Family Health Optima Insurance Plan

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About Star Health Insurance

  • Star Health and Allied Insurance Co Ltd commenced its operations in 2006 with the business interests in Health Insurance, Overseas Mediclaim Policy and Personal Accident. Star built a promising path for our future with a capital base of Rs.985 crores. Star have emerged as India’s first stand-alone Health Insurance Company, dealing in personal accident, medi-claim and overseas travel insurance.
  • At Star Health Insurance, the company offers a wide range of health insurance products at affordable prices to make health insurance every human being’s right. And as a company, single-mindedly dedicated to health insurance.

Sum Insured Options Available

                                                                                             

Age Limit

                                                                                                               

Policy Combination

                                                                                                                   

In-Patient Treatment

Star Comprehensive will cover all medical expenses in case of medically necessary hospitalization of an Insured person incurred due to Disease, Illness or injury when the Insured person is admitted as an in-patient for more than 24 consecutive hours. 
  • Nursing expenses. 
  • Surgeon
  • Anaesthetist
  • Medical Practitioner
  • Specialist Fees
  • Ana'esthesia
  • Blood
  • Oxygen,
  • Operation Theatre charges
  • Surgical Appliances
  • Medicines and Drugs
  • Diagnostic Materials and X-ray

Pre And Post Hospitalization

  • Pre Hospitalization: Star will cover medical expenses of an Insured person due to a disease or injury or illness incurred immediately prior to hospitalization, up to 60 days under the plan opted by the Insured subject to a claim being admissible under In-patient Hospitalization and expenses are related to the same illness/condition.
  • Post Hospitalization: Star will cover  medical expenses of an Insured person incurred post hospitalization due to a disease or injury or illness up to 90 days under the plan opted by the Insured subject to a claim being admissible under In-patient Hospitalization and expenses are related to the same illness/condition.

Room Rent Or Hospital Accommodation

Day-Care Procedures

All those medical expenses of an Insured Person in case of medically necessary day care treatment or surgery that requires less than 24 hours hospitalization due to advancement in technology and which is undertaken in a hospital / nursing home will be covered

                                                                            

Emergency Ambulance

New Born Baby Cover

No Claim Bonus

Automatic Restoration Of Sum Insured

  • There  shall be automatic restoration of the basic SI once immediately upon exhaustion od the limit of converge, which has otherwise been defined, during the policy period subjected to the following terms and extent thereof.
  • Restored SI can be utilized only for illness/disease unrelated to the illness/disease for which claims was/were made. 
                                                                               

Domiciliary Treatment

Domiciliary Hospitalization means medical treatment for a period of exceeding 3 days, for an Illness/Injury which in the normal course would require care and treatment at a Hospital but is actually taken while confined at home under any of the following circumstances:
  • The attending Doctor confirms that the Insured Person could not be transferred to a Hospital or 
  • The customer satisfies the company that a Hospital bed was unavailable.

Donor Expenses for Organ Transplantation

Star will cover in-patient hospitalization medical expenses towards the donor for harvesting the organ in case of major organ transplant if it is in accordance with the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules. The organ donated is for the use of the Insured person as per Medical Advice and a claim has been admitted under in patient hospitalization.
  • Up to a limit of 10% of SI or Rs. 1 Lakhs or whichever is less.
  • Donor Screening Expenses and Post Donation Complications of the donor not covered.

Health Check-Up

For every block of 3 years irrespective of claim, Benefit is available up to the limit of 1% of SI or Maximum of Rs.5000. No Provision for 2 Lakh sum insured.

Recharge Benefit

If the limit of converge under the policy is exhausted/ exceeded during the policy period , additional indemnity up to the limits  indicated in the schedule would be provided once for the remaining policy period.

Waiting Periods

  • 30 Days Initial waiting period except Accidents
  • 48 Months waiting period if any Pre-Existing diseases.
  • 24 Months waiting period for specific diseases.

List Of Specific Diseases

  • The expenses for treatment of Cataract, Glaucoma, Retinal detachment, Macular degeneration, prolapse of intervertebral disc, Varicose Veins and Varicose ulcers, benign Prostatic hypertrophy, Deviated Nasal Septum.
  • All treatments (conservative, interventional, laparoscopic and open) for Hepatobiliary gall bladder and Pancreatic calculi and Genitourinary calculi.
  • All treatments (conservative, interventional, laparoscopic and open) for Uterine Prolapse, Dysfunctional Uterine Bleeding, Fibroids, Pelvic Inflammatory Diseases, all diseases of Fallopian tubes and Ovaries.
  • Conservative and operative treatment of joint diseases (other than caused by accident).
  • All types of joint replacement (other than caused by accident).
  • Any transplant and related surgery.
  • Degenerative disc and vertebral diseases and degenerative diseases of the Musculo-Skeletal system

Permanent Exclusions

  • Addictive conditions and disorders; Ageing and puberty, Artificial life maintenance; Circumcision, Dental /oral treatment, Conflict and disaster, Congenital conditions, Convalescence and Rehabilitation,
  • Cosmetic surgery, Drugs and dressings for OPD Treatment or take-home use; Eyesight, Unproven/ Experimental treatment, Health hydros, nature cure, wellness clinics etc.
  •  HIV and AIDS, Obesity, Hereditary conditions (specified), Items of personal comfort and convenience, Alternative treatment, Psychiatric and Psychosomatic Conditions, OPD Treatment, Stem cell implantation, Ancillary Hospital Charges,
  • Preventive care, Treatment for Alopecia, Unrelated diagnostic, x-ray or laboratory examinations, Charges for medical papers, Reproductive medicine, Self-inflicted injuries, Sexual problems and gender issues, Sexually transmitted diseases, Unrecognized physician or Hospital,
  • Active participation in adventure or hazardous sports including but not limited to para-jumping, rock climbing, mountaineering, motor racing, horse racing or deep-sea diving, Unlawful Activity, Any costs or expenses specified in the List of Expenses Generally Excluded at Annexure I .

Enquiry

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