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Star Family Health Optima Insurance Policy
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Star Family Health Optima Insurance Policy

Star Family Health Optima is a supersaver insurance plan by Star Health Insurance that serves the insurance needs of the entire family. Star Family Health Optima Insurance Policy offers complete protection for you and your entire family on the purchase of a single premium policy. It is a family floater health insurance plan i.e., the whole sum assured floats among all the insured persons covered under the policy. 

What’s Star Family Health Optima Insurance Policy

Star Family Health Optima is a comprehensive insurance plan as it provides a protective cover to the entire family under one umbrella. Under this policy, you can cover the medical expenses incurred by any of your family members due to any illness or injury by paying a single premium.

Features of Star Family Health Optima Insurance Policy

This health insurance policy comes with a host of benefits that includes the following:

Automatic Restoration of Basic Sum Insured

  • In case the limit of coverage that is defined during the policy period gets exhausted, the basic sum insured is restored automatically.
  • Such automatic restoration is available for up to 100% of the necessary sum insured, only for a maximum of three times.
  • However, such restoration is operational only after the earlier amount gets exhausted.
  • The restored sum insured cannot be utilized for illness/disease related to the illness/diseases for which any claim was made previously.
  • The unutilized restored amount cannot be carried forward
  • This facility is available only to policyholders whose sum assured is Rs.3,00,000/- or above

Option to Port

  • If the insured wants to port his/her Star Family Health Optima Insurance Policy, he/she can do so by applying the prescribed form to Star Health Insurance Company at least 45 days prior, but not earlier than 60 days from the renewal date

Free Look Period

  • Star Family Health Optima Insurance Plan provides a free look period of 15 days
  • If the policyholder is not satisfied with the terms and conditions of the policy, he/she may opt for cancellation within the free look period

Revision of Sum Insured

  • The policyholder is permitted to revise his/her sum insured. But this option is available only at the time of policy renewal, subject to insurance provider’s approval

Recharge Benefit

  • Star Family Health Optima Insurance Plan offers recharge benefit i.e., additional indemnity up to a specified limit, in case the limit of the coverage mentioned under the policy gets exhausted during the policy period.
  • Such recharge benefit can be utilized even for the same hospitalization or for the treatment for which a claim was previously made under the policy.
  • The recharge amount that is not utilised cannot be carried forward.
  • The recharge benefit is available to the policyholder in addition to the ‘Automatic Restoration’ benefit.
  • The limits specified for the recharge benefit are as follows:

Sum Insured (Rs.)

Limit Per Policy Period (Rs.)

1,00,000, 2,00,000

Not Available

3,00,000

Up to 75,000

4,00,000

Up to 1,00,000

5,00,000- 25,00,000

Up to 1,50,000

Cumulative Bonus

  • The policyholders have entitled a bonus up to a specific limit, post a claim free year of insurance.
  • To be eligible for the bonus the minimum basic sum insured should be Rs 3,00,00.
  • The policyholder shall be entitled a bonus of 25% of the non-claimed basic sum insured in the second year and an additional bonus of 10% of the expiring Basic sum Insured for subsequent years.
  • The maximum allowable bonus under Star Family Health Optima Insurance Plan shall not exceed 100% of the sum insured.
  • For calculation of bonus, the lower of the expiring sum insured or the renewed sum insured is considered.

Pre-acceptance Screening

  • Applicants aged above 50 years are required to undertake a pre-acceptance medical screening.
  • The cost incurred about such screening shall be borne by Star Health Insurance Company.

Additional Sum Insured for cases of Road Traffic Accident (RTA)

  • Under the Star Family Health Optima Insurance Policy, if the policyholder, unfortunately, meets with a Road Traffic Accident (RTA), resulting in an in-patient hospitalisation, then the Basic Sum Insured shall be increased by 25%.
  • Such increment shall be subject to a maximum limit of Rs 5,00,000.
  • This additional sum insured is available only once during the policy period.
  • This benefit is available subject to the condition that at the time of the accident, the policyholder was wearing a helmet while travelling in a two-wheeler, either as a rider or as a pillion rider.

