Star Family Health Optima Insurance

Key Features and Benefits of Star Family Health Optima Insurance Plan

The key features and benefits of the Star Family Health Optima plan are as follows:

• Floater Coverage: This plan offers coverage to the policyholder and the family members on a floater basis.
• Sum Insured: It comes with a range of sum insured starting from Rs 1 lakh to Rs 25 lakh.
• Automatic Restoration of Sum Insured: The sum insured amount will be restored up to 100% upon exhaustion for a maximum of 3 times during the policy period.
• Lifetime Policy Renewals: Lifelong policy renewal is possible for all policyholders
• Co-Payment: If the age of the applicants is above 60 years, then 20% of co-payment is applicable to each and every claim and their subsequent renewals.
• Pre-acceptance Medical Screening: People above 50 years will need to undergo pre-acceptance medical check-ups at the registered diagnostic centre The cost of medical check-ups is also borne by the insurer.
• Pre-Existing Illnesses: Coverage for pre-existing diseases is provided after 48 months of continuous coverage.
• Recharge Benefit: Additional coverage amount up to the specified limit will be provided once in the policy year in case of exhaustion of the sum insured.
• Cumulative Bonus: Enhancement of sum insured by 25% in the second year and an additional 10% in the upcoming years for every claim-free year (subject to policy terms and conditions)
• Direct Claim Settlement: Direct claim settlement without the involvement of any third party administrator
• Faster Settlement of Claims: The insurance company offers hassle-free and faster claim settlements.
• Cashless Treatment: Cashless hospitalization can be availed at more than 11,000 network hospitals across India

Inclusions of Star Family Health Optima Insurance Plan

The coverage provided in the Star Family Health Optima Insurance plan are as follows:

• Cost of Health Check-up: It provides health check-up benefit for each claim-free year.
• Domiciliary Hospitalization: It provides coverage for treatment taken at home for a period exceeding 3 days on a doctor’s recommendation.
• DayCare Procedures: It covers all day care procedures that require less than 24 hours of hospitalization.
• In-patient Hospitalization Expenses: It covers the cost of hospitalization for at least 24 hours, including room charges, boarding expenses, nursing expenses, medical practitioner, surgeon, anesthetist, specialist & consultant’s fees, etc.
• Emergency Road Ambulance:It provides coverage for emergency ambulance services taken to reach the nearest hospital as per the specified limits.
• Air Ambulance:It provides coverage for air ambulance services up to 10% of the SI.
• Pre-hospitalization Expenses:It covers up to 60 days of pre-hospitalization expenses before the hospital admission.
• Post-hospitalization Expenses:It covers hospitalization costs incurred up to 90 days after getting discharged from the hospital.
• Organ Donor Cover:It pays for organ donor expenses up to 10% of the SI or Rs 1 lakh, whichever is less.
• Coverage for Newborn Baby:It offers newborn baby cover subject to a limit of 10% of the SI or Rs 50,000, whichever is less.
• Coverage for Modern Treatment:It covers the expenses incurred on modern treatments.
• Emergency Domestic Medical Evacuation:The insurer compensates the expenses incurred towards conveyance of the policyholder from one hospital to another hospital up to the specified limits. The coverage is limited within India.
• Repatriation of Mortal Remains:The insurer will reimburse up to Rs 5,000 towards the cost of repatriation of mortal remains of the insured to the city of residence.
• Compassionate Travel:The insurer will recompense the air transport expenses for one family member up to Rs 5000 if the insured is admitted to a hospital in another city.
• Treatment in the Network Hospital:In case of emergency hospitalization, the insurer can suggest an appropriate hospital from the list of network hospitals for treatment and will provide a lump sum payment of up to 1% of SI subject to a maximum of Rs 5000 per policy period.
• Shared Accommodation:It pays for the shared accommodation expenses during in-patient hospitalization up to the specified limits.
• AYUSH Treatment:It covers the cost of treatment taken through AYUSH hospitals up to the specified limits.
• Second Medical Opinion:It pays for the cost of availing second medical opinion from any of the empanelled medical practitioners.
• Additional Sum Insured for Road Traffic Accident:In case of an accidental hospitalization, the basic sum insured shall be increased by 25 per cent subject to a maximum limit of Rs 5 lakh. But to avail this benefit, the insured rider/pillion rider should be wearing a helmet while travelling in a 2-wheeler.
• Assisted Reproductive Treatment: Compensation is provided for expenses incurred on assisted reproduction treatment for sub-fertility. It can only be covered after the completion of a waiting period of 36 months from the policy commencement date. For a sum insured of Rs 5 lakh, the limit of compensation is Rs 1 lakh and for a sum insured of Rs 10 lakh & above, the limit is Rs 2 lakhs.

Eligibility Criteria of Star Family Health Optima Plan

Take a look at the eligibility criteria of the Star Family Health Optima plan below:

• Anyone between the age group of 18 years and 65 years, who are residing in India, can buy this plan.
• Lifetime renewal is possible for all applicants
• Children between the age of16 days to 25 years can be covered
• Family members that can be covered, include self, spouse, dependent children, dependent parents and dependent parent-in-law

Exclusions of Star Family Health Optima Plan

Star Health & Allied Insurance Company Limited shall not be liable to pay for any expenses incurred due to the following reasons under the Family Health Optima plan:

• Congenital external defects/condition /anomalies
• Preputioplasty, circumcision, frenuloplasty, removal of SMEGMA and preputial dilatation
• Vaccination or inoculation (unless it is for post-bite treatment and therapeutic reasons)
• General debility, convalescence, run-down condition, nutritional deficiency states
• Dental surgery or treatment unless it has incurred due to accidental injuries and results in hospitalization(it doesn’t cover dental implants)
• Self-inflicted injuries
• Expenses due to the use of drugs, intoxicating substances, smoking, alcohol, and chewing tobacco chewing
• Hospitalization directly or indirectly related to war, warlike operations, an act of foreign enemy and invasion
• Hospitalization directly or indirectly resulting due to the damage caused by nuclear weapons and materials
• Chondrocyte implantation, intraarticular injection therapy and procedures using Platelet Rich plasma
• Plastic surgery (unless it is required due to an accident or is a part of an illness)
• Aesthetic treatment, cosmetic surgery, sex-change operations, and all treatment related to erectile dysfunctions

Claims Procedure of Star Family Health Optima Plan

To file a claim under the Star Family Health Optima plan, just follow the simple process given below:

• Report the medical emergency/ claim on the insurance company’s 24-hour assistance number
• Furnish the policy number and ID proof
• For planned hospitalizations, inform the insurer before 24 hours of hospitalization
• Cashless hospitalization cover can be availed in the network hospitals
• For treatment in non-network hospitals, the insured needs to make the payments and then file for a reimbursement
• Claim approval is based on the submission of the required documents
• In the case of a cashless claim, the claim amount will be settled directly with the hospital.
• Ina reimbursement claim, the claim amount will be paid to the policyholder after verification of submitted documents.

Star Family Health Optima FAQs