Star Health Comprehensive 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.

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. No cap on room rent and treatment cost.

2. Covers medical expenses incurred on Bariatric surgical procedures and its complications.

3. Air ambulance assistance, Second medical opinion are covered.

4. Cost of health check up for every block of 3 claim free years.

5. Cover for maternity (normal and caesarean delivery) and New born baby.

6. Automatic restoration of entire Sum insured by 100%.

7. Dental / ophthalmic cover on OPD basis.

8. Hospital cash benefit.

9. Cover for over 400 day care procedures.

10. Personal accident cover against Death and Permanent total disablement (equal to the Health Insurance cover) at no additional cost.

11. 100% Increase in Sum Insured upon a claim free renewal

What does the plan cover?

Section 1:

Hospitalization cover protects the insured for in patient hospitalization expenses for a minimum period of 24 hrs. These expenses include room rent (Single Standard A/C room), nursing and boarding charges, Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees, Cost of Medicines and Drugs.

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

2. Air Ambulance Benefit Permitted up to 10% of the Sum Insured opted, during one policy period, applicable for sum insured of Rs.7.5 lakhs and above only.

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

3. Post hospitalization expenses up to 60 days after discharge from the hospital.

4. Out-patient consultation (other than dental and ophthal) expenses up to limits mentioned in the table of benefits.

5. Coverage for Domiciliary hospitalization for a period exceeding three days.

Section 2:

Expenses for Delivery - including Pre-natal and Post natal expenses up-to the limits specified. A waiting period of 36 months of continuous coverage under this policy with Star will apply.Automatic coverage for the New Born (including internal and external congenital problems) up to the expiry of the current policy (On renewal this new born baby should be covered specifically) Vaccination expenses for the New Born upto Rs.1000/- payable.

Section 3: Outpatient Dental, Ophthalmic treatment

Dental / Ophthalmic treatments as an out-patient - once in a block of every three years irrespective of whether a claim is made or not.

Section 4: Hospital Cash

Dental / Ophthalmic treatments as an out-patient - once in a block of every three years irrespective of whether a claim is made or not.

Section 5: Health Check up

Cost of Health Check-up once after a block of every three claim-free years

Section 6: Bariatric Surgery

Expenses incurred on hospitalization for bariatric surgical procedure and its complications thereof are payable subject to a maximum of Rs.2,50,000/- during the policy period. This maximum limit of Rs.2,50,000/- is inclusive of pre-hospitalization and post hospitalization expenses. Claim under this section shall be processed only on cashless basis. Coverage under this section is subject to a waiting period of 36 months and payable only while the policy is in force

Section 7: Accidental Death and Permanent Total Disablement Cover against Accidental Death

The person chosen by the Proposer at the time of payment of premium as mentioned in the schedule herein is covered for Personal Accident. The sum insured for this section is equal to the sum insured opted for the Health insurance.

Section 8: Option for Second Medical Opinion

The Insured Person is given the facility of obtaining a Second Medical Opinion in electronic mode from a Doctor in the Company's network of Medical Practitioners. Medical records can be sent to the mail id e_medicalopinion@starhealth.in

Automatic Restoration of Sum Insured (Applicable for Section 1 Only)?

Upon exhaustion of Basic sum insured and the Bonus, sum insured will be automatically restored by 100% once policy period. Such restored Sum Insured can be utilized only for illness / disease unrelated to the illness / diseases for which claim/s was / were made.

Bonus:

Following a claim free year bonus at 50% of the basic sum insured (max.100%) would be allowed. Where there is a claim the Bonus would be reversed in the same order in which it was given.

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,.

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?
There will be no medical check-up for availing this health insurance plan.

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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