Key features and exclusions of Star-Medi Classic Insurance Plan
Features:
- Entry Age: 5 months to 65 years
- Exit Age: No
- Renewal: Lifelong renewal beyond 65 years
- Policy Type: Individual/ Floater
- Sum Insured: Rs.1.5 lacs to Rs.15 Lacs
- Pre- acceptance medical test: All persons above 50 years of age and those who declare adverse medical history in the proposal form are required to undergo pre-acceptance medical screening at the company designated centers the cost of which would be borne by the insurance company.
- Day Star procedure: All day Star procedures are covered
- Room Rent: At 2% of sum insured per day up subject to a maximum of Rs.5k
- ICU Charges: Actual
- Road Ambulance: Covered up to Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period.
- Pre-Hospitalization: 30 days prior to the date of hospitalization
- Post hospitalization: 60 days from the date of discharge from hospital
- Coverage for modern treatments: Available
- Health Check up: Up to 1% of the sum insured or a maximum of Rs.5000 once in a block of every four claim free years provided the star health insurance policy is in force at the time of availing this facility
- Psychiatric and Psychosomatic disorder: If the insured person is diagnosed with psychiatric or psychosomatic disorder for the first time and hospitalized for a minimum period of 5 consecutive days, the company will pay hospitalization expenses up to the basic sum insured, provided the insured has been covered under this policy continuously for a period of 24 months
- Cumulative Bonus: Cumulative bonus calculated at 5% of the basic sum insured for every claim free year subject matter to a maximum of 25%.
- Cover for Accidental death and Permanent Total Disability: Up to Rs.1 Cr
- AYUSH Treatment: Up to 25% of the basic sum insured subject to a maximum of Rs.20, 000/- during the policy period.
- Automatic restoration of Basic sum insured: There shall be automatic restoration of the basic sum insured by 200% once during the policy period, immediately upon the exhaustion of the coverage which has been defined.
- Super Restoration: If the sum insured is exhausted during the policy period, an additional basic sum insured of 100% would be provided for once, for the remaining policy period for the subsequent hospitalization. This additional basic sum insured can be utilized even for the illness or disease for which the claim is already made.
- Domiciliary Hospitalization: Covered
- Organ Donor expenses: In patient hospitalization medical expenses incurred for organ transplantation from the donor to the recipient insured person are payable provided the claim for transplantation is payable. Donor screening expenses and post-donation complications of donor are not payable.
- Cataract Surgery: Up to Rs.30k per eye per person and Rs.40k per person during the policy period
- Shared Accommodation: If the insured person occupies a shared accommodation during in-patient treatment, then the allied insurance company would pay up to Rs.1k per day for such stay subject to a maximum of Rs.6k per hospitalization.
- Accidental Basic Sum insured for Road Traffic Accident (RTA): If the insured person meets with a Road traffic accident resulting in in-patient hospitalization, then the basic sum insured shall be increased by 50% subject to the terms and conditions mentioned under the policy.
- Hospitalization nursing expenses for treatment of New Born Baby: Starts from 16th day after its birth till the expiry of the policy and is subject to a limit of 10% of the sum insured or Rs.50k whichever is less; subject to availability of the sum insured.
- Co-payment: 10% co-pay for each and every claim for insured person whose age at the time of entry is 60 years and above.
- Pre Existing waiting period: 48 months
- Specific Waiting period: 24 months
- Initial Waiting period: 30 days except for accidents
- Moratorium Period: After completion of 8 continuous years under the policy no look back to be applied. After the completion of moratorium period no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.
- Revision of Sum Insured: Reduction or enhancement of sum insured is permissible only at the time of renewal. The acceptance or rejection for such request would depend on the discretion of the company.
- Discount: 5% discount is available if 2 or more family members and senior citizens are covered under the policy and 25% discount on premium at the time of renewal if the insured person can submit the proof that he/she has donated a major organ.
Exclusion:
- Obesity and weight control treatments are not covered
- Gender change treatments
- Cosmetic or plastic surgery
- Engagement in Hazardous or Adventure sports
- Claims resulting from Breach of law
- Treatment for Alcoholism, drug or substance abuse or any addictive condition thereof
- Dietary supplements and substances that can be purchased without prescription including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner s part of hospitalization expense.
- Refractive Error less than 7.5d
- Expenses incurred towards Sterility and Infertility
- Congenital external conditions
- Intentional self injury etc
- War, nuclear, chemical or biological attack or weapon
- Expenses incurred on Investigation & Evaluation primarily for diagnosis.
- Expenses for treatments arising directly from or consequent upon any insured person committing a breach of law with criminal intent
- Expenses incurred towards treatment in any hospital cash or by any medical practitioner or any other service provider specifically excluded by the insurer and disclosed on its website and notified to the policyholders are not admissible.
- Medical or surgical treatment of Endocrine disorders
- Cost of spectacles and contact lens, hearing aids, cochlear implants, and procedure-related hospitalization expenses, walkers and crutches, wheelchairs, etc. Please refer to our website Policybachat for more information such as tax benefits, claim settlement,etc.