Star Health Gain Insurance Policy

Star Health Gain insurance policy is a health insurance plan offered by Star Health and Allied Insurance Co. Ltd. The design of this plan is formulated to provide the best medical procedures and treatment possible to policyholders and their families. This plan is completely flexible in terms of choosing the sum assured, premium amount to be paid, number of family members to be included, and so on. Not only is the Star Health Gain Insurance Policy a perfect health insurance choice for families but also an ideal tax-saving instrument.

Star Health Gain Insurance plan offers lifelong renewal and a one-year policy term. There are no third-party administrators for claim settlement, where claims are directly settled in-house.

What is Star Health Gain Insurance Policy?

Star Health Gain insurance plan offers medical coverage to the policyholders ranging from in-patient expenditure, day procedure charges, pre-hospitalization and post-hospitalization expenses, regular medical check-ups, cataract treatments, and many more.

There is a range of sum assured offered under the plan, starting from Rs 1 Lakh to Rs 5 Lakh. The Star Health Gain insurance is available as an individual policy option or family floater policy option.

There is a fixed amount of premium for this plan irrespective of the number of people covered or their age group. Hence, it is an ideal health insurance plan if health coverage is required to cover for more than one individual.

Features and Benefits of the Star Health Gain Insurance plan

Key features of Star Health Gain insurance plan are:

• The policy provides coverage ranging from Rs1 lakh to Rs 5 lakh as sum insured.
• The policyholder can choose the premium amount to be paid. The premium options are Rs 15,000, Rs 20,000, Rs 25,000 or Rs 30,000, excluding GST charges.
• The policy tenure can be up to one year.
• There is no exit age for the policyholder for this policy.
• The plan covers in-patient hospitalization charges up to the sum assured amount due to an illness or an accident.
• This policy covers pre-hospitalization expenses for up to 30 days if the policyholder is hospitalized due to any illness.
• This policy covers post-hospitalization expenses for up to a specific lump sum amount after the policyholder is discharged from the hospital.
• Room rent of up to:
• 2% of the sum insured is covered in the plan subject to a maximum of Rs 4000 a day for Class A cities
• 1% of the sum assured is covered in the plan subject to a maximum of Rs 3000 a day for Class B cities
• 1% of the sum assured is covered in the plan subject a maximum of Rs 1000 a day in other places
• Specific day care treatment expenses are covered up to the amount of the sum assured.
• Ambulance charges are covered up to Rs 750 per hospitalization and overall policy limit of Rs 1500.
• Customer can avail tax benefit in this policy under section 80D of the Income Tax Act for any non-cash amount of premium paid.
• If the insured does not make any claim during the policy tenure, he/she can claim a bonus in addition to the sum assured. There is also a no claim discount of 10% on a claim free year which can be availed on premium renewal.
• The plan covers payment of out-patient expenses up to a fixed limit that can include doctor consultation fee, health check-ups, dental works, pharmacy bills, diagnostic tests and so on.

Benefits of Star Health Gain insurance policy are:

• There is coverage for both in-patient and out-patient expenditure under one insurance policy.
• Any amount unutilized under the plan can be carried forward to the next year of the policy tenure.
• Any pre-existing illnesses are covered post four years of holding the policy
• Any specified disease or illness is covered after two months of a waiting period
• There is no claim discount of up to 10% applicable up to the next policy renewal
• Boarding, nursing and room charges will be covered up to 1% of the sum assured per day.
• There will be a balanced deduction in the hospitalization expenses if the limit of room rent is exceeded.
• This Star Health insurance plan covers fees of a medical surgeon, anesthetist, specialists, consultants, drugs, and medicine costs up to a limit.
• Pre-hospitalization expenses incurred within 30 days and post-hospitalization expenses incurred within 60 days after discharge will be covered.
• Out-patient hospitalization expenses incurred in any hospital within the insurance company network is covered.
• There is no involvement of any third-party administration for claim settlement purposes.
• The claim settlement process is simple, smooth and hassle-free
• Cashless hospitalization is offered in any of the hospitals in the insurance company’s network
• Personal health record of the insured can be maintained in digital format.
• Star Health helpline is available 24X7 to resolve customer queries.

