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Star Health Comprehensive Insurance Policy

09.06.20 10:25 AM Comment(s) By Gaurav

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POLICY BENEFITS
ELIGIBILITY
GENERAL TERMS
POLICY BENEFITS
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Section 1: Hospitalization

  • Hospitalization cover protects the insured for in patient hospitalization expenses for a minimum period of 24 hrs. These expenses include room rent (Private Single A/C room), nursing and boarding charges, Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees, Cost of Medicines and Drugs.
  • Road Ambulance charges for emergency transportation to hospital as per specified limits.

  • Air Ambulance Benefit expenses up to Rs.2,50,000/- per hospitalization, not exceeding Rs.5,00,000/- per policy period.
  • Pre hospitalization expenses up to 60 days prior to admission in the hospital
  • Post hospitalization expenses up to 90 days after discharge from the hospital
  • Outpatient consultation (other than dental and ophthal) expenses up to limits mentioned in the table of benefits
  • Coverage for Domiciliary hospitalization for a period exceeding three days.

Section 2: Delivery and New born

  • Expenses incurred as in-patient for Delivery including Delivery by Caesarean section
  • Treatment of the New Born
  • Vaccination expenses for the new born baby are payable up to the limits mentioned in the schedule of Benefits, until the new born baby completes one year of age and is added in the policy on renewal.

Section 3: Out-patient Dental and Ophthalmic Treatment

  • Dental / Ophthalmic treatments as an out-patient - once in a block of every three years.

Section 4: Organ Donor Expenses

  • Expenses incurred for organ transplantation from the Donor to the Recipient Insured Person are payable provided the claim for transplantation is payable.

Section 5: Hospital Cash

  • Hospital cash benefit for each completed day of hospitalization for maximum of 7 days per occurrence is payable.

Section 6: Health Check up

  • Cost of Health checkup is payable after every claim free year

Section 7: Bariatric Surgery

  • Expenses incurred on hospitalization for bariatric surgical procedure and its complications thereof are payable upto the limits mentioned, during the policy period.
  • The maximum limit of Rs.2,50,000/- and Rs.5,00,000/- are inclusive of pre-hospitalization and post hospitalization expenses.

Section 8: Option for Second Medical Opinion

The Insured Person is given the facility of obtaining a Second Medical Opinion in electronic mode from a Doctor in the Company’s network of Medical Practitioners - Medical records can be sent to the mail id e_medicalopinion@starhealth.in

Section 9: AYUSH Treatment

Inpatient Hospitalisation expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in a Government Hospital or in any institute recognized by the government and/or accredited by the Quality Council of India/National Accreditation Board on Health as in patient is payable up to the limits mentioned in the Schedule of Benefits.

Section 10: Accidental Death and Permanent Total Disablement

  1. Accidental Death
  2. Permanent Total Disability following an accident
  3. Dependent Children and persons above 70 years can be covered under Accidental Death and Permanent Total Disablement up to the sum insured of Rs.10,00,000.

Section 11: Star Wellness Program

  • Discount in the Renewal premium for healthy life style through wellness activities.

Section 12: Buyback PED (Optional Cover)

  • The Buyback PED waiting period will be reduced from 36 to 12 months on payment of additional premium.

Automatic Restoration of Sum Insured (Applicable for Section 1 Only)

Upon exhaustion of Basic sum insured and the Bonus, sum insured will be automatically restored by 100% once during policy period. Such restored Sum Insured can be utilized for illness /disease unrelated to the illness / diseases for which claim/s was / were already made.

Such restoration will be available for section 1 other than outpatient medical consultation.

Cumulative Bonus -maximum benefit of bonus is 100% of the basic sum insured.
Midterm inclusion of newly married / wedded spouse and New Born Baby is permissible on paying additional premium. The intimation about the marriage / new born should be given within 60 days from the date of marriage or new born

Waiting Period: The Company shall not be liable under this policy directly or indirectly for

  • First 30 days for illness/disease (other than accidents)
  • 24 months for specified illness/disease/treatments
  • 36 months for pre-existing diseases
Pre-Acceptance Medical Screening: Only for Buyback PED (Optional Cover).

Pre-Existing Diseases/Illness: Are covered after 36 months of continuous Insurance without break. If insured opts Buyback PED then Pre-Existing Diseases covered after 12 months of continuous coverage from the inception of this policy

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ELIGIBILITY
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  • Persons between 18 years and 65 years of age at the time of entry can take this Insurance. Dependent children can be covered from 3 months and up to 25 years of age. There is no upper age limit for continuous renewals.
  • This policy is both on Individual basis and on Family Floater basis. Family for the purpose of this policy means self, spouse and dependent children, not exceeding 3
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GENERAL TERMS
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Co-Payment: 10% of each and every claim for persons above 60 years at entry level and their subsequent renewals.

Tax Benefit: 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:

At the time of inception of the policy, the Insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the policy if not acceptable. In such a case, the premium refund shall be as follows :

If the Insured has not made any claim during the free look period, the Insured shall be entitled to –

  1. a refund of the premium paid less any expenses incurred by the Insurer on medical examination of the insured persons and the stamp duty charges

    or

  2. where the risk has already commenced and the option of return of the policy is exercised by the policy holder, a deduction towards the proportionate risk premium for period on cover

    or

  3. where only a part of the insurance coverage has commenced , such proportionate premium commensurate with the insurance coverage during such period. Free look period shall not be applicable at the time of renewal

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

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