Treatment in Suggested Network Hospital

  • In case the policyholder undergoes treatment in the hospital suggested by the company, he/she shall be liable to receive a lump-sum amount calculated at 1% of Basic Sum Insured.
  • Such amount is subject to a maximum of Rs 5,000/- per policy period.

Shared Accommodation

  • If during the hospitalisation the policyholder occupies a shared accommodation, for each continuous and completed period of 24 hours of stay, he/she shall be liable to receive an amount from the insurance provider, subject to the following limits:

Sum Insured (Rs.)

Limit per day (Rs.)

1,00,000/- & 2,00,000/-

Not Payable

3,00,000/- to 15,00,000/-

800/- per day

20,00,000/- & 25,00,000/-

1,000/- per day

Star Family Health Optima Insurance Policy – Benefits

The policy offers ample benefits that can be clubbed under the below categories:

Insurance Coverage for the Following Hospitalisation Expenses

Room charges along with boarding and nursing expenses up to the given limits:

Sum Insured (Rs.)

Limit (Rs.)

1,00,000/- & 2,00,000/-

Up to 2,000/- per day

3,00,000/- & 4,00,000/-

Up to 5,000/- per day

5,00,000/- to 25,00,000

Single Standard A/C Room

  • Anaesthetist, Surgeon, Consultants, Specialist Fees, Cost of Pacemaker, blood, oxygen, medicine, etc.
  • For insurance policies having sum insured of Rs 5,00,000 or above, Air Ambulance cover of up to 10% of basic sum assured is allowed, per policy period

Pre and Post Hospitalisation Expenses

  • Medical expenses incurred up to 60 days before hospitalisation are payable to the policyholder.
  • Medical expenses incurred up to 90 days post hospitalisation are payable to the policyholder.

Cover for Pre-existing Diseases

  • Star Family Health Optima Insurance Plan provides coverage for pre-existing diseases after 48 months of continuous renewal of insurance.

Cost of Medical Check-up

For every claim-free year, the expenses incurred by the policyholder towards health check-up shall be subject to the following limits:

            Sum Insured (Rs)

Limit Per Policy Period (Rs)

1,00,000 & 2,00,000

Not Available

3,00,000

Up to 750

4,00,000

Up to 1,000

5,00,000

Up to 1,500

10,00,000

Up to 2,000

15,00,000

Up to 2,500

20,00,000

Up to 3,000

25,00,000

Up to 3,500

List of Some Medical Expenses Covered

  • Expenses on Assisted Reproduction treatment shall be reimbursed by the Company, subject to certain conditions. This benefit is available only if the sum assured is Rs 5,00,000 or above.
  • Donor expenses for transplantation of organs, where the insured undergoes the procedure, the lower of 10% of the sum insured or Rs 1,00,000 shall be payable.
  • Expenses incurred concerning AYUSH treatment shall be payable to the policyholder up to the specified limits
  • It covers all day-care procedures

Repatriation of Mortal Remains

  • The expenses incurred for repatriation of mortal remains of the policyholder to the city of his/her residence shall be reimbursed by the Company up to Rs 5,000.

Compassionate Travel

  • In case the policyholder is hospitalised at a place away from his usual place of residence, the insurance provider shall reimburse the air travelling expenses incurred by one immediate family member.
  • The reimbursement is subject to a maximum of Rs 5,000 and is available to policyholders having a minimum sum insured of Rs 10,00,000

Tax Benefit

  • The premium paid towards Star Family Health Optima Insurance Plan is eligible for tax deduction u/s 80D of the Income Tax Act, 1961.

