Star Family Health Optima Insurance Plan

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Star Family Health Optima Insurance Plan

	Objective			This is a family floater health insurance policy that aims to provide adequate cover even after one of the insured members has used the initial sum.
Suited for			Any two or more family members up to 65 years of age can take this policy on a floating sum basis.
What does it do?			This policy requires at least two family members to initiate the cover. The policy is different from others due to its automatic restoration facility wherein, the insurance company reinstates entire sum insured if it is exhausted by any of the members during a policy year. This restoration benefit is not available only on covers of value higher than Rs 2 lakh. Also, the restored benefit cannot be used for treatment of illness for which the claim was made.
Pros			A sufficient sum is available for other family members even after a member has used the amount. Policy pays a no-claim bonus up to 35 per cent. One can avail 5 per cent discount on premium if the policy is bought online. Premium paid under this policy qualifies for deduction under section 80D of Income Tax Act.
Cons			Restored benefit amount cannot be used for same illness by same member again. There is a co-payment clause for each admissible claim for members between 61 years and 65 years, which is a drawback.
Our View			Automatic restoration benefit is a great feature for family floater policies where single sum insured is shared among many members. It ensures that other members are not deprived of insurance cover if a member has exhausted the initial cover. We recommend this policy.
Eligibility
Entry Age (years)
Minimum		5 months
Maximum		65
Maximum Policy Renewal Age (years)		65
Coverage Type		Family floater
Policy Term (years)		1
Sum Insured (Rs)
Maximum		15 lakh
Minimum		1 lakh
Tax Benefit		Premium paid is eligible for tax benefit under section 80D of the Income Tax Act
No Claim Bonus		5% to 35% in event of a claim free year
Pre Policy Medical Check Up		Required for person above 45 years of age at company's cost
Grace Period for Policy Renewal		15 days
Policy Termination		Insurer may cancel the policy by giving a 30 days notice. The policyholder is allowed to cancel the policy too by giving a 30 day notice. The company shall refund a part of premium on basis of elapsed policy period provided no claim has been made during such period
Customer Service
Address		Star Health and Allied Insurance Company Limited Corporate Office: No.1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600034.
Mail to		support@starhealth.in, info@starhealth.in
Call to		1800 425 2255/ / 044 2826 3300
SMS		STAR to 56677

 

	No Claim Bonus
Basic Sum Insured (Rs)		First Renewal		Second Renewal		Maximum Bonus Allowable
100000		0.1		0.05		0.15
200000		0.1		0.05		0.15
300000		0.25		0.1		0.35
400000		0.25		0.1		0.35
500000		0.25		0.1		0.35
1000000		0.25		0.1		0.35
1500000		0.25		0.1		0.35
The Bonus will be reduced by 50% in the event of a claim. If there is a claim in the successive year also the bonus will become zero. The basic sum insured shall however not be reduced.

 

	Exclusions and Waiting Period
Automatic Restoration of Sum Insured		Restored Sum Insured can be utilized for illness/disease unrelated to the illness/diseases for which claim's was/were made.
Pre existing diseases		covered after 48 months
No claim period		Any disease contracted during the first 30 days of commencement of the policy
Waiting Period		Certain diseases such as cataract, Varicose veins and Varicose ulcers etc shall be covered after a waiting period of 2 year.Certain diseases such as hernia, piles, sinusitis and related disorders etc. will be covered after a period of 1 year.
Copayment		20% of each and every admissible claim for person aged between 61 to 65 years at entry level
General Exclusions		Naturopathy treatment and any treatment other than allopathyCosmetic, beauty or slimming treatment

 

	Scope of Cover
Cashless facility		Available at empanelled hospitals in India
Re-imbursement		Available at non empanelled network of hospitals
Pre hospitalisation		Covered; upto maximum of 30 days prior to hospitalisation
Post Hospitalisation		lumpsum calculated at 7% of the hospitalization expenses (excluding room charges) subject to a maximum of Rs.5,000
In-patient hospitalisation		Covered
Room rent, boarding and nursing expenses		2% of sum insured,subject to a maximum of Rs.5000/- per day in Class A cities and 1% of Sum Insured upto a maximum of Rs 3000 per day in Class B cities and 1% of Sum Insured subject to a amximum of Rs 1000 per day in other cities
Surgeon's fees, Consultant's fees, Anaesthetist's and Specialist's fees, Cost of medicines and drugs		Covered
Emergency Ambulance		Rs 750 per hospitalisation upto maximum of Rs 1500 per policy period
Day Care Procedures		covers 101 procedures
Cataract Treatment		Rs 12000 per policy perisod for Sum Insured upto Rs 2 lakhRs 20000 in respect of one eye and Rs30000 for entire policy period for Sum Insured ranging between Rs 3 lakh to Rs 5 lakhRs 30000 in respect of one eye and Rs 40000 for the entire policy period for Sum Insured above Rs 5 lakh

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