Star Outpatient Star Insurance Policy

Key features and exclusions of Star Outpatient Star Insurance Plan

Features:

• Entry Age: 18 years to 50 years
• Dependent Children: 31st day to 25 years
• Family Size: Up to 6 members
• Exit Age: No
• Renewal: Lifelong renewal beyond 65 years
• Sum Insured: Rs.25k to Rs.1 Lac
• Policy Type: Individual & Floater
• Plans: Silver, Gold & Platinum
• Policy Term: 1 year
• Outpatient Consultation expenses: Incurred at any network facility in India
• Diagnostics, Physiotherapy and Pharmacy expenses: Covered
• Dental treatment expenses: Arising out of accidents covered
• Ophthalmic treatment expenses: Arising out of accidental injuries covered
• 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.

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 or by any medical practitioner or any other service provider specifically excluded by the insurer and disclosed in 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, wheel chairs etc.

Star Health Insurance Add-ons/Riders

Add-ons or Riders are a form of extra coverage available to the insured customer on payment of additional premiums which are to opted at the time of policy purchase. There are different add-ons with Star Health insurance companies to cover your specific needs at different points in time.There are certain add-ons which are available in the Star health insurance policies on payment of extra premium. They are:

Buy Back Pre-Existing Diseases:

Under this add-on or Rider the pre existing disease waiting period reduces from 36 months to 12 months. The pre existing disease waiting period is the time during which the insurance coverage would not be applicable for the diseases or illnesses or conditions that exist prior to the inception of the policy. If the customer purchases this add-on or rider the pre existing disease waiting period would be reduced from 3 years to 1 year and after the completion of 1 year policy period the customer can avail the benefits of pre existing disease cover from the next year policy period. The add-on is to be purchased at the time of taking the policy and the waiting period is one year from the purchase of first policy date.

Hospital Daily Cash:

Star Health Insurance Company will pay cash benefit of Rs.1000 per day for each completed day of hospitalization subject to a maximum of 7 days per hospitalization and 14 days per policy period. For the purpose of this optional cover, the days of admission and discharge will not be taken into account. The hospital daily cash benefit is available on payment of additional premium by the insured customer at the time of policy purchase. The hospital cash benefit option enables the customer to get his/her petty expenses covered during their stay in the hospital. The hospital daily cash should be reimbursed from the insurance company and doesn’t require any bills to be submitted for the reimbursement to happen. It is important to note that the hospital daily cash benefit is payable only in case of in-patient treatment and not for other treatments.

Patient Star:

Star Health Insurance Company will pay the cost of engaging an attendant at the residence of the insured person immediately after discharge from the hospital provided the same is recommended by the physician. Such expenses are payable up to Rs.400 per day for each completed day in the hospital for 5 days per occurrence and a total of 14 days during the policy period. 1 day deductible will be applied for this add-on at the time of claim settlement. This benefit is applicable only for insured persons above 60 years of age and becomes payable only upon a valid claim for hospitalization. The add-on should be purchased at the time of policy start or renewal since the midterm addition of add-on would not be possible.

Maternity Cover:

Star Health Insurance Company pays the Maternity related claim expenses as an add-on to the existing health insurance plan. The maternity cover includes maternity-related expenses such as Child delivery, Abortion, or Miscarriage. In addition to the maternity expenses, the Star health insurance policy also covers the newborn baby expenses. Few of the health insurance plans offer the maternity cover inbuilt while the other plans offer maternity as a rider on payment of additional premium. The maternity add-on has to be purchased at the time of policy issuance or at the time of renewal as the midterm addition is not possible.

