STAR FAMILY HEALTH OPTIMA INSURANCE PLAN

Table of Contents

What is Health Insurance?

what is health insurance vikramnvp11
what is health insurance vikramnvp11

Medi-Claim is a General term used for Health Insurance. Health Insurance simply means Freedom from medical bills. Health-related hospitalization cost or bill paid by the Insurance Company.

Health Insurance Covers all Medical Expenses due to Accident/Illness in a Hospital/Nursing Home with minimum of 24 hours of Hospitalization. A minimum of 24 hours of hospitalization is exempted from Listed Daycare Treatments.

Why you need Health Insurance?

why you need health insurance vikramnvp11
why you need health insurance vikramnvp11
  • Health Insurance Scenario in India
    • Only 5% of people have Health Insurance in India. Out of 135+ Crore, only 7-8 Crore people have Health Insurance.
    • 71% of all deaths are due to Cancer, Heart Attack, Stroke, and Renal Failure.
    • Treatment for all major ailments costs between 5 to 8 Lacs which is beyond the reach of the middle class population.
  • You need Health Insurance to have peace of mind during any Health Emergencies.
  • Health Insurance is not Expense, IT IS AN INVESTMENT.
  • It is just not a Health Insurance, It is Confident that can make you go through any sudden Health Emergencies.
  • Due to Health Insurance, You no longer have to borrow money from your relatives or friends, no need to pledge your gold ornaments, no need sell your properties during Health Emergencies.

Spending Bank Savings on Health Care As Follows:

  • UNITED STATES – 13%
  • THAILAND – 26%
  • MEXICO – 51%
  • INDIA – 78%

What are the types of cover you can get from Star Health Insurance?

  • Accidental Cover
  • Sickness Cover (ಅನಾರೋಗ್ಯ)
  • Cover for Disease (ರೋಗ)

Family Health Optima is One of the Best Selling Star Health Insurance in Star. Let us know more about this Plan.

Eligibility

  • Any person aged between 18 years and 65 years
  • Child above 16 days of age can be covered as part of the family
  • FAMILY: Proposer, Spouse, Dependent Children from 16 days up to 25 years (children who are economically dependent on their parents )

SUM INSURED:

1,00,000
LIMIT UP TO 2000/DAY
2,00,000
LIMIT UP TO 2000/DAY
3,00,000
LIMIT UP TO 5000/DAY
4,00,000
LIMIT UP TO 5000/DAY
5,00,000SINGLE STANDARD A/C ROOM
10,00,000
SINGLE STANDARD A/C ROOM
15,00,000
SINGLE STANDARD A/C ROOM
20,00,000
SINGLE STANDARD A/C ROOM
25,00,000
SINGLE STANDARD A/C ROOM

POLICY BENEFITS

In-patient hospitalization ( ರೋಗಿಗಳ ಆಸ್ಪತ್ರೆಗೆ ದಾಖಲು, रोगी में अस्पताल में भर्ती ) benefits

  • Surgeon, Anesthetist, Medical Practitioner( ವೈದ್ಯಕೀಯ ವೃತ್ತಿ ಮಡುವವ ), Consultants & Specialist Fees.
  • Anesthesia, Blood, Oxygen, Operation Theatre charges, Cost of a pacemaker (ಹೃದಯ-ನಿಯಂತ್ರಕ/ ಗತಿರೂಪಕ), etc.
  • Cost of medicine and drugs.
  • AMBULANCE CHARGES: Emergency ambulance charges up to a sum of Rs 750/- per hospitalization and overall limit of Rs 1500/-per policy period.
  • AIR AMBULANCE COVER: up to10% of the basic sum insured per policy period. Available for sum insured of Rs.5 lakhs and above only.

PRE & POST HOSPITALIZATION

  • Pre-hospitalization (ಆಸ್ಪತ್ರೆಗೆ ಮುಂಚಿತವಾಗಿ, पूर्व अस्पताल में भर्ती ) medical expenses incurred up to 60 dAYS are payable.
  • Post-hospitalization (ಆಸ್ಪತ್ರೆಗೆ ದಾಖಲಾದ ನಂತರ, अस्पताल में भर्ती) medical expenses incurred up to 90 days are payable.

PRE-EXISTING DISEASES (ಮೊದಲೇ ಅಸ್ತಿತ್ವದಲ್ಲಿರುವ ರೋಗಗಳು, पूर्व परीक्षा छूट): covered after 48 months.

WAITING PERIODS (ಕಾಯುವ ಅವಧಿಗಳು, प्रतीक्षा कर रहे हैं) :

  • 30 days initial waiting period. Except For Accidental case. The helmet should be worn, no claim for drink and drive, and breaking road traffic rules and regulations.
  • 24 hours waiting period for specified illness /diseases/treatments
  • 36 months waiting period for assisted reproduction treatment (PED).

DAYCARE PROCEDURES (ಡೇಕೇರ್ ಕಾರ್ಯವಿಧಾನಗಳು, DAYCARE प्रक्रियाएं):

All daycare procedures covered. Daycare Procedures means, Hospitalization that requires less than 24 hours. Due to latest technology treatments.

