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Star Family Health Optima Plan

Star Health And Allied Insurance

3.5/5 22 User Reviews

Family Health Optima from Star Health Insurance is a cover that provides protection for the entire family on the payment of a single premium under a floating sum insured. It offers valuable benefits like the cover for 405 Day-care Procedures, Domiciliary Hospitalization, Donor Expenses for Organ Transplantation, Coverage for Newborn Baby, and so on.

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Highlights of Star Family Health Optima Plan

  • Single plan, wider coverage for the whole family at a reasonable premium.
  • Get extra sum insured (auto recharge) at no additional cost, up to 30% of sum insured.
  • Compensation for Health Checkup costs up to Rs.5,000 once every three years of policy coverage
  • 100% automatic restoration of entire Sum Insured
  • New-born baby cover from 16th day of birth
  • Domiciliary Hospitalization Expenses for treatment exceeding three days.
  • Cover for over 400 day-care procedures
  • Tax benefits on the premium paid as per the prevailing Income Tax rules

Family Floater Plan

Entry Age

For children : 16 days old

Adults :

Minimum : 18 yrs

Maximum : 65 yrs

Number of Members Covered

Maximum Members : 05

Maximum Adults : 02

Maximum Children : 03

Sum Insured

2/3/4/5/10/15 lakhs


discount

NA


Policy Periods Available

Annual


Pre-Policy Medical Check-up

Above 50 years of age


Important Features

Day Care Treatments

The plan covers the expenses towards 405 day-care procedures that would otherwise require hospitalization of a minimum of 24 hours.

    No-Claim Benefits

    Depending on the sum insured you have opted, for every claim free year, you will be entitled to a bonus of up to 35% of your sum insured.

      Organ Donor Cover

      If you are the recipient, then the expenses for organ transplantation will be paid up to 10% of the sum insured or Rs.1 lakh (whichever is less) subject to the availability of the sum insured.

        Pre Hospitalization

        Compensates for the Pre-Hospitalisation expenses for consultations, investigations and medicines incurred up to 60 days before Hospitalisation

          Post Hospitalization

          Compensates for the Post-Hospitalization expenses for consultations, investigations and drugs incurred up to 90 days after discharge from Hospitalization.

            Restore Benefits

            For sum insured of Rs.3 lakh and above, there is 100% automatic restoration of the sum insured in case the original is exhausted.

              RECHARGE BENEFIT

              This plan has recharge benefit which would get activated even when the entire sum insured is not exhausted, and the claim is raised for the same illness. This benefit is applicable for sum insured in the range of Rs.3 lakh and Rs.5 lakh. The recharge amount is in the range of 15% to 30% of sum insured depending on the zone and sum insured opted. Note: Both the restore and recharge can be used up for the same hospitalization.

                Good to Have Benefits

                PORTABILITY

                If you want to transfer the policy to another insurer, the plan allows you to do so without losing your accrued benefits after the waiting periods.

                  TAX BENEFITS

                  You can avail tax benefits for the premium amount paid towards this plan under Section 80D of the Income Tax Act,1961.

                    Health Check-up

                    This plan offers health check-up benefit up to 1% of sum insured for a maximum of Rs.5,000 every three years for those with sum insured of Rs.3 lakh and above.

                      Home Hospitalization/ Domiciliary Hospitalization

                      You can avail treatment at home up to the base sum insured exceeding three days. There are certain terms and conditions related to this privilege, and you can refer them in the policy wordings.

                        SUM ASSURED ENHANCEMENT

                        You can apply for the sum increase at the time of renewal. However, there should not be any claim made on the policy for considering the request.

                          Emergency Ambulance

                          Compensates you up to Rs.750 for each hospitalization towards the emergency ambulance services up to a maximum of Rs.1,500 per policy period.

                            Value Adds

                            NEW BORN BABY COVER

                            This plan offers newborn coverage up to 10 % of sum insured for a maximum of Rs.50,000. This newborn coverage is appropriate for newborn above age 16 days at an additional premium.

                              FREE LOOK PERIOD

                              For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.

                                Terms & Conditions

                                Room Rent / Room Category

                                Depending on the geographical zone you reside in and on the sum insured you have opted, there’s a room rent limit that varies from 1% of the sum insured to a Single Standard AC Room up to a maximum of Rs.10,000 per day.

                                  Co-Payment

                                  This plan has age based co-pay equal to 20% of claimable expenses for individuals with entry age above 60 years.

                                    SUB-LIMITS

                                    CATARACT: Depending on the sum insured you have paid for, expenses incurred on the treatment of cataract will be paid Rs.12,000 and Rs.40,000 for the entire policy period.

                                      Waiting Period

                                      Cooling Off Period

                                      A 30 days cooling off period for all claims except any arising out of accidental injuries.

                                        Specific Illnesses

                                        The policy covers some specific diseases/treatments only after 24 months. These include Cataract, Arthritis, Hernia, Kidney Stone, and so forth.

                                          Pre-Existing Illnesses

                                          You can claim for any pre-existing conditions after 24 months from the policy start date.

                                            Permanent Exclusions

                                              The Plan will not cover any liabilities towards the treatments of following conditions-

                                              • Intentional self-injury
                                              • Mental illness
                                              • Cosmetic, aesthetic treatment
                                              • Dental surgery
                                              • AIDS
                                              • Pregnancy, childbirth, miscarriage, and abortion
                                              • Congenital disease
                                              • Infertility and in vitro fertilization.
                                              • Hospitalization out of war, riot, strike and nuclear weapons

                                            Review of Star Family Health Optima Plan

                                            This is Star's flagship standard family health insurance product in the market. To keep the premiums affordable, the plan comes with Room Rent capping of 1-2% of sum insured depending on the customer's location. In case of Sum Insured opted of Rs. 5,00,000 in Mumbai/Thane, Delhi/NCR and Gujarat, one will be eligible for Single AC Room.

                                            The product recharges your cover up-to 15% in case it exhausts for related or unrelated claims. Further, it also has the restore option that restores your coverage amount when the sum insured is completely exhausted.

                                            Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.

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