Star Family Health Optima Health Insurance Policy

Star Family Health Optima Health Insurance Policy

Star Family Health Optima Plan covers the entire family, including your spouse, dependent kids within the age groups of 16 days to 25 years. Individuals from 18 years to 65 years of age can buy this plan, and beyond 65 years, the plan can be renewed for a lifetime. The plan offers a wide range of coverage and benefits, covering hundreds of day-care procedures, pre-hospitalization, and post-hospitalization, newborn baby cover from the 16th day, etc.

The plan also comes with add-on benefits like 3 times automatic restoration, health check-up benefit, and additional sum assured by spending a little more.

Eligibility criteria for Star Family Health Optima Health Insurance Policy

Minimum entry age  16 days
Maximum entry age 65 years 
Sum assured options
Rs 3 lakh to Rs 25 lakh 

Key highlights of Star Family Health Optima Health Insurance Policy

  • Star Family Health Optima Health Insurance Policy offers automatic restoration of the sum assured, which is applicable 3 times during the policy tenure. The amount gets restored when the available amount gets exhausted.
  • This plan comes with lifelong renewal options for insured persons above 65 years.
  • A co-payment facility is available under this policy. If the applicant is above 60 years, then 20% co-pay is applicable for every claim and subsequent renewals.
  • Policy applicants above 50 years are required to undergo pre-medical check-ups at the registered diagnostic centers. The insurer bears the cost of the medical check-ups.
  • This policy also offers a no-claim bonus of 25% in the second year and an add-on of 10% in the next year subject to the terms and conditions of the policy.
  • Tax benefits are applicable as per the prevailing norms of the Income Tax Act.
  • It offers wider coverage for all the family members under a single plan at affordable premiums.
  • The plan offers a free look period for 15 days.
  • The policyholders are given health-related information through a free health magazine.
  • Cashless treatment is available at any network hospital.
  • The plan includes donor expenses for organ transplantation.
  • 3 times automatic restoration of the sum insured by about 100%, every time on complete exhaustion of sum insured

Inclusions in Star Family Health Optima Health Insurance Policy

  • Pre and Post hospitalization expenses: the policy covers medical expenses up to 60 days before and 90 days after hospitalization.
  • Air Ambulance Cover: Star Family Health Optima Health Insurance Policy provides air ambulance cover up to 10% of the basic sum assured per policy period. It is available only for a sum assured of Rs 5 lakh and above.
  • Pre-existing Diseases: the plan covers pre-existing diseases after 48 months.
  • Daycare procedures: Star Family Health Optima Health Insurance Policy covers expenses incurred for all daycare procedures.
  • Expense for a newborn baby: Expenses of a newborn baby are covered from the 16th  day from the day the baby is born.
  • Health check-up: it covers the cost of health check-up for every claim-free year
  • Domiciliary treatment expenses: the expenses incurred for domiciliary treatment are covered in case the treatment exceeds 3 days.
  • In-patient hospitalization: the plan covers in-patient hospitalization expenses that include room, boarding and nursing charges, cost of medicines, etc.
  • Ayush treatment: the plans cover Ayush treatment up to specified limits.

Exclusions in Star Family Health Optima Health Insurance Policy 

  • Circumcision, Preputioplasty, Frenuloplasty, Preputial Dilatation, and Removal of SMEGMA.
  • Inoculation or Vaccination (except for post-bite treatment and for medical treatment for therapeutic reasons).
  • Congenital External Condition / Defects / Anomalies.
  • Dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization. (Dental implants are not payable)
  • Convalescence, general debility, run-down condition or rest cure, Nutritional deficiency states.
  • Psychiatric, mental and behavioral disorders.
  • Intentional self injury.
  • Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing.
  • Venereal Disease and Sexually Transmitted Diseases.
  • Injury/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, warlike operations (whether war be declared or not).
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
  • Obesity-related treatment
  • Cosmetic or Plastic surgery
  • Gender change treatment

 

FAQs:

Does Star Family Health Optima Plan cover pre-existing diseases?

Yes, the Star Family Health Optima plan covers pre-existing diseases but after 48 months of buying the policy.

How much coverage is available for air ambulance cover under the Star Family Health Optima plan?

10% of the basic sum insured per policy period is available for air ambulance cover. This feature is available for people having a sum insured of Rs. 5 Lakh and above only.

Who are all required to go through pre-acceptance medical screening?

Individuals above 50 years of age or those with medical history mentioned in the proposal form are required to undergo pre-acceptance medical screening at the company's impaneled centers. The insurer bears the expense of such medical screening. Moreover, the age for screening and the cost-sharing is subject to change.

What is the coverage of newborn babies under the Star Family Health Optima Plan?

Star Health Optima Insurance plan offers coverage for newborn babies starting only after the 16th day of its birth until the plan expires. Based on the sum insured, the respective coverage is subject to an expense of 10% of the sum insured or Rs 50,000, whichever is less. It is applicable only if the baby's mother is insured under the plan for a continuous period of 1 year without a break.

How much co-payment is available under Star Family Health Optima insurance policy?

Star Family Health Optima insurance policy is subject to co-payment of 20% for every claim amount - fresh as well as renewal policies for policyholders whose age at the time of entry is above 60 years.

Is Domiciliary Hospitalisation covered under Star Family Health Optima?

Yes, Domiciliary Hospitalisation is covered under the Star Family Health Optima insurance policy. But the coverage is available only for medical treatments exceeding more than 3 days.

Does Star Family Health Optima health insurance cover organ donor expenses?

Yes, Star Family Health Optima health insurance covers organ donor expenses up to a limit of 10% of the sum assured or Rs 1 lakh.

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