Star Family Health Optima Health Insurance Plan

Brief Overview: Star Health and Allied Insurance Family Health Optima Plan

There has been a constant surge in the cost of healthcare in India, and with the scare of COVID-19 hovering over the whole world, health insurance has become a basic necessity. When you have a health insurance plan, it gives you the safety of a financial backup, much needed during a medical urgency. Your health insurance policy would help in dealing with medical expenses. Today, there are numerous health insurance companies offering different benefits and advantages through their health insurance plans. One such company is Star Health and Allied Insurance 

 Star Health & Allied Insurance Company Limited commenced its operations in the year 2006. The company is India’s first standalone health insurance company and has offered exceptional services in health and personal accident insurance. With its customer-friendly and easy-to-understand plans, the company caters to the insurance needs of individuals from all sections of society.  With a presence in over 640 branches throughout the country, the company aims to be India’s leading insurance company. 

If you are looking for comprehensive health insurance plans to cover yourself and your immediate family then Star Health and Allied Insurance Family Health Optima Plan is a plan worth considering. Known as the  ‘complete protection plan’ for the entire family, it can help you in coping with the sky-high costs of medical treatment. An affordable plan, it offers you a lot of in-built features and benefits.

Best Features of Star Health and Allied Insurance Family Health Optima Plan

Listed below are some of the highlighting features of Star Health and Allied Insurance Family Health Optima Plan that make it a popular plan:

1. This is a health insurance plan designed exclusively to offer widespread coverage
2. The plan is available on a family floater basis, which means apart from yourself you can purchase it for your spouse and your children between the age group 16 days -25 years (dependent)
3. You can cover your whole family under a single policy
4. You can opt for the auto-recharge facility, that too without any extra cost
5. The Sum Insured ranges from INR 3 lakhs to INR 25 lakhs
6. In case the sum insured gets exhausted, you would be given an automatic restoration
7. To buy the policy the Age of Entry is 18 years to 65 years, a newborn baby (from an insured mother) can be covered from the 16th day
8. All day-care procedures are covered under the plan
9. The policy also covers air ambulance charges
10. Avail bonus in case of a claim-free year
11. The Policy Term is 1 year
12. There is a co-payment of 20% for each claim that is made by an insured individual over 60 years of age

Benefits of Star Health and Allied Insurance Family Health Optima Plan

1. In-Patient Benefits
   The boarding and nursing room charges are covered up to a specified limit. The doctor’s fee, cost of medicines, anaesthesia, OT charges, oxygen and blood are covered.
2. Ambulance Charges
   In case you make use of an ambulance for the emergency transport of an insured individual, up to INR 750 per hospitalisation and overall of INR 1,500 per policy would be compensated for.
3. Automatic Restoration of Sum Insured
   If you exhaust the limit of the basic sum insured, the company would automatically restore 100% of the cover. This restoration is available 3 times during the policy period. This benefit is applicable for policies where the sum insured is INR 3 lakhs and above.
4. Compassionate Travel
   Under this benefit in case the insured individual has been hospitalised due to a life-threatening condition, at a place away from his usual residence, air transport expenses up to INR 5,000 for an immediate family member would be covered. This benefit is available if the sum insured is over INR 10 lakhs.
5. Pre and Post-Hospitalisation 
   The expenses on treatment are not limited to the hospitalisation alone. Under this plan, the expenses that you incurred 60 days prior and 90 days after hospitalisation respectively would be covered.
6. Organ Transplantation
   Expenses for organ transplantation are covered when the insured individual is the organ recipient.
7. Domiciliary Treatment
   If a treatment that required hospitalisation had to be taken at home for a period of over 3 days, the medical expenses would be covered.
8. Newborn Baby Cover
   If a woman is insured under this policy then her baby would also be covered for the same. From the 16th day of the baby’s birth to the date of expiry of the policy to a limit of 10% of the sum insured or up to INR 50,000 (whichever is less).
9. Repatriation of Mortal Remains
   The company would reimburse up to INR 5,000 for the cost of repatriation of the mortal remains of an insured individual.
10. AYUSH Benefits
    The treatment that you take in a government recognised hospital, under Ayurveda, Unani, Sidha and Homeopathy would be payable as per specified limits.
11. Second Opinion
    In case required, you can also take a second medical opinion from a doctor who is in the network of the company.
12. Health Check-Ups
    Cost of health check-ups up to the specified limits are provided for every claim-free year. These check-ups are done only at a network hospital.
13. Bonuses
    After a claim-free year, you would be eligible for 25% of the expiring basic sum insured. This amount increases in the subsequent years, up to a limit of 100%.
14. Assisted Reproduction Treatment
    Unlike most other plans, Star Health and Allied Insurance Family Health Optima Plan covers the medical expenses on Assisted Reproduction Treatment, after a waiting period of 36 months.
15. Pre-Policy Check-Up
    Individuals who wish to buy this policy and are over the age of 50 years, would have to undergo a  pre-acceptance medical screening, at a medical centre designated by the company. The cost of this screening will be paid for by the company.
16. Tax Benefits
    Under the Star Health and Allied Insurance Family Health Optima Plan, you can avail of tax exemption under Section 80D of the Income Tax Act, 1961.

