Star Health Senior Citizen Plan

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(eldest member)
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About Star Health Company


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 India’s 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 India’s 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, it’s a great way to keep one’s 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

• It offers 5% discount on premium if you do Online purchases.

• 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?

The coverage is excluded of the following:

• 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

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.)
5251 100000 4450 100000
9978 200000 8456 200000
15222 300000 12900 300000
18291 400000 15501 400000
21240 500000 18000 500000
24780 750000 21000 750000
26550 1000000 22500 1000000

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 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.


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. Can a request for Authorization for cashless claim be rejected / repudiated?
Yes, a request for authorization for cashless access may be rejected by Star’s 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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