PRE-ACCEPTANCE MEDICAL SCREENING (ಪೂರ್ವ-ಸ್ವೀಕಾರ ವೈದ್ಯಕೀಯ ಸ್ಕ್ರೀನಿಂಗ್,

पूर्व स्वीकृति चिकित्सा स्क्रीनिंग):

All persons above 50 years of age and those who declare adverse medical history in the proposal form are required to undergo pre-acceptance medical screening at the company designated centers the cost of such screening will be borne by the company. the age of screening and subject to change.

SPECIAL FEATURES

  • DOMICILIARY HOSPITALIZATION (ನಿವಾಸ ಚಿಕಿತ್ಸೆ, निवास का इलाज)
  • DONOR EXPENSES (ದಾನ ವೆಚ್ಚಗಳು, डोनर एक्सपोर्ट्स) FOR ORGAN TRANSPLANTATION (ಅಂಗ ವರ್ಗಾವಣೆ, अंग प्रत्यारोपण)
  • COST OF HEALTH CHECK-UP (ಆರೋಗ್ಯದ ವೆಚ್ಚವನ್ನು ಪರಿಶೀಲಿಸಿ, हेल्थ चेक यूपी के सीओएसटी)
  • COVERAGE FOR NEWBORN BABY (ನವಜಾತ ಶಿಶುವಿಗೆ ಕವರೇಜ್, NEWBORN शिशु के लिए सहयोग)
  • EMERGENCY DOMESTIC MEDICAL EVACUATION (ತುರ್ತು ಗೃಹ ವೈದ್ಯಕೀಯ ಸ್ಥಳಾಂತರ, आपातकालीन चिकित्सा चिकित्सा विकास)
  • COMPASSIONATE TRAVEL (ಹೊಂದಾಣಿಕೆಯ ಪ್ರಯಾಣ, घटक यात्रा)
  • REPATRIATION OF MORTAL REMAINS (ಮರಣದಂಡನೆಯ ವಾಪಸಾತಿ, आम अवशेषों की वापसी)
  • TREATMENT IN PREFERRED NETWORK HOSPITALS (ಆದ್ಯತೆಯ ನೆಟ್‌ವರ್ಕ್ ಹಾಸ್ಪಿಟಲ್‌ಗಳಲ್ಲಿ ಚಿಕಿತ್ಸೆ, पसंदीदा नेटवर्क हॉस्पिटल में उपचार)
  • SHARED ACCOMMODATION (ಹಂಚಿದ ವಸತಿ, साझा आवास)
  • AYUSH TREATMENT (ಆಯುಶ್ ಚಿಕಿತ್ಸೆ, आयुर्वेद )
  • SECOND MEDICAL OPINION (ಎರಡನೇ ವೈದ್ಯಕೀಯ ಅಭಿಪ್ರಾಯ, सेकंड मेडिकल ऑपिनियन)
  • ASSISTED REPRODUCTION TREATMENT (ಸಹಾಯ ಪುನರುತ್ಪಾದನೆ ಚಿಕಿತ್ಸೆ, सहायता प्राप्त मरम्मत उपचार)
  • ADDITIONAL SUM INSURED FOR ROAD TRAFFIC ACCIDENT (RTA) (ರೋಡ್ ಟ್ರಾಫಿಕ್ ಆಕ್ಸಿಡೆಂಟ್, सड़क यातायात दुर्घटना)
  • AUTOMATIC RESTORATION OF SUM INSURED (ಮೊತ್ತದ ಸ್ವಯಂಚಾಲಿತ ಮರುಸ್ಥಾಪನೆ, स्वचालित पुनर्स्थापना)
  • LIMITS FOR CATARACT SURGERY (ಕಣ್ಣಿನ ಪೊರೆ ಶಸ್ತ್ರಚಿಕಿತ್ಸೆ, मोतियाबिंद ऑपरेशन)
  • RECHARGE BENEFIT (ಲಾಭವನ್ನು ಮರುಪಡೆಯಿರಿ, तंत्र लाभ)
  • BONUS (ಬೋನಸ್, बक्शीश)
  • CO-PAYMENT (ಸಹ-ಪಾವತಿ, सह-भुगतान) is only after 65 years.
  • EXCLUSIONS (ಹೊರಗಿಡುವಿಕೆಗಳು, बहिष्कार)

Grace Period

  • A Grace Period of 120 days from the date of expiry of the policy is available for renewal.
  • If any illnesses or disease contract in this period will be subject as PED, and have to wait 48 months.

Portability:

At least 45 days before you need to inform the company regarding portability but not earlier than 60 days from the date when the renewal is due.

Main and Most Important Claim Procedure:

  • Call the 24-hour helpline for assistance – 18004252255/18001042277
  • Afterward, Inform the ID number for easy reference
  • At the same time, On admission in the Hospital, produce the ID Card issued by the Company at the Hospital Desk.
  • Obtain the Pre-Authorisation Form from the Hospital Help Desk, Complete the Patient information and resubmit to the Hospital help desk.
  • In case of emergency hospitalization, give information within 24 hours after hospitalization.
  • While in non-network hospitals First, you make payment and then reimbursement is made on submission of documents.

Star Health Insurance All Products and Services

Note: The information given here is only indicative. For more details on the risk factors, terms and conditions, please read the policy wordings before concluding the purchase. Or visit www.starhealth.in

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