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Star Health Family Health Optima Insurance Plan

17.04.20 10:13 AM Comment(s) By Gaurav

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1. Policy Benefits:

  • Room, boarding and nursing expenses all inclusive as per the limits.
  • Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Oxygen, Operation Theatre, Diagnostics, imaging modalities and Medicines and Drugs, Oxygen, Blood, Operation theatre, Diagnostic and Cost of pacemaker.
  • Ambulance charges for emergency transportation to hospital as per specified limits.
  • Air Ambulance charges upto 10% of the Basic Sum Insured during the entire policy period.
  • Pre-Hospitalization expenses up to 60 days prior to admission in the hospital.
  • Post-hospitalization expenses incurred up to 90 days after discharge from the hospital.
  • Domiciliary hospitalization: Cover for medical treatment for a period exceeding three days.
  • Organ Donor Expenses: Cover upto 10% of the Sum Insured or Rupees One lakh, whichever is less.
  • Cost of Health Checkup: Expenses incurred towards cost of health check-up up to the limits
  • Emergency Domestic Medical Evacuation: Company reimburse the expenses incurred towards transportation of the insured person from the treating hospital to another one upto the limits.
  • Compassionate Travel: The Company will reimburse the transportation expenses by air incurred upto Rs5000/- for one immediate family member (other than the travel companion) for travel towards the place where hospital is located.
  • Repatriation of Mortal Remains: the Company shall reimburse up to Rs.5,000/- towards the cost of repatriation of mortal remains of the insured person to the residence of the insured.
  • Lump-sum for Treatment in Preferred Network Hospital: In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, the Company may suggest an appropriate hospital from the network for treatment upto 1% of Basic Sum Insured subject to maximum of Rs.5000/- per policy is payable as lumpsum.
  • Shared Accommodation: Upto the limits.
  • AYUSH treatment: Upto the limits.
  • Second Medical Opinion: The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company‚Äôs network of Medical Practitioners
  • Assisted Reproductive Treatment: The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility
    1.Waiting period of 36 months from the date of first inception of this policy.
    2.Maximum liability of the Company for such treatment shall be limited to Rs.1 lakh for sum insured of Rs.5 lakh and Rs.2 lakhs for sum insured of Rs.10 lakhs and above for every block of 36 months.
  • Additional Sum Insured for RTA(Road Traffic Accident): If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of Rs.5,00,000/- .This benefit is payable if the insured person was wearing a helmet and travelling in a two wheeler either as a rider or as a pillion rider

3. Automatic Restoration of Sum Insured : Available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one.

4.Recharge Benefit: Available up to the limits.

5. Bonus: Following a claim free year bonus of 25% of the expiring basic sum insured in the second year and additional 10% for subsequent years (max.100%) would be allowed. Where there is a claim the Bonus would be reversed in the same order in which it was given.

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  1. Any person aged between 18 years and 65 years, residing in India, can take this insurance.
  2. Beyond 65 years only renewals
  3. Child from 16th day of age can be covered as part of the family.
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This policy is on floater basis. Family : Proposer, spouse, dependent children from 16 days up to 25 years (those who are economically dependent on their parents)

Tax Benefits

Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.

Free Look Period A free look period of 15 days from the date of receipt of the policy is available for reviewing the policy terms and conditions. In case insured is not satisfied he can seek cancellation of the policy and in such event the Company will allow refund of premium after adjusting the cost of pre- acceptance of medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Free look cancellation is not applicable at the time of renewal.

Guaranteed Lifetime Renewals Life-long renewals beyond 65 years are offered under this policy.

Co-Payment: 20% of each and every claim for persons above 60 years at entry level and their subsequent renewals.

Pre-Acceptance Medical Screening: Persons above 50 years will be required to undergo pre-acceptance medical screening at the Company nominated centres. Cost of screening is currently borne by the company.

Pre-Existing Diseases/Illness: Are covered after 48 months of continuous Insurance without break with any Indian Insurance Company.

NOTE: Renewal premium, terms and conditions are subject to change with prior approval from IRDAI.

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