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Star Outpatient Care Policy
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Star Outpatient Care Policy

Star Health Insurance Company has launched a health-specific insurance plan which provides coverage against outpatient treatment procedures. The policy was launched for policyholders who face financial crunches while covering outpatient care expenditure under traditional health insurance plans. Although traditional insurance policies which provide health cover are created to pay for the expenses incurred due to hospitalisation of greater than 24 hours to treat a disease or injury, they don't cover all related costs. Star Outpatient Care plan covers the cost of pre and post-hospitalisation expenditures due to various check-ups and diagnoses related to a particular disease. 

What is Star Outpatient Care Policy?

The Start Health Insurance Company launched Star Outpatient Care Plan, which is a standalone plan, which is different from traditional health insurance coverage.

All the required expenditures related to outpatient care are covered in this plan in comparison to normal health insurance plans. This policy covers the treatment of disease, injury, or illness that requires medical care from a medical practitioner without being admitted to the hospital. General expenses incurred due to outpatient treatment are also covered like diagnostic test expenses, doctor fees, charges of physiotherapy, pharmacy bills, non-allopathic treatments, therapeutic procedures, and dental treatments.

Features of Star Outpatient Care Policy 

The features of availing Star Outpatient Care Policy are:

  • Star Outpatient Care Policy is a policy that covers all the related OPD expenditure which doesn't require hospitalisation. 
  • The Star Health Company provides direct in-house settlement of claims which reduces the turnaround time for settlement of the claim. The plan cuts down any third-party administrator which further reduces the time taken.
  • Star Health Insurance provider has a list of 9800+ network hospitals in India.
  • The policy offers immediate consultation of outpatients at any of the network hospitals.
  • The plan covers the expenditures of non-allopathic treatments like Yoga Naturopathy treatments, Ayurvedic treatment, Siddha, Unani, and Homeopathic treatments availed from a recognised institute by government and accredited by the National Accreditation Board on Health or Quality Council of India.

Benefits of Star Outpatient Care Policy

The benefits of availing the Star Outpatient Care Policy are: 

  • The plan provides coverage against expenses that are related to pharmacy bills, diagnostic tests, and physiotherapy treatments.
  • As compared to the outpatient care policy, no other plan covers dental treatment expenditures that are carried out at any of the network hospitals
  • Eye treatment due to any accidental injury is also covered under this plan. But the treatment needs to be carried out at a network hospital in India.
  • The person insured is entitled to receive a 25% rebate during renewal on the premium amount paid. The renewal rebate can be received after 2 continuous claim-free years.
  • The plan has a hassle-free and faster claim settlement process.
  • The plan has a free look period of 15 days in which customers can review their decision to purchase a policy. They can return the policy and all premiums paid are returned without any extra charge.
  • There is a grace period of 30 days offered from the date of the expiry of the policy for renewal of the policy.
  • The policyholder is eligible to get rebates on tax on the premiums paid under section 80D of the Income Tax Act, 1961.

Inclusions of Star Outpatient Care Policy

The inclusions of the Star Outpatient Care Policy are

  • It covers various outpatient consultation expenditures incurred at network hospitals.
  • The treatment expenses and medical outpatient consultation is offered under Ayurveda, Unani, Yoga, Siddha, Naturopathy, and Homeopathy system of medicine from any institute which must be recognised by the Government of India.
  • The plan covers pharmacy expenses and diagnostics costs which are incurred for treatment as an outpatient at a networked hospital in India.
  • Dental treatment expenditures due to accidents or natural tooth problems, which are incurred at a network facility as an outpatient is covered.
  • Ophthalmic treatment expenditures due to accidental injuries at any network hospital are covered.

Exclusions of the Star Outpatient Care Policy

Exclusion of the Star Outpatient Care Policy are:

  • Anomalies or congenital external condition or defects
  • All types of Cosmetic, Aesthetic treatment
  • Convalescence or general debility or run-down condition or rest cure
  • Expenses due to weight control services and bariatric surgery or medical treatment of obesity.
  • Expenses on vitamins and tonics due to treatment or disease as certified by the attending physician
  • Hospital record charges or inoculation or vaccination
  • Hearing aids, wheelchairs or walkers and crutches
  • Hospital registration charges, admission charges, telephone charge
  • Injury or disease indirectly or directly caused by attribution to war or act of foreign enemy or invasion or warlike operations (whether war is declared or not)
  • Injury and disease indirectly or directly caused due to nuclear weapons.
  • Intentional self-injury
  • Nutritional Supplements
  • Nutritional deficiency states
  • Sexually transmitted diseases or venereal disease (other than HIV)
  • Surgery due to dental treatment
  • Treatment arising from pregnancy
  • Treatment for subfertility, or assisted conception
  • Treatment for erectile dysfunctions, priapism and change of sex
  • Unconventional, untested, experimental, unproven, therapies
  • Use of substance abuse, intoxicating substances, drugs or alcohol or smoking or tobacco chewing.

*This list is only indicative and not exhaustive. Insured are recommended to refer to the policy document for the complete list.

Waiting Period Applied

The plan has a waiting period to serve when a claim is not liable to be covered directly or indirectly. The waiting period of the plan is as follows:

  • First, 30 days starting from the date of commencement of the policy, when no claim is provided, except for the accidental claim.
  • In the Silver Plan, 48 months is the waiting period for a pre-existing illness.
  • In the Gold Plan, 24 months is the waiting period for a pre-existing illness.
  • In the Platinum Plan, 12 months is the waiting period for pre-existing illness. 