Key Features of Star Health Insurance Company

Star Health insurance offers comprehensive health insurance plans which make the best choice for you and your family. Some of the exclusive features offered by Star health insurance company are

Star Wellness Program:

This program intends to promote, incentivize and reward the insured person’s healthy lifestyle through various wellness activities. The wellness activities are designed to help the insured person to earn wellness reward points which will be tracked and monitored by the insurance company. These wellness points can be utilized by the insured to claim discounts on the renewal premium. The following table shows the discount on premium available under the wellness program:

Star Health In-House Claim Settlement:

Star Health & Allied insurance company has no Third-party administrators to settle the claim. All the reimbursement and cashless claims are settled through the in-house claim settlement team of Star insurance company. This is an advantage to the customer as the in-house claim settlement would be available round the clock. The customer’s reimbursement claim would also be settled within a few days as there would be no involvement of a third party in the claim settlement process. The in-house claim settlement process was proved to reduce the claim settlement time and has also improved customer satisfaction.

Faster & Hassle-free claim settlement:

The main purpose of taking a health insurance policy is to avail cashless/ reimbursement facility at the time of hospitalization and to reduce the chance of going bankrupt due to the hospitalization expenses which may involve in disposing of the assets such as Gold or other properties. If the claim settlement is not faster and hassle-free the insured customer would suffer a lot and the use of insurance policy would be limited. Star Health Insurance Company provides faster claim settlement service to their customers, in case of cashless claim settlement 90% of the claims are settled within 2 hours, and in case of reimbursement claim settlement would be done within 7 days from the receipt of all the required documents.

All the claims settled by Star Health Insurance Company are hassle-free as the claim settlement process is made simpler and faster. The duly filled claim settlement form should be filled by the insured customer and submitted to the insurance company along with the discharge summary and other bills for the claim to be processed within the time limit mentioned in the policy document.

Cashless facility:

Star Health Insurance Company has tied up with more than 10, 000 hospitals and diagnostic centers to provide cashless claim settlement service to its customers. The cashless claim settlement facility can be availed by the customers in any of the network hospitals or tie-up hospitals pan India. Most customers prefer to avail of cashless service at the time of hospitalization due to the comfort it offers to the customers. Almost 90% of the cashless claims are approved and settled within 2 hours of notifying the insurance company. All the major hospitals in India are tied up with Star Health and Allied insurance company.

Automatic Restoration of Sum Insured:

Automatic restoration of the sum insured is the restoration of the sum insured upon complete exhaustion during the policy period. The sum insured would be restored up to 3 times during the policy period without any extra premium to be paid. The sum insured restored under the policy can be used only for the new illness or a new family member for the same illness. It is to be noted that the restoration happens only after the complete exhaustion of the sum insured available in the policy.

Super Restoration of Sum Insured:

If the limit of coverage under this policy is exhausted during the policy period, an additional basic sum insured of 100% would be provided once, for the remaining policy period for subsequent hospitalization. Under the Super Restoration plan, the sum insured would be restored up to 100% of the basic sum insured and the same can be utilized for the same ailment in subsequent hospitalization.

The difference between the Automatic restoration of the sum insured and Super restoration of the sum insured is that the reinstated sum insured can be used for the same illness in the latter while the former doesn’t have this option. Super restoration of the sum insured is like an additional sum insured given to the insured for treatment of existing or new illnesses.

The unutilized additional basic sum insured cannot be carried forward at the end of the policy period during the renewal. The super restoration of the sum insured is not available for modern treatments. The super restoration of the sum insured is done only once during the policy period.

Installment options:

Star Health Insurance Company provides customers with installment options for the health insurance premiums. The health insurance premium can be paid in installments for long-term health insurance policy periods. Installment options help the customers to pay the health insurance premium more than once during the policy period. This way customers can save money by opting for higher coverage and paying later.

No pre-acceptance medical screening:

Most of the health insurance plans in Star Health Insurance Company do not require pre-acceptance medical screening for the policy issuance. The pre-acceptance medical screening would be required only in few cases such as Higher sum insured selection, adverse health conditions declared in the proposal form, etc. The pre-acceptance medical screening would be done at the company network diagnostic centers where the cost of screening would be borne by the Star health insurance company.