The Star Health Gain Insurance Policy, covering eligibility, policy features, coverage options, and benefits:
1. Policy Overview
- Flexibility: Policyholders can choose a customized sum insured, premium level, and family size based on personal health needs and financial preferences.
- Tax Savings: Premium payments are eligible for tax deductions under Section 80D of the Income Tax Act, providing additional financial benefit.
2. Eligibility
- Age Range: Available for individuals aged between 18 and 65 years.
- Family Coverage: Includes the proposer (policyholder), spouse, and dependent children (ages 91 days to 25 years) who rely on the policyholder financially.
3. Coverage Highlights
Section I: In-Patient Hospitalization Coverage
- Room, Boarding, and Nursing: Reimburses expenses for room, boarding, and nursing care up to 1% of the sum insured per day.
- Medical Practitioners: Includes fees for surgeons, anesthetists, consultants, and specialists involved in treatment.
- Operation and ICU Costs: Coverage extends to costs for anesthesia, blood transfusions, oxygen, operation theatre, ICU charges, diagnostic materials, pacemaker implantation, and other similar procedures.
- Emergency Ambulance Services: Provides up to ₹750 per hospitalization and an overall limit of ₹1,500 per policy period for emergency ambulance transport.
- Modern Treatments: Covers various advanced medical treatments, with certain limits depending on the specific procedure.
Section II: Outpatient Treatment Benefits
- Outpatient Treatment: Covers outpatient (OPD) medical consultations and treatments in the Star Health network facilities.
- Benefit Carry-Forward: Any unutilized amount in the outpatient benefit can be carried forward to the next policy year upon renewal. This carry-over is limited to one immediately succeeding year only.
Additional In-Patient Coverage
- Day Care Procedures: Covers all day care treatments, such as minor surgeries or treatments that don’t require a 24-hour hospital stay.
- AYUSH Treatment: Includes inpatient hospitalization expenses for treatments under Ayurveda, Unani, Siddha, and Homeopathy. Coverage is limited to recognized AYUSH hospitals.
- Pre-Hospitalization: Covers medical expenses incurred up to 30 days before the date of hospital admission.
- Post-Hospitalization: Medical expenses incurred up to 60 days after discharge from the hospital are covered under this policy.
4. Waiting Periods and Exclusions
- Pre-Existing Conditions: Coverage for pre-existing conditions is available after a 36-month waiting period. If there is a sum insured increase, the waiting period applies afresh for the additional sum.
- Specified Condition Waiting Period: Certain conditions and surgeries, such as cataract surgery, joint replacement, and ENT surgeries, have a 24-month waiting period unless caused by an accident.
- 30-Day Initial Waiting Period: No coverage for illness-related treatment within the first 30 days of policy commencement, except for accidental injuries.
- General Exclusions: Coverage does not include cosmetic or plastic surgeries (unless for reconstruction after an accident or to treat a health risk), weight loss treatments (without medical necessity), injuries from self-harm, or conditions caused by alcohol or drug abuse. Additional exclusions apply to adventure sports injuries, infertility treatments, and treatments in unregistered hospitals or facilities.
5. Policy Options
- Sum Insured Choices: Coverage levels and policy types can be selected based on family needs and budget.
- Individual Basis: Each insured person has a separate sum insured under the policy.
- Family Floater: A single sum insured is shared by all insured members under one family plan.
6. Claim Process and Renewal
- In-House Claims Assistance: Claims are processed directly through Star Health’s in-house claims team, avoiding third-party administrators for faster service.
- Grace Period: The policy allows a 30-day grace period after the renewal due date to maintain coverage continuity.
- No Penalty for Renewals: Renewal premiums are not increased based on individual claim history, making it accessible for regular policyholders without financial penalties for past claims.
7. Premium Options and Sum Insured
- Premium Options: Based on the chosen sum insured and policy term, policyholders can select premiums that best match their coverage needs.
Outpatient Benefit Variability: Outpatient limits adjust depending on the chosen sum insured, premium option, and family size.
This policy provides a wide range of benefits for inpatient and outpatient treatments, day care procedures, and alternative (AYUSH) treatments, making it suitable for individuals and families looking for comprehensive health insurance coverage.
- What is Star Health Gain Insurance?
- Star Health Gain Insurance is a comprehensive health insurance policy that offers coverage for hospitalization, pre- and post-hospitalization expenses, and various other medical expenses.
- What are the benefits of Star Health Gain Insurance?
- Benefits include cashless hospitalization, coverage for daycare procedures, pre-existing disease coverage after a waiting period, and a wide network of hospitals.
- What is the eligibility for Star Health Gain Insurance?
- Eligibility typically includes Indian residents within a certain age range, often starting from a few days old up to 65 years or older, depending on the specific plan.
- Does Star Health Gain Insurance cover pre-existing conditions?
- Yes, but there is usually a waiting period (commonly 24 months) before coverage for pre-existing conditions begins.
- How do I make a claim with Star Health Gain Insurance?
- Claims can be made through cashless hospitalization at network hospitals or by submitting required documents for reimbursement in case of non-network hospitals.
- Is there a waiting period for certain conditions?
- Yes, most health insurance policies, including Star Health Gain, have a waiting period for certain pre-existing conditions and specific illnesses.
- Can I include my family under Star Health Gain Insurance?
- Yes, many plans allow for family floater options where you can cover multiple family members under one policy.
- What is the premium for Star Health Gain Insurance?
- Premiums vary based on factors like age, coverage amount, and family size. It’s best to get a personalized quote for an accurate figure.
- Are there any exclusions in the Star Health Gain Insurance policy?
- Yes, common exclusions may include certain diseases within the initial waiting period, self-inflicted injuries, and cosmetic procedures.
- How can I renew my Star Health Gain Insurance policy?
- Policies can typically be renewed online through the Star Health website or by contacting customer service.
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