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STAR HEALTH FAMILY HEALTH OPTIMA INSURANCE

The Star Health Family Optima Insurance is a super saver family-floater healthcare policy that covers your entire family under a single sum insured and at an affordable premium.

 

Star Family Health Optima Insurance Plan Details

  • Health insurance policy on floater basis.
  • 18-65 years old individuals residing in India are eligible, including a child above 16 days of age (covered as part of the family).
  • If the newborn child is less than 16 days of age at the time of commencement of the policy, the proposer can opt to cover him/her by paying the full applicable premium(cover comes into effect only from the 16th day afterbirth).
  • The family includes the proposer, spouse and dependent children from 16 days to 25 years old (economically reliant on parents).
  • Initial waiting period for hospitalisation: 30 days (excluding accidental hospitalisation).
  • Covers pre-existing diseases/illnesses after 48 months of continuous insurancewith any of the Indian insurance providers.
  • Slow-growing diseases/specific illnesses are covered after 24 months.
  • Star health family optima policy covers donor expenses for organ transplantation, Assisted-reproduction treatment and day-care procedures.
  • Newborn baby cover from the 16th day.
  • Three-times automatic sum-insured restoration by 100% every time it gets completely exhausted.
  • Offers extra sum-insured (auto recharge) at zero cost.
  • Co-payment:20% of every claim for those above 60 at entry-level and subsequent renewals.
  • Health-checkup benefit for each claim-free year.
  • Pre-acceptance medical screening for individuals above the age of 50 (at company-nominated centres).
  • Free-look period of 15 days from the date of receipt of the insurance policy.
  • 120-days grace period for renewal after the expiry date of the policy.
  • Guaranteed life-long renewals beyond 65 years.

 

Family Health Optima Policy Benefits

  • A network of 9,900+ hospitals across India.
  • Room/boarding/nursing expenses included as per the limits.
  • Anaesthetists, Surgeons, Medical Practitioners, Consultants, Specialist Fees, Oxygen, Operation Theatre, Diagnostics, Imaging modalities, Medicines/Drugs, Oxygen, Blood, Diagnostic and Cost of the Pacemaker.
  • Ambulance charges for emergency transportation to the hospital.
  • Air-ambulance charges up to 10% of the basic sum-insured during the entirepolicy period.
  • Pre-hospitalisation expenses: up to 60 days.
  • Post-hospitalisation expenses: up to 90 days after discharge.
  • Domiciliary hospitalisation: Covers medical treatment exceeding three days.
  • Organ-donor expenses: Cover up to 10% of the sum-insured or 1 lakh rupees, whichever is less.
  • Cost of health-checkups up to the limits.
  • The newborn baby cover is subject to a limit of 10% of the sum-insured or fifty thousand rupees, whichever is less.
  • Emergency domestic medical evacuation where the insurer reimburses expenses incurred towards transportation of the insured from the treating hospital to another (up to the limits).
  • Compassionate travel: The insurance company reimburses transportation expenses by air up to 5,000 rupees for one immediate family member (excluding the travel companion) towards the hospital location.
  • Repatriation of mortal remains: Get reimbursed up to 5,000 rupees towards the cost of repatriation of insured's mortal remains to his/her residence.
  • During a medical contingency requiring hospitalisation, if the insured individual asks for advice from the insurer, you may be suggested an appropriate hospital from the network. Treatment up to 1% of the basic sum-insured (maximum 5,000 rupees/policy is payable as lumpsum).
  • Shared accommodation- up to the limits.
  • AYUSH treatment-up to the limits.
  • The insured can obtain a second medical opinion from any doctor in the insurance company’s network of medical practitioners.
  • Insurance provider reimburses medical expenses on Assisted-reproduction treatment. Thirty-six months waiting period from the date of inception of the policy. The maximum liability is limited to 1 lakh rupees for the sum-insured of 5 lakhs and 2 lakh rupees for the sum-insured of 10 lakhs and above (for each block of 36 months).
  • If the insured meets with a road traffic accident resulting in an in-patient hospitalisation, the basic sum-insured is increased by 25% (subject to a maximum of 5,00,000 rupees).
  • Direct in-house, faster and hassle-free claims settlement.
  • After a claim-free year bonus of 25% of the expiring basic sum-insured in the second year, an additional 10% for subsequent years (maximum 100%) is allowed.
  • Amounts paid by modes other than cash are eligible for relief under the Section 80D of the Income Tax Act.

