Star Health Insurance

Star Family Health Optima insurance

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Date of birth
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* Name, Email Id & Mobile No. are optional 
Any person between 18 to 65 years of age can take this insurance for their family on floater basis. Cashless hospitalisation at network hospitals with all the day care surgeries covered.

Family Health Optima health insurance - Eligibility

  • Anyone between the ages of 18 and 65 who lives in India can take this insurance.
  • Only renewals after 65 years.
  • It is possible to cover children from the age of 16 as part of the family.

Star Health insurance review

Star Health Insurance
Star health insurance sum insured
1 lac − 100 lacs options available
Incurred Claims Ratio *
63.00%
Star health insurance tenure options
1, 2, 3 years options available
Claims Settlement Ratio **
81.62%
List of network hospitals
9,900+ hospitals
Number of policies issued *
3,734,365
Maximum family floater coverage
Self, Spouse + 3 dependent children
Number of lives covered *
11,617,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Family Health Optima insurance review

  • Key Features
  • Benefits
  • Claims
  • How to buy
  • Exclusions

Key features of Family Health Optima insurance

  • Room Rent :Capped at ₹2,000 / ₹5,000 / Single Standard A/c based on Plan SI
  • Co-pay :No co-pay if entry age < 60 yrs / 20% co-pay for ages > 60 yrs
  • Restoration Benefit: Thrice upto 100% of Base SI for plans with SI > 3 lacs
Highlights of Family Health Optima insurance This is one of the largest selling plans under the Star Health umbrella of products. The unique features of this plan include:
  • Single policy, broader coverage at an affordable premium for the entire family
  • Eligibility for Coverage
    • Adults: 18 to 65
    • Dependent children: 16 days old to 25 years (can cover upto 3 children)
  • 7 Sum Insured options - 3 lacs, 4 lacs, 5 lacs, 10 lacs, 15 lacs, 20 lacs, 25 lacs
  • With Auto Recharge option additional coverage at no additional cost
  • Automatic Restoration of Sum insured by 100% upon complete exhaustion available 3 times.
  • Free Look Period - 15 days
  • 60 days of Pre-hospitalization & 90 days of Post-hospitalization Expenses Covered on actual cost
  • Additional Sum Insuredupto 25% of Sum Insured - Max 5Lac for Two Wheeler Road Accidents
  • Health Check-up Benefit for every claim free year.
  • Domiciliary Hospitalization Expenses for treatment exceeding 3 days.
  • CoversAll Day Care procedures - Cataract with enhanced coverage limits
  • Assisted Reproduction (Infertility) Treatment Coverage - up to Rs. 2 Lac - Every block of 3 years
  • Free Medical Second Opinion

Family Health Optima Insurance Plan Benefits (All Amounts in ? INR)

3 lac 4 lac 5 lac 10 lac 15 lac 20 lac 25 lac
Policy Period
1 year 1 year 1 year 1 year 1 year 1 year 1 year
Family Definition
Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children Upto Primary Insured + Spouse + 3 children
Hospitalisation - Room Rent limit per day
Upto 5,000 Upto 5,000 Single Standard A/C Single Standard A/C Single Standard A/C Single Standard A/C Single Standard A/C
ICU / Operation Theatre Charges
Actual Actual Actual Actual Actual Actual Actual
No. of Daycare Treatments / Procedures Covered
All Daycare Procedures covered All Daycare Procedures covered All Daycare Procedures covered All Daycare Procedures covered All Daycare Procedures covered All Daycare Procedures covered All Daycare Procedures covered
Sub Limits for Treatment of Cataract as Daycare (per episode / per policy period)
25,000 / 35,000 30,000 / 45,000 40,000 / 60,000 50,000 / 75,000 50,000 / 75,000 50,000 / 75,000 50,000 / 75,000
Ambulance Charges by Road (per policy period)
Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period Upto 750 per hospitalisation and maximum of 1,500 per policy period
Air Ambulance (per policy period)
- - Upto 10% of Sum Insured Upto 10% of Sum Insured Upto 10% of Sum Insured Upto 10% of Sum Insured Upto 10% of Sum Insured
Pre Hospitalisation Expenses incurred
Upto 60 days Upto 60 days Upto 60 days Upto 60 days Upto 60 days Upto 60 days Upto 60 days
Post Hospitalisation Expenses incurred
Upto 90 days Upto 90 days Upto 90 days Upto 90 days Upto 90 days Upto 90 days Upto 90 days
Domiliciary Hospitalisation - for period exceeding 3 days
Covered Covered Covered Covered Covered Covered Covered
Organ Donor
Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000 Upto 10% of Sum Insured and maximum of 1,00,000
Free Annual Health Check Up (available after every claim free year on the policy)
750 1,000 1,500 2,000 2,500 3,000 3,500
New Born Baby Cover (provided mother is insured for 12 months without a break)
Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth Upto 10% of Sum Insured and maximum of 50,000 - Child covered from Day 16 after birth
Emergency Domestic Medical Evacuation (per Hospitalisation)
Upto 5,000 Upto 5,000 Upto 7,500 Upto 7,500 Upto 7,500 Upto 10,000 Upto 10,000
Compassionate Visit (Travel)
- - - Upto 5,000 per Hospitalisation Upto 5,000 per Hospitalisation Upto 5,000 per Hospitalisation Upto 5,000 per Hospitalisation
Repatriation of Remains
Upto 5,000 per policy period Upto 5,000 per policy period Upto 5,000 per policy period Upto 5,000 per policy period Upto 5,000 per policy period Upto 5,000 per policy period Upto 5,000 per policy period
Treatment in Preferred Network Hospitals (payable as lump sum)
Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period Upto 1% of Sum Insured subject to maximum of 5,000 per policy period
Shared Accomodation (benefit per day)
800 800 800 800 800 1,000 1,000
AYUSH Treatment
Upto 10,000 Upto 10,000 Upto 15,000 Upto 15,000 Upto 15,000 Upto 20,000 Upto 20,000
Second Medical Opinion
Covered Covered Covered Covered Covered Covered Covered
Assisted Reproduction Treatment (after a waiting period of 36 months)
- - Upto 1,00,000 Upto 2,00,000 Upto 2,00,000 Upto 2,00,000 Upto 2,00,000
Automatic Restoration of Basic Sum Insured (3 times during the policy period, 100% each time)
Covered Covered Covered Covered Covered Covered Covered
Recharge Benefit (Provided once during the policy period)
75,000 1,00,000 1,50,000 1,50,000 1,50,000 1,50,000 1,50,000
Waiting Period
30 days - for fresh proposals excluding Accidental Hospitalisation
Covered Covered Covered Covered Covered Covered Covered
24 months - for specified illness / diseases
Covered Covered Covered Covered Covered Covered Covered
48 months - for Pre Existing Diseases )
Covered Covered Covered Covered Covered Covered Covered

