manage. It gets difficult to keep up with the bills and especially in any emergency situation. Therefore, a health care insurance for people in their late 60s is a must. With a full coverage and offers like lifetime renewals, its a great way to keep ones safety in own hands.
Highlights of Senior citizen Plan
It gives two additional Sum Insured Options namely Rs.7.5 lacs and Rs.10 lacs
A discount of 10% of the premium will be allowed if the proposer produces the following documents to the satisfaction of the Company:-
a. Stress Thallium Report
c. Sugar (blood & urine)
d. Blood urea & creatinine .
The tests should have been taken not before 45 days from the date of the proposal
It covers the insured for in patient hospitalisation expenses for a minimum of 24 hrs including expenses of room rent, nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs upto the limits specified.
What does the plan cover?
The coverage is inclusive of the following:
In-patient care: expenses include room rent, nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs upto the limits specified.
Ambulance costs: Ambulance transport charges for emergency transportation to hospital as per specified limits.
Pre and post hospitalization: Post-hospitalisation paid as lump-sum upto the limit specified.
Daycare procedure: Protects the insured for in patient hospitalisation expenses for a minimum of 24 hrs.
What is not covered?
1. Pre Existing Diseases as defined in the policy until 12 consecutive months of continuous coverage have elapsed, since inception of the first policy with any Indian Insurer.
2. Any disease contracted by the insured person during the first 30 days from the commencement date of this policy. This exclusion shall not apply in case of the insured person having been covered under any health insurance policy (Individual or Group Insurance policy) with any of the Indian Insurance companies for a continuous period of preceding 12 months without a break.
3. During the first two years of continuous operation of this Senior Citizens Red Carpet Health Insurance Policy any expenses on
a) Cataract, Glaucoma, Diseases of the anterior segment and posterior segment of the eyes, All Diseases related to ENT, Diseases related to Thyroid, Prolapse of intervertebral disc (other than caused by accident), Varicose veins and Varicose ulcers, all diseases of Prostate, Stricture Urethra, all types of Hernia, Varicocele, Hydrocele, Fistula / Fissure in ano, Hemorrhoids, Pilonidal Sinus and Fistula, Rectal Prolapse, Stress Incontinence and Congenital Internal disease / defect.
b) Gall bladder and Pancreatic diseases and all treatments (conservative, interventional, laparoscopic and open) related to Hepato-pancreato-biliary disease including Gall bladder and Pancreatic calculi. All types of management for Kidney and Genito-urinary tract calculi.
c) All treatments (conservative, interventional, laparoscopic and open) related to all diseases of Uterus, Fallopian tubes, Cervix and Ovaries, Dysfunctional Uterine bleeding, Pelvic inflammatory diseases, Benign breast diseases.
d) Conservative, operative treatment and all types of intervention for diseases related to Tendon, Ligament, Fascia, Bones and joint [other than caused by accident]
e) Degenerative disc and Vertebral diseases including replacement of Bones and Joints and Degenerative diseases of the Musculo-skeletal system
f) Subcutaneous benign lumps, Sebaceous cyst, Dermoid cyst, Lipoma, Neurofibroma, Fibro adenoma, Ganglion and similar pathology
g) Any transplant and related surgery
4. Circumcision (except where medically necessary), Inoculation or Vaccination (except for postbite treatment and for medical treatment other than for prevention of diseases)
|INCLUDING TAX @ 18%||Premium rating||EXCLUDING TAX||Premium rating|
|60 yrs to 75 yrs||Sum Insured (Rs.)||60 yrs to 75 yrs||Sum Insured (Rs.)|
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 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 OP treatment which leads to IP hospitalization 30 days prior to the date of hospitalization is settled as Pre hospitalization. All original bills have to be produced.
To claim post hospitalization expenses, 7% of the Hospital bill (excluding Room rent) up to a maximum of Rs.5000/ is settled as post hospitalization.
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.
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
Q1. Can a request for Authorization for cashless claim be rejected / repudiated?
Yes, a request for authorization for cashless access may be rejected by Stars doctors based on various reasons. Some common reasons are:
The ailment/ disease for which hospitalisation is required is not covered at all by insurance policy.
The person does not have insured amount left to cover the hospitalisation costs.
This means that cashless claim access is rejected, AND policyholder cannot come for reimbursement as well.
Q2. What do you mean by Cashless Hospitalization? In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient is not required to settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by Star Health Insurance.
Q3. What do you mean by Network /Non-network Hospitalization? A Hospital, which has an agreement with the company for providing Cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those with whom the company does not have any agreement and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per reimbursement procedure.
Q4. How does hospitalisation for Planned Hospitalisation work?
The request for Pre-authorization form for planned treatment has to be signed by the customer and sent by Hospital.
This request must reach Star Health at least 2 days before hospitalisation.
Any change in the date of hospitalisation, Hospital, nature of illness or surgeon who is going to perform the procedure will make the authorization invalid. A fresh authorization will have to be taken.
The authorization is valid only for Network Hospitals.
The authorization will be addressed and faxed to the hospital.
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