 

Star Family Health Optima Policy Exclusions

  • Expenses on Circumcision,Preputioplasty, Frenuloplasty, Preputial Dilatation and Removal of SMEGMA.
  • Inoculation/Vaccination.
  • Congenital External Condition, Defects and Anomalies.
  • Dental Treatments/Surgeries unless necessary due to accidental injuries and requiring hospitalisation(excluding Dental implants).
  • Convalescence, General Debility, Run-down Condition/Rest cure, Nutritional Deficiency States.
  • Psychiatric/Mental/Behavioural Disorders.
  • Intentional Self-injuries.
  • Use of Intoxicating Substances, Substance Abuse, Drugs, Alcohol, Smoking or Tobacco Chewing.
  • Venereal Disease and Sexually Transmitted Diseases.
  • Injuries/Diseases directly/indirectly caused by/arising from/attributable to Wars, Invasions, Acts of Foreign Enemies, Warlike operations (war declared or not).
  • Injuries/Diseases directly/indirectly caused by/contributed to by Nuclear Weapons/Materials.
  • Expenses arising out of Conditions directly/indirectly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV-III) or Lymphadenopathy Associated Virus (LAV) or HIV/AIDS.
  • Treatments arising from/traceable to Pregnancy, Childbirth, Family planning, Miscarriage/Abortion and Complications(other than Ectopic Pregnancy).
  • Treatments for Sub-Fertility, Assisted Conception/or other related complications.
  • Expenses incurred on Weight Control Services such as Surgical procedures, Bariatric Surgery/Medical treatment of obesity.
  • Medical/Surgicaltreatments of Sleep Apnea, treatment for Genetic/Endocrine disorders.
  • Expenses on High Intensity Focused Ultrasound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter Pulsation Therapy, Chelation Therapy, Deep Brain Stimulation, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low-level Laser Therapy, Photodynamic Therapy and other such therapies.
  • Expenses on Lasik Laser/other procedures, Refractive Error Correction and its complications, treatments for disorders of Eye requiring Intravitreal Injections.
  • Diagnostics not consistent with the treatment for which the insured is admitted to the hospital or a nursing home.
  • Admission primarily for diagnostic purposes with no positive existence of sickness, disease, ailment, injury and no further treatment is indicated.

 

Claims Procedure, Insurance Portability& Cancellation

  • 24-hour help-line: 1800-425-2255 Or 1800-102-4477.
  • Mention the ID/Policy number for easy reference.
  • Planned hospitalisation- Please inform 24 hours before admission.
  • Emergency hospitalisation. The information must be shared within 24 hours.
  • Cashless facility is available in all network hospitals, wherever possible.
  • Payments made up-front in non-network hospitals are reimbursed after the submission of documents.
  • The insured can port the policy by submitting an appropriate application form to the insurance company at least 45 days before, no earlier than 60 days from the renewal date.
  • Email portability@starhealth.inor reach out to +91-044-28288869.
  • The policy can be cancelled by the insurance company on the grounds of misrepresentation/fraud, moral hazard or non-disclosure of material facts (as stated in the proposal/claim form) at the time of claim and non-co-operation of the insured individual by serving a 30-days notice at his/her last known address.
  • A policyholder can also cancel it at any time, and the company allows refund after retaining premium at a short Period-rate, provided no claim has occurred up to the cancellation date.

 

Star Health Optima Insurance: FAQs

Q: What is the policy term for the Star Family Health Optima insurance plan?

One year and it can be renewed.

Q: What are the sum insured options I can choose from?

1 & 2 lakh rupees (only available for renewals), 3, 4, 5, 10, 15, 20 and 25 lakh rupees.

Q: Are pre-existing diseases covered by the Star Family Health Optima insurance plan?

Yes, they are, after a waiting period of 48 months.

Q: Can I pay my premium in instalments?

Yes, you may choose from monthly, quarterly, half-yearly and annual options.

 

Star Health Insurance

  • Star Health and Allied Insurance Co. Ltd., started operations in 2006. As an exclusive health insurance provider, it is admired across India for setting international benchmarks in service and personal caring.
  • Registered Office: No 1, New Tank Street, Valluvarkottam High Road, Nungambakkam, Chennai 600034.
  • IRDAI Registration No: 129 | CIN :U66010TN2005PLC056649 | Ph: 044-28288800 | Fax: 044-28260062 |Info@Starhealth.In l www.starhealth.in.

 

Disclaimer:The information shared is only indicative. Please go through the actual policy wordings for details on risk factors, terms and conditions Or visit www.starhealth.in before finalising the purchase.