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Star Special Care Insurance Policy
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Star Special Care Insurance Policy 

Autism Spectrum Disorder (ASD) is a disorder to be found among the children during the early childhood. With goes without saying that with special healthcare it can be treatment, but it comes with a cost. Therefore, a separate health insurance plan is required to finance their treatment and provide medical cover.

Star Special Care Insurance Policy fulfils this purpose by providing adequate coverage to children with ASD, enabling smooth recovery and normal functioning.

What is Star Special Care Insurance Policy?

Star Special Care Insurance Policy is a scheme that covers medical treatment for children suffering from ASD and doubles up as a health insurance plan.

This policy provides coverage for hospitalization, daycare procedures, surgery, specialized medical equipment, and doctor consultation for ASD-related mental and developmental issues.

Star Special Care Insurance Policy takes into account the specific needs of ASD individuals, easing their lives to a great degree.

Features of the Star Special Care Insurance Policy

Some of the salient features of this policy are:

  • Star Special Care Insurance Policy focuses not only on autism but also on issues related to paediatric development. It covers expenses for all medical procedures, including surgery.
  • Considering the insurance plan is focused on children, the insured is offered a payout at 25 years of age. Subsequently, normal health policy is provided with similar benefits having appropriate waiting periods.
  • Many health insurance plans focus on physical ailments and exclude mental illnesses. However, comparing policies, Star Special Care Insurance Policy is unique in two aspects –
    • It concentrates exclusively on ASD and resultant mental, social, and developmental issues. Therefore, health is approached from a holistic viewpoint.
    • It is exclusively focused on children. It does not require an adult to be jointly covered or an adult proposer.
  • The proposer is not required to undergo any medical check-up or screening before policy purchase. However, ASD individuals experience specific health and developmental issues; therefore, policy terms state that all medical records are required to be submitted during purchase.
  • Star Special Care Policy focuses ASD in children; however, it provides the option of portability. A customer can transfer funds from another health insurance provider to this policy. As per policy terms, the portability request should be made 45-60 days before renewal. 

Benefits of Star Special Care Insurance Policy

The policy benefits are categorized into following categories:

  • Accommodation Benefits – As per Star Special Care Insurance Policy terms, the insured is entitled to individual accommodation upon hospitalization (including intensive care) or a nursing home. This is offered at coverage of Rs 5000 per day.

However, if a shared accommodation is chosen, compensation will be paid at Rs 500 per day, or up to Rs 10,000 per year.

  • Hospitalization Compensatory Benefit – For hospitalization lasting more than 24 hours, Star Special Care Insurance Policy provides compensatory benefits to the insured.

As per policy terms, the insured is compensated with expenses amounting to either 7% of hospitalization costs, or 60 days of post-hospitalization treatment – whichever may be higher. The health insurance plan covers only the treatment costs for the ailment that requires hospitalization.

Hospitalization accommodation costs (Rs 5000 per day) are included in the compensatory benefits for treatment.

  • Co-payment Compensation – The insured is levied a co-payment of 20% for the overall claim submission. However, this does not apply to medical personnel and equipment expenses.

For compensation, Star Special Care Insurance Policy offers the insured an option to either opt for increased coverage in the following policy year or reimbursement at the age of 25 when the insurance plan comes to an end.

  • Seamless Claims Processing – Star Special Care Insurance Policy does not engage with a third-party administrator (TPA). All communication with the insured is done directly through the health insurance official at the network hospital. Therefore, the application for the policy claim is processed smoothly without the involvement of multiple channels. This results in rapid claim settlement.
  • Tax Benefits – All health insurance plans are accorded tax benefits as per Section 80(D) of the Income Tax Act, India (1961). Considering that Star Special Care Insurance Policy offers coverage only to children (without adult proposers), the resultant tax benefit is Rs 20,000 per policy.

*Tax benefit is subject to changes in tax laws

Inclusions of Star Special Care Insurance Policy

The policy inclusions are as mentioned below:

  • Medical Coverage – Taking into account the specialized medical needs of ASD, treatment expenses are covered by Star Special Care Insurance Policy. These include medical practitioners, surgeons, anaesthetists, consultants, and therapists.

According to policy terms, no sub-limits are applicable for covering expenses of individuals involved in therapy.

