When a family member is ill, it is a traumatic time for the rest of the family. Star Health provides Family Health Optima to protect all members of a family from financial setbacks in the event of a serious illness. The coverage is applicable equally to all members of the family.
Family Health Optima Benefits
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Hospitalisation Cover: This would protect the insured person for in-patient hospitalisation expenses for a minimum of 24 hours. These expenses include room boarding expenses to a maximum of Rs.1500 per day in Class A cities, Rs.750/- in Class B cities or Rs.500/- in other locations
- Nursing expenses
- Surgeon's fees, Consultant's fees, Anesthetist and Specialist fees
Cost of blood, oxygen, diagnostic expenses, cost of pace makers etc
- Cost of medicines and drugs
- Emergency ambulance charges for transporting the covered patient to the hospital up-to a sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period
Additional Benefits
- The sum insured floats among the family members insured. In other words there is no need to take insurance for each member separately for separate sum insured
- Thus there is considerable premium saving
Family Includes
- Family would mean proposer, spouse, dependent children upto 25 years and those who are economically dependent on their parents
Pre - and Post Hospitalisation cover
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Pre-hospitalisation Medical expenses up-to 30 days prior to the date of admission or post-hospitalisation calculated at 7% of the hospitalisation expenses (excluding room rent) subject to a maximum of Rs.5000 is payable
Discount
- A discount of 10% on Premium is allowed on renewal of the policy if there is no claim in the immediately preceding year of the policy. This discount is not cumulative
IT Benefit
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Premium paid by cheque and credit card is eligible upto Rs.15000/- for relief under Section 80-D of the Income Tax Act (Rs. 20,000 for senior citizens)
Claim Procedure
- Call 24 hour help-line for assistance
- Inform ID number for easy reference
- For planned hospitalisation, please inform 48 hours prior to admission to the hospital
- For emergency hospitalisation, information to be given within 24 hours after hospitalisation
- Cashless facility can be availed at all network hospitals
- For treatment in non-network hospitals, reimbursement of expenses will be effected on submission of all medical documents
Exclusions
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Expenses incurred for treatment of any illness/ disease/ condition, which is pre-existing at the time of commencement of insurance
- Any expenses incurred for treatment of illness/ disease/ sickness contracted by the Insured Person during the first 30 days from the commencement of the policy
- First Year exclusions – Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone / Renal Stone removal / treatment
- Two Years Exclusions – Hysterectomy for Menorrhagia or Fibromyoma, Cataract, Knee Replacement Surgery (other than caused by an accident),Joint Replacement Surgery(other than caused by an accident), Prolapsed Intervertebral Disc(other than caused by an accident), Varicose veins / ulcers
- Naturopathy treatment
- Expenses, which are purely diagnostic in nature with no positive existence of any disease
- Expenses those are mainly cosmetic in nature
- Expenses incurred for treatment of diseases/illness/accidental injuries by systems of medicines other than Allopathic
- Expenses incurred for treatment of congenital disease/defects/anomalies
- For a detailed list of exclusions please refer policy conditions
Eligibility
- Any person aged between 5 months and 60 years residing in India, can take this insurance
To understand the nuances of different types of policies and its price, feel free to seek the help of InsuranceMall to select the right products based on your need. Or you can directly call them on +91-22-30503050
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