Star Family Health Optima Insurance Policy: Exclusions

Star Health Insurance Company shall not be liable to pay the expenses incurred by the policyholder to the following:

  • Circumcision, Prenuptial Dilatation, Congenital External Condition/ Defects / Anomalies
  • Psychiatric, mental and behavioural disorders
  • Dental treatment or surgery, dental implants (unless due to accidental injuries and requires hospitalization)
  • Treatment arising from or related to childbirth, pregnancy, family planning, abortion, miscarriage, and related complications
  • Intentional injury to self
  • Any expenses on diseases or illness following consumption of drugs/alcohol/tobacco
  • Any expenses on sexually transmitted diseases
  • Injury/disease caused by nuclear weapons
  • Treatment for endocrine and genetic disorders
  • All other expenses as mentioned under ‘Other Excluded Expenses’ by the Company

Star Family Health Optima Insurance Policy: Eligibility Criteria

The minimum eligibility criteria to buy this policy are:

  • Applicants aged between 18 to 65 years can are eligible to buy the policy
  • A newborn child can be covered as a part of the family if he/she is 16 days old or more
  • For Star Family Health Optima Insurance Plan, the term family includes proposer, spouse, dependent children aged between 16 days to 25 years (Children who are economically dependent on their parents)
  • The minimum sum assured is Rs.1,00,000/- and the maximum is Rs.25,00,000/-

Star Family Health Optima Insurance Policy: Claims Procedure

The claim process for Star Health insurance is as similar to the other health insurers. The basic claim steps include:

  • Report the claim on the 24-hour helpline for assistance.
  • In the event of planned hospitalisation, the insurance provider should be informed 74 hours before the hospitalisation.
  • In the event of emergency hospitalisation, the insurance provider should be informed within 24 hours of hospitalisation.
  • The facility of cashless hospitalisation can be easily availed at all network hospitals.
  • In case of non-network hospitals, the policyholder is required to make the payment up-front and then file a claim for reimbursement facility.
  • Reimbursement of expenses shall be processed on submission of necessary documents

Star Family Health Optima Insurance Policy: Renewal Process

Star Family Health Optima Insurance Plan allows life-long renewal beyond the age of 65 years. The company offers a grace period of 120 days from the date of the expiry of the policy for renewal. The policyholder can apply for renewal within this time

The continuity of benefits along with reference waiting periods specified shall be available if the policyholder applies within 120 days. If during the grace period, the policyholder gets prone to any disease or illness or injury, it will be deemed as pre-existing and will be subject to a waiting period of 48 months

The renewal steps are mentioned below:

  • Go to the paisawiki.com
  • On the home page, navigate through the “Renewal” option
  • Provide necessary details such as policy number, policy tyme, DOB or other details
  • Get the premum amount to be paid
  • Go for additional covers if required and compare the premiums
  • Pay the premiums online to renew the policy. This will be done through a secured payment gateway at paisawiki.com
  • Get the renewed policy mailed to he registered email id.

Star Family Health Optima Insurance Policy: Steps to Buy

The policy can be bought easily through third party aggregator websites such as paisawiki.com. The buying steps are easy and convenient to follow. These include:

  • Log in to paisawiki.com and go to the “Get Free Quote” option.
  • Fill in the details asked for which include, but are not limited to, the number of members in the scheme, DOB, Policy Tenure, Sum Assured, etc. And click on the "Proceed to Buy" option.
  • Paisawiki might ask you for a few more details, if necessary. If you are satisfied with the premium amount, click on "Buy Now."
  • After choosing your desired plan, the final step is to make an online payment.
  • Pay the premiums online using a debit/credit card or net banking.

Documents Required to Buy the Star Family Health Optima Insurance Plan

The following documents are required to be submitted in respect of all the applicants- 

  • Age proof –Passport, Birth Certificate, etc.
  • Income Proof (if any) –ITR form 16 (Not more than three years old) or Salary slip
  • Address proof –Electricity Bill, Telephone Bill, Bank Statement, etc.
  • Identity Proof – PAN Card, Driving License, Voter Card, etc.
  • Recent passport-sized colour photograph

FAQs

Written By: Paisawiki - Updated: 24 September 2020

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