In today’s fast-paced world, where sedentary lifestyles and health challenges are on the rise, securing your family’s health becomes paramount. Star Family Health Optima Insurance Plan aims to provide extensive coverage under a single plan. This health insurance plan operates on a floater basis, ensuring that the policyholder and the entire family is covered against the escalating costs of medical treatments. With the ever-increasing expenses associated with healthcare, having a reliable and affordable insurance plan is crucial. Star Family Health Optima steps in as a comprehensive solution, offering financial support for hospital bills and medical expenses, thus mitigating the burden on your family’s finances.
In this guide, we will cover the key features, benefits, and nuances of the Star Family Health Optima Insurance Plan.
Key Features and Benefits of Star Family Health Optima Insurance Plan
- Floater Coverage
The plan extends coverage to the policyholder and family members on a floater basis, ensuring comprehensive protection for the entire family unit.
- Adequate Sum Insured
You can choose from a flexible range of sum insured options, starting from Rs 1 lakh to Rs 25 lakh, allowing customization based on individual family healthcare needs.
- Automatic Restoration of Sum Insured
You can experience peace of mind with automatic restoration, replenishing the sum insured up to 100% upon exhaustion – a feature available for a maximum of three times during the policy period.
- Lifetime Policy Renewals
You can enjoy the convenience of lifelong policy renewals, offering continuous coverage for all policyholders throughout their lifetime.
- Co-Payment Clause
Applicants aged above 60 years may note a 20% co-payment requirement for each claim and subsequent renewals.
- Pre-acceptance Medical Screening
Individuals above 50 years undergo pre-acceptance medical check-ups at registered diagnostic centers. The insurer covers the cost of these check-ups, emphasizing proactive healthcare management.
- Pre-Existing Illnesses
You can benefit from coverage for pre-existing diseases under Star Family Health Optima Insurance Plan after 48 months of continuous coverage, addressing long-term health concerns.
- Recharge Benefit
Experience additional coverage up to the specified limit once per policy year in case of exhaustion of the sum insured, providing an extra layer of financial security.
Read More: All About Star Health Insurance
Inclusions of Star Family Health Optima Insurance Plan:
- Cost of a health check-up for each claim-free year, promoting proactive health management
- Domiciliary hospitalization to provide coverage for treatment taken at home for a period exceeding 3 days on a doctor’s recommendation
- DayCare procedures coverage for treatments requiring less than 24 hours of hospitalization
- In-patient hospitalization expenses for hospitalization exceeding 24 hours, encompassing room charges, boarding expenses, nursing expenses, etc.
- Emergency road ambulance covering emergency ambulance services for swift transportation to the nearest hospital within specified limit
- Air ambulance services up to 10% of the Sum Insured (SI), ensuring prompt and efficient emergency medical transport
- 60 days of pre-hospitalization expenses before admission
- Coverage for hospitalization costs incurred up to 90 days after discharge
- compensation for organ donor expenses up to 10% of the SI or Rs 1 lakh, whichever is less
- Newborn baby cover, subject to a limit of 10% of the SI or Rs 50,000
- Coverage for expenses incurred on modern treatments
- Compensation for expenses related to the conveyance of the policyholder from one hospital to another within India, within specified limits
- Reimbursement for repatriation of mortal remains
- Coverage for shared accommodation expenses during in-patient hospitalization
- Coverage for the cost of treatment in AYUSH hospitals up to specified limits
- Coverage for the cost of availing a second medical opinion from empanelled medical practitioners
Exclusions of Star Family Health Optima Plan:
Star Health & Allied Insurance Company Limited, under the Family Health Optima plan, does not assume liability for expenses incurred due to the following reasons:
- Expenses related to congenital external defects, conditions, or anomalies
- Costs associated with preputioplasty, circumcision, frenuloplasty, removal of SMEGMA, and preputial dilatation
- Routine vaccinations or inoculations, except for post-bite treatment and therapeutic reasons
- Expenses related to general debility, convalescence, run-down condition, and nutritional deficiency states
- Dental surgery or treatment except if it is necessitated by accidental injuries resulting in hospitalization
- Expenses arising from self-inflicted injuries
- Costs associated with hospitalization due to the use of drugs, intoxicating substances, smoking, alcohol, etc.
- Hospitalization directly or indirectly related to war, warlike operations, acts of foreign enemies, and invasion
- Expenses incurred due to hospitalization resulting from the damage caused by nuclear weapons and materials
- Plastic surgery unless it is required due to an accident or is part of an illness
- Expenses related to aesthetic treatment, cosmetic surgery, sex-change operations, and treatments for erectile dysfunctions
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Eligibility Criteria of Star Family Health Optima Plan:
To enroll in the Star Family Health Optima plan, applicants must meet the following eligibility criteria:
- Age Group: 18 years and 65 years
- Residency: India
- Lifetime Renewal: Available
- Children’s Coverage: Between the age of 16 days to 25 years
- Family Members Coverage: Includes Self, Spouse, Dependent Children, Dependent Parents, Dependent Parent-in-law
By adhering to these eligibility criteria, individuals and families can secure the Star Family Health Optima plan.
Claims Procedure of Star Family Health Optima Plan
You can file a claim under the Star Family Health Optima plan with this step-by-step guide:
- In the event of a medical emergency, promptly report the claim to the insurance company’s 24-hour assistance number.
- Furnish the policy number along with a valid ID proof to initiate the claim process efficiently.
- For planned hospitalizations, notify the insurer at least 24 hours before admission.
- Enjoy the convenience of cashless hospitalization by availing services at network hospitals. The insurer settles the claim amount directly with the hospital, minimizing financial hassles.
- If seeking treatment in non-network hospitals, the insured must make the necessary payments and then apply for reimbursement. The approval of the claim is contingent upon the submission of the necessary documents. Ensure all required paperwork is accurate and promptly provided for efficient processing.
- In the case of a cashless claim, the approved amount gets settled directly with the hospital, streamlining the financial aspect of the medical treatment.
- For reimbursement claims, the approved amount will be disbursed to the policyholder after a thorough verification of the submitted documents.
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FAQs
Does the Star Family Health Optima plan provide coverage for pre-existing diseases?
Yes, the Star Family Health Optima plan includes coverage for pre-existing diseases following a waiting period of 48 months.
Is air ambulance coverage included in the Star Family Health Optima plan?
Yes, the Star Family Health Optima plan offers air ambulance coverage for a sum insured of Rs 5,00,000 or higher.
Is pre-medical screening required for applicants looking to purchase the Star Family Health Optima plan?
Yes, individuals aged 50 years and above, along with those having a medical history, must undergo pre-medical screening as part of the application process for the Star Family Health Optima plan.
What is the coverage limit for a newborn baby in the Star Family Health Optima plan?
Star Family Health Optima plan provides coverage for newborns starting from the 16th day onwards, with a limit of up to Rs 50,000 or 10% of the sum insured.
Is there a co-payment requirement in the Star Family Health Optima Insurance policy?
Yes, individuals aged 60 years and above are subject to a co-payment of 20% for each claim made under the Star Health Optima policy.
Does the Star Family Health Optima plan provide coverage for organ donor expenses?
Yes, the Star Family Health Optima plan includes coverage for organ donor expenses, with a limit of up to 10% of the sum insured or Rs 1 lakh.
Does the Star Family Health Optima plan include coverage for domiciliary hospitalization?
Yes, domiciliary hospitalization expenses are covered under the Star Family Health Optima plan for a period exceeding 3 days.
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