Exclusions of the Star Health Gain Insurance Plan

The following conditions are excluded from the coverage of Star Health Gain Insurance Plan:

• Attempted suicide or inflicted self-injury intentionally, self-destructive activities, etc.
• Injury, illness, or disability caused due to war, or civil operation
• Treatment for conditions due to congenital disabilities and other anomalies is not covered.
• Medical and treatment expenses for sexually transmitted diseases or other venereal ailments are not covered.
• Ailment or illness caused due to consumption of drugs, alcohol or other intoxicants
• Expenses incurred during treatment of any disease contracted during the first 30 days of the policy cannot be claimed.
• Pre-existing illness cannot be claimed within the first four years of the policy.
• There is a waiting period of 1 year for conditions such as hernia, piles, sinusitis, and so on. There is a waiting period of 2 years for knee replacement, cataract, ulcers, varicose veins, and so on.
• Any expense for dental treatment, eye treatment, or surgery is not covered unless it is a result of an accident and hospitalization.
• Costs of spectacles, hearing aids, wheelchairs, crutches, artificial limbs, etc. are not covered.
• Expenses for treatment of pregnancy-related complications such as miscarriage, stillbirth, or abortion are not covered under this plan.

The company reserves the right to cancel the plan any time on the grounds of fraud or misrepresentation, non-cooperation or any other moral misconduct.

Eligibility Criteria to Buy Star Health Gain Insurance Plan

Any individual who is a resident of India between the ages of 18 and 65 years is eligible to apply for the Star Gain Health Insurance Policy. He/she can include family members in the policy who can be either self, dependent children (91 days old to 25 years old), and spouse. The other eligibility conditions are:

Star Health Gain Insurance Plan- Claim Process

Given below is the claim process of the policy for vailing cashless claim at network hospitals and reimbursement claim facilities at non-network hospitals.

Claim Steps for Cashless Claim

• Claim Intimation – Intimation within 24 hours is required for emergency hospitalization. Intimation within 48 hours before admission is needed for planned hospitalization.
• Claim Processing – Pre-authorisation form must be filled out and submitted at the hospital's insurance desk to initiate a claim
• Claim Settlement – Once the request is approved, the claim is settled. If not, the claim for reimbursement must be submitted post-discharge.
• Claim Assistance – For any assistance or query regarding claims, the insured can contact the toll-free number of Star Health Insurance at 1-800-425-2255.

Claim Steps for Reimbursement Claim

• Claim Intimation – Intimation within 24 hours is required for emergency hospitalization. Intimation within 48 hours before admission is needed for planned hospitalization.
• Claim Processing – The claim form with original documents such as hospital bills, doctors' reports, results of diagnostic tests, etc. must be turned in. The hospitals bills are required to pay initially and register a claim later.
• Claim Settlement – Once the request for reimbursement is approved, the claim is settled.
• Claim Assistance – For any assistance or queries regarding claims, the insured can contact the toll-free number of Star Health Insurance at 1-800-425-2255.

How to Buy Star Health Gain Insurance Plan?

Star Health Gain Insurance Plan can be purchased online easily. In order to buy it online, the insurance seeker must visit the website of Star Health Insurance, compare online the various policies, and choose the policy that is appropriate for you. Fill the details in the form, such as insurer’s name, dependents; sum assured, etc. After this, the premium can be calculated using the online premium calculator in the website. After submitting the required details, the quotes will be suggested as per one’s insurance needs.

After have decided on the plan, one must check the plan details, inclusions, exclusions, and then pay the premium online. The premium can also be paid at the nearest Star Health Insurance office, along with the form filled up.

The main factors to be checked before purchasing the Star Health Gain Insurance policy are:

• Waiting period
• Pre-existing illness coverage
• Terms of co-pay, sub-limit if any
• Policy exclusions

Documents Required to Buy for Star Health Gain Insurance Plan

The documents required by the applicant for purchase of the Star Health Gain Insurance Policy are:

• Documents of age proof such as Aadhar card, birth certificate, or school certificate.
• Document of ID proof such as Aadhar card, PAN card, or drivers' license.
• Document showing address proof like Aadhar card, drivers’ license.
• Passport size photos.

Renewal Process of Star Health Gain Insurance Plan

The renewal conditions of the Star Health Gain Insurance Plan are as follows:

• This policy allows a grace period of 30 days from its date of expiry, after which it can be renewed.
• During this period, enhancements can be made to the plan.
• In case the policyholder wishes to migrate to another insurance company before renewal, he must submit application towards the same at least 45 days before the renewal date.
• The policy can be renewed either online of offline. Online renewal allows the policyholder to pay the premiums through a secured online payment gateway. Where for offline payment, the policyholder has to visit a nearest branch and pay the amount through cheque or cash.

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