  • Medical Equipment – Specialized health care facilities are required for the diagnosis and treatment of illnesses in ASD patients. Star Special Care Insurance Policy provides coverage for blood collection, oxygen, anaesthesia, surgery facilities, diagnostics, X-ray equipment, dialysis, chemotherapy, radiotherapy, etc. Therapeutic drugs provided should not have any side-effects in ASD individuals.
  • Ambulance Expenses – ASD individuals are sensitive to sounds. Therefore, specific needs are required to shield external noises while travelling in ambulances. Star Special Care Insurance Policy covers this. Additionally, emergency ambulance services may be required to transport the insured to the hospital for treatment. Policy terms provide a coverage of Rs. 1500 is provided over a single policy period for this purpose.
  • Surgery and Therapy Expenses – According to Star Special Care Insurance Policy terms, expenses for surgery and ASD therapy are covered as follows –

Ailment / Therapy

Coverage per policy period

Adenotonsillectomy

Rs 25,000

Seizure therapy

Rs 30,000

Hospitalization for fractures with surgery

20% of the sum insured

Botulinum toxin injection

(only for hospitalized patients)

Rs 5000 per sitting

(till Rs 20,000)

Behaviour and speech therapy, physiotherapy, and occupational therapy

Rs 1500

  • Pre-existing Autism – Comparing health insurance plans, specific pre-existing illnesses are either excluded from or included at the end of the waiting period. However, Star Special Care Insurance Policy does not consider ASD as a pre-existing condition.

For instance, if an individual has been diagnosed with ASD at the age of 5, and policy is purchased at the age of 8, the application will be accepted for coverage. All policy terms will be applicable to the insured.

Exclusions of Star Special Care Insurance Policy

Claims made under the following are excluded as per the norms of Star Special Care Insurance Policy –

  • Surgical procedures such as circumcision; vaccination as preventive therapy
  • Congenital defects and genetic disorders
  • Neurological disorders, such as cerebral palsy
  • Dental treatment is excluded – except requiring hospitalization
  • Overdose or consumption of tobacco, drugs, and alcohol
  • Nutrition deficiency; rest and rehabilitation for fatigue
  • Injury or illness due to war or social unrest
  • Treatment for HIV/AIDS and weight loss
  • Expenses for treatment other than allopathy – AYUSH treatment is excluded from the policy.

Eligibility Criteria to Buy the Star Special Care Insurance Policy

Eligibility criteria to apply for the plan are -

  • Age limit for entry –

Minimum

3 years

Maximum

25 years

Beyond the age of 25 years, a regular health policy will be offered - containing similar benefits as Star Special Care Insurance Policy.

  • As the policy is specifically meant for children with ASD, there are no plan variants.
  • Policy tenure – 1 year
  • Sum insured – 3 lakh
  • The gross premium to be paid is staggered. It is divided among three age-groups depending on the requirements – 

Age (in years)

Gross premium

3-10

Rs 4800

11-20

Rs 5325

21-25

Rs 6075 

  • Waiting Period – As per Star Special Care Insurance Policy, the waiting period is divided into four phases –
  • No waiting period – If the insured was previously covered by another policy for 12 months continuously, the waiting period would not be applicable.
  • First 30 days – This is applicable only for a disease contracted in this period.
  • 24 months – During this period, expenses on the following are covered:
  • Disorders of eye, ENT, hernia, fistula, rectal prolapse
  • Treatment for kidney, genitourinary tract, gallbladder and pancreatic disorders
  • Benign lumps and cysts
  • Disorders of tendon, ligament, bone, and muscle (except accident)

The above waiting period does not apply for the insured being covered by a previous policy for 24 months continuously.

  • 48 months - This is applicable for pre-existing diseases. Although Star Special Care Insurance Policy does not regard autism as pre-existing disease, this waiting period is applicable for disorders existing before policy purchase. Here, 48 months refers to the time-period of elapsing of the original health insurance plan before porting to the current policy.
  • All waiting periods are dependent on portability regulations.
  • The policy is renewable until the age of 25. Subsequently, another insurance plan will be offered with similar benefits.
  • Policy withdrawal – Star Special Care Insurance Policy deems a 15 days free look period. In other words, policy withdrawal, is permitted till up to 15 days without any loss in the premium payment.
  • Grace period – According to policy terms, the grace period (30 days) comes into effect in case the health insurance premium is not paid within the stipulated due date. 

Claim Process of Star Special Care Insurance Policy

Policy claims can be obtained by cashless and reimbursement methods under Star Special Care Insurance Policy.

Cashless claims

This is for network hospitals. Policy terms state that the insurance provider must be notified within 24 hours of hospitalization.

  • Contact the provider through the 24-hour helpline provided on the health insurance card.
  • Provide the policy ID for intimation of the incident.
  • Collect the pre-authorization form from the hospital, fill it up, and return it.
  • As treatment proceeds, the hospital authorities will complete the form, with the total expenses involved. This is sent to the insurance provider.
  • Documents may be required to clarify the information provided.
  • The policy claim request is processed as per policy terms and conditions.
  • After approval of the request, the insurance provider conveys the information accordingly.