Eligibility Criteria to Buy the Star Outpatient Care Policy 

The below eligibility criteria are applied while buying Star Outpatient Care policy:

  • Minimum entry age under the policy of an adult- 18 years
  • Maximum entry age under the policy of an adult- 50 years
  • Minimum entry age under the policy of a child - 31 days
  • Maximum entry age under the policy of a child - 25 years
  • The dependent children can only be included if both of the parents are covered in the policy. Dependent children mean those children who don't have a financial income
  • Sum insured options - Rs 25,000, Rs 50,000, Rs 75,000, and Rs 1,00,000
  • There are three types of plan available - Silver plan, Gold plan and Platinum plan.

*The above information is subject to change as per the norms of the insurance provider. 

Claim Process of Star Outpatient Care Policy

Star Outpatient Care Policy has two ways in which a claim can be made. They are the reimbursement process and the cashless claim process.

Reimbursement Process

  • Step 1: If the policyholder wants to get outpatient treatment from a non-network hospital, he/she must inform the policy provider at least a week before undergoing any treatment against a covered disease. For emergency treatment, inform within 24 hours.
  • Step 2: After undergoing the treatment, register the claim with the insurer by filling the claim form and submitting along with the required documents.
  • Step 3: If the plan is in the grace period or up for renewal, renew the policy. For applying for a claim, download the claim form from the website or one can fill it up online. For online filling up, enter various details asked like the cause of treatment, type of treatment undergone by the patient, etc. Once done with the form, attach the required documents like prescriptions, diagnosis reports and other such details. Once done, cross-check and submit the claim form.
  • Step 4: After cross-checking and verifying the documents, the insurer will notify if any further documentation is required.
  • Step 5: If the documents are found correct, and the treatment is done according to the terms of the policy, Star Health Company will reimburse the claim through NEFT to the policyholder's bank account.

Cashless Claim 

  • Step 1: Cashless claim is made when the treatment is undergone in a network hospital. For cashless treatment, the policyholder must inform the insurance company about the treatment. They are required to show essential documents such as policyholder's policy document and health card at the hospital's outpatient department. 
  • Step 2: When the treatment is completed, the policyholder needs to submit the claim form which can be availed from the insurer’s website.
  • Step 3: For the claim application, one can fill it up online. For the online filling, enter the details asked like the cause of treatment, type of treatment undergone by the patient and other such details. Once done with the form, attach the required documents like prescriptions, diagnosis reports. Once done, submit
  • Step 4: Once the verification is done by the insurance company, it will pay the bill amount directly to the hospital.

Documents Necessary for Claim Settlement Process

The required documents are:

  • A duly filled claim form
  • A medical certificate from the attending or treating doctor about the diagnosis
  • FIR for accidents
  • A prescription from treating doctor
  • Receipt from the physiotherapist or treating doctor or hospital
  • A receipt is required from chemists or pharmacy
  • Receipts and reports for tests done

For emergency treatments and accidents, the person insured can claim for outpatient treatment expenses and diagnosis reports, and pharmacy expenses in non-network hospitals too. 

How to Buy Star Outpatient Care Policy? 

The stepwise process to buy Star Outpatient Care Policy is as follows:

  • Step 1: Go to the Paisawiki.com and click on the “health insurance’ tab on the home page and click ‘Get Free Quote’. On the website, there is a box that asks for mobile number, members, email, city, income, name.
  • Step 2: After entering the details, click on the 'Get Free Quotes' button. The search result shows various policies. One can check all policy related details by clicking on 'View Features'.
  • Step 3: One can buy a plan or compare online with various other health plans by clicking on the compare button. One can shortlist the policies here.
  • Step 4: On the next page, the base premium & sum insured is calculated. Choose the plan term. Below there are tabs like members & contact information. Click on edit & enter details.
  • Step 5: There are tabs for key features, benefits, documents or brochures, proposal form, policy terms, claim form, premium chart and product leaflet. There are other tabs that contain information about the terms & conditions section.
  • Step 6: There riders are available which are shown below these tabs. Choose them for enhancing covers.
  • Step 7: Premium is calculated on this page. Fill up details of insured members like email address, name, birth date, height, weight & occupation.
  • Step 8: Agree to the declaration & click on the ‘proceed’ option. In the check out option, proposal details are mailed to the policyholder's email id. Click on the payment button.
  • Step 9: Here, the policyholder needs to enter the bank details. One can use debit, credit card, net banking, UPI, wallet and EMI to pay the premium amount.

Documents Necessary to Buy Star Outpatient Care Policy

The following documents are to be furnished at the time of buying health insurance from Star Health:

  • Coloured photograph
  • Age proof and photo id proof- Voter Card, School Leaving Certificate, PAN card, Passport, Driving License, Birth Certificate and Aadhar Card
  • For address proof - Utility Bill, Telephone Bill, Ration Card, Postpaid Bill, Passport, Electricity Bill and Bank A/C statement

Renewal Process of the Star Outpatient Care Policy

For renewing the policy visit Paisawiki.com. Go to the renewal section, enter policy number and birth date. After entering the information, the website will check if the policy is up for renewal. The premium amount, policy number and the policyholder's name will be displayed. There is a choice to add or remove members or riders. Once the changes are done, the premium to be paid will be shown. Click on 'pay premium' to complete the renewal. Once the payment is done, a new policy will be issued to the policyholder.

FAQs About Star Outpatient Care Policy

Written By: Paisawiki - Updated: 22 September 2020

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