Star Health Comprehensive Plan

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Star Health Comprehensive Plan


While the cost of healthcare is on the rise, the Star Health Comprehensive Plan comes as a saviour for those in medical need. The policy assuages your financial burden considerably by the exclusive benefits it has to offer. The company does not levy unnecessary caps on the charges incurred in the treatment. The policy becomes effective if the policyholder falls for an injury, illness or happens to be a victim of some mishappening. The policy takes care of the costs incurred in hospitalization, pre and post hospitalization or any other health procedure that do not require hospitalization.

A health insurance is a must thing in this uncertain world. To have a hassle free time getting the best health care during the time of adversities, monetary aspect is the last thing you need to give a thought and with Star Health Comprehension Plan you get the same as an assurance.

Highlights of Star Health Comprehensive Plan:

1. You do not have to abide any pre-described limit for the room rent and the treatment cost as the Company lays no caps on the aforesaid expenses.

2. It covers the entire medical expenses incurred in the treatment of the policyholder. Also, the policy undertakes the costs sustained in a Bariatric Surgical Procedures and any other complications associated with it.

3. To ensure that you get the best medical aid in time, the policy offers you air ambulance services and also pays for any second opinion that you wish to seek for betterment.

4. The expenses for maternity are also covered. There are same rules for normal and caesarean procedures.

5. It covers the health check up costs that you avail for every block of three claim free years.

6. The policy extends automatic restoration of the entire sum insured at the rate of 100 percent.

7. Dental or Ophthalmic OPD expenses are also taken care under this policy.

8. In the case of a personal accident, the policy offers accidental cover against death or permanent total disablement which is just equal to the health care cover without any additional costs.

9. Sum insured to increase by 100 percent at the time of claim-free renewal.

What does the plan cover?

1. Hospitalization:

2. Inpatients charges: The policy covers your room (single air conditioned room), boarding and nursing charges. The fees of the doctors, anaesthetists, surgeons and consultants are covered under the same.

3. Costs: The cost of the oxygen, blood, artificial limbs, medicines, drugs in use, pacemakers and other diagnostic expenses are taken care of under the policy.

4. Services: Complete expenses for 101 days of hospitalization are covered. Also, the emergency transportation charges of Ambulance are permitted up to a limit mentioned as under the benefits table.

5. Pre and Post Hospitalization: All the medical expenses up to 30 days prior to the date of admission and 60 days period after the discharge are covered under the policy.

6. Pre-existing Diseases:Any pre-existing disease is only covered if the person is covered under any Indian insurance company, for a continuous period of 48 months.

7. Delivery and Newborn: All the expenses incurred in the delivery including caesarean, any treatment of the newborn and vaccination charges up to rupees 1000 are included in the policy.

8. Out Patient Dental & Ophthalmic Treatment: Any eye or teeth treatment charges is covered under the policy once in every 3 years of continuous coverage.

9. Health Checkups: Payable only for a block of three years of continuous coverage.

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.

S.No. Features/Sum Insured 25 Lacs 20 Lacs 15 Lacs 10 Lacs 7.5 Lacs 5 lacs
1 Room, Boarding and Nursing Charges Single Standard A/C Single Standard A/C Single Standard A/C Single Standard A/C Single Standard A/C Single Standard A/C
2 ICU/Operations Charges Actual Actual Actual Actual Actual Actual
3 Ambulance Charges (by Road) Up to 5000 INR Up to 4500 INR Up to 4000 INR Up to 3500 INR Up to 3000 INR Up to 2000 INR
4 Air Ambulance Up to 10% of Insured Sum Up to 10% of Insured Sum Up to 10% of Insured Sum Up to 10% of Insured Sum Up to 10% of Insured Sum Not
5 Pre-Hospitalization Expenses Up to 30 days Up to 30 days Up to 30 days Up to 30 days Up to 30 days Up to 30 days
6 Post Hospitalization Expenses Up to 60 days Up to 60 days Up to 60 days Up to 60 days Up to 60 days Up to 60 days
7 Delivery Charges 25000 25000 25000 25000 20000 10000
8 Waiting Period for Delivery 36 months for first delivery 36 months for first delivery 36 months for first delivery 36 months for first delivery 36 months for first delivery 36 months for first delivery
    24 months after a delivery claim 24 months after a delivery claim 24 months after a delivery claim 24 months after a delivery claim 24 months after a delivery claim 24 months after a delivery claim
9 Coverage for a new born Up to 100000 Up to 100000 Up to 100000 Up to 100000 Up to 100000 Up to 50000
10 Vaccination expenses of New Born Up to 1000 Up to 1000 Up to 1000 Up to 1000 Up to 1000 Up to 1000
11 Outpatient dental/ opthal coverage in a block of 3 years of continuous renewal. Up to 10000 Up to 10000 Up to 10000 Up to 10000 Up to 5000 Up to 5000
12 Outpatient medical consultation except than above Up to 3300 (per consultation limit 300) Up to 3000 (per consultation limit 300) Up to 2400 (per consultation limit 300) Up to 2100 (per consultation limit 300) Up to 1500 (per consultation limit 300) Up to 1200 (per consultation limit 300)
13 Hospital cash up to 7 days per occurrence and up to 120 days per policy period. 1500 per day 1000 per day 1000 per day 750 per day 750 per day 500 per day
14 Health Checkup once in a period of 3 claim free years of continuous renewal. Up to 12000 Up to 12000 Up to 12000 Up to 7500 Up to 7500 Up to 5000
15 Restoration benefit after exhaustion of sum insured. 100% 100% 100% 100% 100% 100%
16 Bariatric surgery 250000 250000 250000 250000 250000 250000
17 Cover for accidental death and permanent/ total disablement 2500000 2000000 1500000 1000000 750000 500000

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,.

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.

FAQs


Q1. What is the maximum number of claims allowed per year?
You may claim the policy as many times as the need occurs. However, the sum insured will depend upon the maximum limit under the policy availed.

Q2. What is a Family Floater Plan?
This is a plan that covers the hospitalization expenses of the entire family. The Family Floater Plan covers the medical expenses occurred due to unexpected illness, accidents, and surgeries.

Q3. Is it a must to have a medical checkup before availing the policy?
A medical checkup while availing a new insurance policy is a must only if you are above 50 years of age. Also, a medical check-up is not required for the policy for a senior citizen from age 60 years to 69 years.

Q4. Can a request for Authorization for a cashless claim be rejected/ repudiated?
Yes, the same may be rejected on the following basis:
1. No proper amount left to cover the hospitalization expenses.
2. The disease or ailment to which hospitalization is sought is not covered under the policy terms.

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