Star Family Health Optima Insurance Plan

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Star Family Health Optima Insurance Plan Overview

Star Family Health Optima health insurance plan offers wider coverage to the entire family under a single plan. It is a complete protection plan for you and your entire family. Due to the sedentary lifestyles, everyone is now more vulnerable to health issues. And the cost of medical treatment is quite exorbitant now. A health insurance policy helps in coping up with the mounting hospital bills. And this plan is a comprehensive and affordable one to help you insure your entire family.

Key Features of Star Family Health Optima Insurance Plan

The key features of this plan are as follows:

  • Automatic Restoration of Sum Insured: It is applicable 3 times during the policy period. The amount will be restored upon exhaustion of the available amount.
  • Lifetime Policy Renewals: Life-long policy renewal option for applicants aged above 65 years.
  • Co-Payment: If the age of the applicants is above 60 years then 20% of co-pay is applicable to each and every claim and their subsequent renewals.
  • Pre-medical Screening: People above 50 years will need to undergo pre-medical check-ups at the registered diagnostic centers. And the cost of medical check-ups is also borne by the insurer.
  • Pre-Existing Illnesses: Compensation is provided after 48 months of continuous coverage with any Indian Insurance provider.
  • Recharge Benefit: Up to the specified limit.
  • Bonus:No-claim-bonus of 25% in the second year and an additional 10% for in the next year ( subjected to policy terms and conditions)
  1. Direct claim settlement without the involvement of any third party administrator
  2. Hassle free and faster claim settlement
  3. More than 8800 network hospitals across India
  4. Electronic maintenance of personal health records

Star Family Health Optima Insurance Plan Inclusions

The coverage provided in this plan is as follows:

  • Coverage for the new-born baby from the 16th day
  • Wider coverage for the entire family in a single plan at an affordable premium
  • 100 percent reinstatement of the sum insured
  • Assisted Reproductive treatment cover
  • Health check-up benefit for each claim free year
  • Organ transplantation including donor expenses
  • Domiciliary hospitalization cover for a period exceeding 3 days
  • Daycare procedures are also covered
  • 120 days of a grace period from the expiry date of the policy for renewal

Star Family Health Optima Policy Benefits

It covers the following hospitalization expenses:

  • Room charges, boarding expenses as well as nursing expenses as per the specified limit
  • Medical Practitioner, Surgeon, Anesthetist, Specialist & Consultants Fees. Expenses incurred on diagnostic and imaging procedures, oxygen, medicine, operation theatre, drugs, and also a pacemaker.
  • Emergency ambulance cover to the hospital as per the specified limits
  • Air Ambulance cover up to 10% of the basic SI during the policy term
  • Up to 60 days of pre-hospitalization expenses before the hospital admission
  • Post-hospitalization expenses incurred up to 90 days after getting discharged from the hospital
  • Organ donor expenses up to 10% of the SI or one lakh rupees, whichever is less
  • Medical checkup expenses up to the specified limits
  • Newborn baby cover subjected to a limit of 10% of the SI or 50,000 rupees, whichever is less

New Benefits of Star Family Health Optima Plan

  • Emergency Medical Evacuation: The insurer compensates the expenses incurred towards conveyance of the policyholder from the hospital to another one up to the specified limits. The coverage is limited within India.
  • Repatriation of Mortal Remains: The insurer will reimburse up to 5,000 rupees towards the cost of repatriation of mortal remains of the insured person to their city of residence.
  • Compassionate Travel: The insurer will recompense the air transport expenses got a visiting family member. And the limit for one family member is up to Rs. 5000 for travel towards the concerned hospital.
  • Lump-sum Payment for Treatment in the Network Hospital: In case of emergency hospitalization, the insurer can suggest you an appropriate hospital from the list of network hospitals and the limit for treatment is up to 1% of Basic SI subjected to a maximum of Rs.5000 per policy period.
  1. Shared Accommodation expenses are paid up to the specified limits
  2. AYUSH treatment cover up to the specified limits
  3. Second medical opinion from any of the empanelled medical practitioners
  • Accidental Cover: In case of an accidental hospitalization, your basic sum insured shall be increased by 25 percent subject to a maximum limit of Rs. 5 lakhs. It is required for the insured rider/pillion rider to be wearing a helmet and travelling via 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 completion of a waiting period of 36 months from the policy commencement date. For a sum assured of Rs.5 lakhs the limit of compensation is Rs. 1 lakhs and for a sum assured of Rs. 10 lakhs the limit is Rs. 2 lakhs, with a waiting period of 36 months.

Eligibility Criteria of Star Family Health Optima Plan

  • 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 applicants beyond 65 years of age
  • Family cover to the spouse and dependent children starting from 6 days to 25 years (only dependent children)

Exclusions of Star Family Health Optima Plan

Star Health Insurance shall not be liable to pay for any expenses incurred due to the following reasons:

  1. Congenital Defects/External Condition / Anomalies
  2. Preputioplasty, Circumcision, Frenuloplasty, Removal of SMEGMA and Preputial Dilatation
  3. Vaccination or Inoculation or (unless it is for post-bite treatment and for therapeutic reasons)
  4. General debility, Convalescence, run-down condition, Nutritional deficiency states.
  5. Dental surgery or treatment unless it has incurred due to accidental injuries and results in hospitalization. (it doesn’t cover dental implants)
  6. Behavioral, psychiatric, and mental disorders
  7. Self-inflicted injuries
  8. Sexually Transmitted Diseases
  9. Use of drugs, intoxicating substances, smoking, alcohol, and chewing tobacco chewing
  10. Venereal Diseases
  11. Immunotherapy, Oral Chemotherapy, and Biologicals
  12. Hospitalization directly or indirectly related to war, warlike operations, an act of foreign enemy and invasion
  13. Hospitalization directly or indirectly resulting due to the damage caused by nuclear weapons and materials
  14. Chondrocyte Implantation, Stem cell Therapy, Intraarticular injection therapy and procedures using Platelet Rich Plasma
  15. Plastic surgery (unless it is required due to an accident or is a part of an illness)
  16. 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 just follow the simple process:

  • Report the claim on their 24-hour assistance number
  • Furnish your Policy number and ID proof
  • For planned hospitalizations, you need to inform the insurer before 24 hours of hospitalization
  • Cashless hospitalization cover in the network hospitals
  • For treatment for in non-network hospitals, you need to make the payments and then file for reimbursement
  • Claim approval is based on submission of the required documents