Reimbursement claims

This is applicable for non-network hospitals. Policy terms state that the claim application must be submitted within 15 days of discharge.

  • The required payment and other dues are cleared by the insured as specified by the hospital.
  • The original medical documents are taken from the hospital.
  • The claim form is obtained from the health insurance provider’s website and filled up.
  • The required documents are attached to the claim form and submitted.
  • The company processes the claim request. If accepted, the company informs the insured accordingly.
  • The claim is settled by transferring the funds to the bank account of the insured. 

Required Documents for Claim Submission 

Cashless and reimbursement policy claims are required to be submitted with the following documents –

  • Duly-filled claim form
  • Health insurance card
  • Doctor’s report stating the reason for hospitalization and the treatment provided
  • Medical documents (original) –
  • Tests carried out before admission
  • Doctor's report permitting the discharge
  • Cash receipts from the hospital for tests and treatment
  • Reports from medical personnel (if surgery occurred)
  • Post-hospitalization treatment prescription
  • Report on the diagnosis of an ailment
  • Recommending therapy report (physical therapy, physiotherapy, etc.)
  • Receipt for payment of therapy
  • Copy of PAN card

Additional documents may be called for as required.

How to Buy Star Special Care Insurance Policy?

The policy can be bought easily online through Paisawiki.com. Online purchase of Star Special Care Insurance policy takes place in three steps –

Premium Amount Enumeration

  • Visit the website Paisawiki.com. Choose the required health insurance plan providing a health cover. It should meet the treatment needs of ASD children as required.
  • Provide details of the child to be covered under Star Special Care Insurance Policy.
  • Depending on the age of the child, the premium amount for payment is displayed.

Adding Details

  • The contact number that is to be listed with Star Special Care Insurance Policy is provided.
  • Provide the name, age and the gender of the child for whom the policy is to be purchased. Subsequently, provide the residential area.
  • The health insurance plans related to the requirements will appear. 'View Features' reveals further plan information - policy cover, a monthly premium to be paid, features, highlights, and claim procedure with hospital coverage. Comparing insurance plans helps decide the required scheme.
  • Selecting “Proceed to Buy” displays the selected health insurance plan in totality (with benefits and inclusions). Thus, policy terms can be known before payment.
  • Also, the buyers can maintain a record of the selected plan. Therefore, two documents are given for downloading – one contains policy terms and conditions, and the other gives the provider details. The policy tenure of Star Special Care Insurance Policy is 1 year. There are no multi-year variants for financial savings. However, certain benefits and inclusions result in a reduction in the premium amount.
  • Choose “Proceed” after the plan is finalized.
  • The following page contains five sections - insured details (name, date of birth, height, weight, and occupation), contact address, medical history, nominee details, and declaration. Check the added details and upload the documents needed. Make the payment for the plan.
  • Alternatively, the proposal form of Star Special Care Insurance Policy can be obtained from the official website of the health insurance provider. The duly filled form is to be submitted with the specified documents and the required premium.

Premium Payment

  • Premium is to be paid digitally. The levying of 18% GST on health insurance premium results in a higher payment.
  • Offline purchase of the policy can be made by contacting the nearest branch office of the health insurance provider. 

Documents Required for Purchasing the Star Special Care Insurance Policy

While purchasing Star Special Care Insurance Policy, documents are required to be provided. These form the KYC of the insured –

  • Identity proof – PAN card, Aadhar card, driving licence, passport, voter I-card
  • Age proof – Birth certificate, passport
  • Address proof – Aadhar card, driving licence, passport
  • Passport-size photographs
  • Previous medical reports

Renewal Process of Star Special Care Insurance Policy

Star Special Care Insurance Policy offers renewal until the age of 25. The procedure for policy renewal is as follows - 

  • Go to Paisawiki.com. Select the ‘Renewal Option’. Enter your login details by selecting "Policy Renewal."
  • Enter the policy ID, mobile number, and date of birth.
  • Plan details reveal the insured details and the sum insured amount, with the premium payment details. Verify the provided plan details before making the payment.
  • Click on “Plan Renewal”.
  • Pay the required amount. This renews the health insurance plan.

For continuation of policy benefits and avoiding dormancy, ensure timely payment of insurance premium. The frequency of payment can be monthly or annually.

FAQs About Star Special Care Insurance Policy

Written By: Paisawiki - Updated: 22 September 2020

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