Plan Details of Star Health and Allied Insurance Family Health Optima Plan

Waiting Period
A Waiting Period is applicable in the following ways:

• 30 days for treatment of any illness
• 24 months for specified treatments/illnesses
• 36 months for Assisted Reproduction Treatment
• 48 months for Pre-Existing diseases

Free Look Period
When you purchase the Health Optima plan, you get a 15-day free look period. During this period, if you do not feel comfortable with the terms and conditions of the policy, you can cancel the policy. In case no claims have been made, you will get a refund of the premium paid by you. A deduction of the expenses for the pre-policy medical check-ups, stamp duties and a proportionate amount as the risk premium will be made from the premium amount.

What is not Covered in Star Health and Allied Insurance Family Health OptimaPlan?

Despite a wide coverage, there are certain exclusions in the Star Health and Allied Insurance Family Health Optima Plan. Given below are some common exclusions, for an exhaustive list, please refer to the policy document:

• Pre-existing diseases other specified diseases/ illnesses/ treatments come with a waiting period
• For the first 30 days of policy purchase, all treatments are excluded, except when it is an injury that arises due to an accident
• Dental treatments, unless required after an accidental injury
• Self-inflicted injury
• Mental and behavioural disorders
• Sexually transmitted diseases
• Surgical treatment of obesity (under specific conditions)

Renewal Process of Star Health and Allied Insurance Family Health Optima Plan

Star Health and Allied Insurance Company will mostly grant the request for renewal unless there has been a fraud or misinterpretation on behalf of the insured individual.  At the time of renewal, keep the following things in mind-

• Make sure you renew the policy before it expires, in order to save yourself from the risk of being cover-free
• Make sure to register the renewal request on time and pay the due amount before the expiry date
• If you do not renew the policy within the 30-day grace period, the policy will terminate automatically and you would lose out on all benefits and bonuses if any
• You will not be able to claim during the grace period
• No Loading Charges are applicable on a renewal based on the individual claim history

Star Health and Allied Insurance Family Health Optima Plan - Claim Process

Star Health and Allied Insurance Company assures its customers a simple and easy-to-follow claim process. The company sees to it that the claims are taken care of promptly. In the event of making a claim, you need to intimate the company at the earliest. 

When it is a planned hospital admission, inform the company at least 24 hours prior, however, in case of an emergency, the intimation can be done within 24 hours of hospitalisation. To notify the company you can:

• Call customer care at 1800 425 2255 / 1800 102 4477 OR
• e-mail them at this address support@starhealth.in or cashless.network@starhealth.in or
• Send a fax to 1800 425 5522.

On the basis of the hospital you seek treatment in, the claim would be processed, let us see how:

Cashless Claim 
Cashless treatment is a service offered by network hospitals. These hospitals have a collaboration with the company and the bills are settled directly by it. In order to avail of this facility, you need to get admitted to a network hospital.  
When you reach the hospital, show your Health Card and submit the treatment-related documents. Once the verification of the documents is complete, the treatment will be started and the bill will be settled by the company. Keep in mind that you can make a cashless claim of the expenses, only up to your base sum insured of your policy. In case there are any non-covered expenses, you would have to pay for them from your pocket.

Reimbursement Claim 
In case you get the treatment at a non-network hospital, you would still be able to make a claim. You would have to pay your bill yourself, once all the paperwork is verified, the company will reimburse the expenses. 
Please ensure that you intimate the company on time and submit the claim form and all the mentioned documents within 15 days of the date of discharge. Post verification, the claim amount will be reimbursed in the savings account. The non-covered expenses would have to be borne by you.

Required Documents
When a claim is to be made, the following documents are to be produced:

1. Health Card issued by Company, along with KYC papers
2. Policy Papers
3. Name and address of policyholder and/or Insured person
4. Nature of Illness and the Treatment required
5. Name and Address of Doctor and the Hospital
6. Date of Admission
7. Consultation Papers
8. Original ambulance receipt, if used
9. All Bills and Receipts related to the treatment
10. Police FIR or Medico-Legal Certificate in case of accidental injuries

Star Health and Allied Insurance Company - Policy Network Hospitals

With a network of over 10,200 hospitals, Star Health and Allied Insurance offers cashless treatments  all over the country. As discussed earlier, in a network hospital, you can make a cashless claim of the expenses, up to your base sum insured. Seeking treatment in a network hospital becomes very easy and hassle-free. It saves you from all the running around you may have to do to manage funds for the treatment. Instead of stressing over the procedures and paying the bills, you can focus on your or your family member’s treatment. 

Review of  Star Health and Allied Insurance Family Health Optima Plan

Star Health & Allied Insurance Company Limited recorded a gross written premium of INR 6,865 crores in the financial year 2019-20. The company was also felicitated with “Health Insurance Provider of the Year-2018”, Outlook Money Awards. When you purchase a health insurance plan from such a reputed company, you can rest assured that the services you receive would be efficient and customer-friendly. 

Family Health Optima Plan is available on a family floater basis, which means that under a single plan you can cover yourself, your spouse and your dependent children. The plan thus is an affordable option to get a health cover for your family. There are numerous benefits of this health plan such as an automatic restoration of the sum insured, health check-ups, daycare procedures etc. which make this plan an excellent choice to protect yourself from suffering a financial setback in case of an illness.

Star Health and Allied Insurance Company - Customer Care Details