Main Highlight of the plan
This plan has different sum insured for different geographical region.
This plan provides coverage for expenses on pre and post hospitalization, health check-up benefit, etc.
Scope of cover
Coverage: Benefits & Features
Most Important
ROOM RENT/ ROOM CATEGORY
This plan covers room expenses up to 2% of sum insured for a maximum of INR 5000 per day.
CO-PAYMENT
This plan has age based co-pay equal to 10% of claimable expenses for individuals above 60 years of age.
NO-CLAIM BENEFITS
In this plan no-claim bonus equal to 5% of basic sum insured up to a maximum of 25% is available for each unclaimed year. However, the cumulative bonus is reduced by 5% of sum insured once a claim is made.
Note: After any claim, only the cumulative bonus would be reduced at the time of renewal. However, the basic sum insured will not be affected.
SUB-LIMITS
In this plan sub limit of 80% of sum insured is applicable for package treatments.
Good to have
PRE/POST HOSPITALIZATION
30 days of pre-hospitalization and 60 days of post hospitalization are provided in this plan. However, the post hospitalization expense will be limited up to 7% of hospitalization expense or a maximum of INR 5000.
Note: For an individual above age 60 years covered under this health insurance policy, special daily cash allowance up to INR 400 per day post discharge for a maximum 5 days per occurrence and 14 days per policy period is provided in this plan.
For package treatments post hospitalization expenses would be covered up to INR 5000 per day.
RESTORE BENEFITS
The individual plan has restore benefit equal to 200% of the sum insured during a policy period.
Note: Family Package plan does not have restore benefit.
HEALTH CHECK-UP
This plan offers health check-up benefit equal to 1% of the sum insured up to a maximum of INR 5,000 for sum insured above 2,00,000 and above after every 4 claim free years.
Note: In case of Family Package Plan, the health check-up benefit will be available only to individuals covered under the Star Health &
Allied Insurance policy and who have not claimed.
Value Adds
AMBULANCE CHARGES
This plan provides coverage for ambulance expense in the range of INR 750 per hospitalization to a maximum of INR 1500 per policy period.
EYE COVER
This plan does not cover expenses for eye treatments.
DOMICILIARY HOSPITALIZATION
This plan does not cover domiciliary treatment expenses.
OUTPATIENT BENEFITS
This plan does not cover out-patient treatment expenses.
CRITICAL ILLNESS COVERAGE
This plan does not have an additional cover for critical illnesses.
ALTERNATIVE PRACTICE
This plan covers alternative medical practices up to 25% of sum insured for a maximum of up to INR 25,000 per policy period.
DENTAL COVER
This plan does not cover expenses on dental treatments.
DAILY CASH
This plan provides daily cash allowance of INR 1000 per day for a maximum of 7 days per hospitalization and 14 days per policy period.
ORGAN DONOR COVER
This plan does not cover expenses for organ donor.
CONVALESCENCE BENEFIT
This plan does not have any convalescence benefit.
MATERNITY COVER
This plan does not cover maternity expenses.
Exclusions
A cooling off period of 30 days is applicable on buying a policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of this policy.
Waiting period of 2 years is applicable for specified ailments. Refer to the policy wordings for the list of these specified ailments.
Waiting period of 4 years is applicable for pre-existing diseases.
PERMANENT EXCLUSIONS
Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self inflicted injuries, war related injuries, etc are some of the permanent exclusions. For the detailed list of please refer the policy document.