Claims Settlement Process for Star Health Insurance

Cashless Claim Procedure during hospitalization
Cashless Claim: a six step process
  • Step 1 - Approach the insurance desk at a network hospital. Intimation can be given either through contacting us at 1800 425 2255 / 1800 102 4477 or e-mail us at support@starhealth.in
  • Step 2 - Show your Star Health ID card for identification purpose at the hospital reception.
  • Step 3 - Submit to the hospital Pre admission investigations and Doctor’s consultation papers.
  • Step 4 - Network hospitals will verify your identity and submit duly filled pre - authorization form with Star Health.
  • Step 5 - Our doctors verifies all the submitted documents before processing the claim as per terms and conditions. An assigned field doctor may visit the patient at the hospital if required.
  • Step 6 - After discharge, the hospital will send the claim documents to the company and the authorized amount will be settled directly to the hospital.
(Note: Non-Payable items would be at the insured's own cost)
a) In case of planned hospitalization:
  • Please contact the toll-free help line: 1800 425 2255 / 1800 102 4477
  • The hospital will send the duly filled pre-authorization from through hospital portal (or) at the below number (or) Email ID
    • Call : Toll-free FAX: 1800 425 5522 (or)
    • Call : Non Toll-free FAX: 044 -28302200
    • Email : cashless.network@starhealth.in
  • Please carry your ID card.
b) Procedures to be followed in case of emergency hospitalization: In case of Emergency like accident or sudden bout of illness may that requires immediate admission to the hospital
  • Upon receiving intimation from the insured/insured’s attender, they are contacted by the network hospital
  • Customer Care will verify the validity and coverage of the policy
  • A field visit doctor is deputed to visit the patient at the hospital if required.
  • Our medical team will process the cashless request for the insured person subject to policy terms and conditions.
c) Cashless claim authorization process
  • Upon receiving intimation from the insured/insured’s attender, they are contacted by the network hospital.
  • Customer Care will verify the validity and coverage of the policy
  • A field visit doctor is deputed to visit the patient at the hospital if required
  • Our medical team will process the cashless request for the insured person subject to policy terms and conditions.
d) Documents required for cashless claim submission by Hospital
  • Health card
  • Doctor's consultation papers
  • Discharge summary
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  • KYC documents of the insured if claimed amount exceed Rs.1, 00,000/-
(Note: Documents other than the Health Card should be submitted in original)
When the Insured gives prior intimation about the treatment and the insured pays the expenses himself with the hospital and then claims for a reimbursement of those expenses within 15 days from the date of discharge.

Reimbursement Claims Procedure following hospitalization

Procedure for Reimbursement of Claim
  • All claims need to be intimated within 24 hours of hospitalization. Reimbursement facility is available at network hospitals as well as at non-network hospitals
  • Avail treatment, settle all bills and file a claim for reimbursement.
  • Submit the claim documents to the company within 15 days from the date of discharge.
  • To receive the claim form, cite your policy number and intimate Star Health about hospitalization.
Reimbursement Claim Procedure
  • Upon discharge, pay all hospital bills and collect all original documents of treatment undergone and expenses incurred.
  • Claim form has to be filled in and along with, all the relevant original documents have to be submitted at the nearest Star Office
  • We settle the claim in subject to policy terms and conditions.
  • Non-Payable items would be at the insured's own cost.
Documents required for reimbursement claim submission
  • Copy of Health card
  • Duly filled claim form
  • Pre admission investigations and Doctor's consultation papers
  • Discharge summary from hospital in Original.
  • Investigation reports (e.g. X-ray, scans, blood report, etc.)
  • Pharmacy invoices supported by respective prescriptions
  • Case receipts from hospital, chemist
  • In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  • Copy of the KYC documents - NEFT details, Contact number and E-mail ID

How can one Buy a Star Health Insurance cover?

Today in the India market, it is not very difficult to purchase an appropriate Health insurance plan, on the contrary it is relatively simple if one follows the defined steps below:
  • Step 1- Visit a product comparison website like eindiainsuranceto review and compare policy benefits, coverage and premium details online
  • Step 2 - Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy
  • Step 3 - Fill the online Star Health Insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate
  • Step 4 – Star Health will then process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy medical examination at Star Health’s network diagnostic centers.
  • Step 5 - Depending on Star Health team’s evaluation, if the proposal is accepted, then they will issue the policy subject to receipt of annual single premium as published on the website and remitted online through the payment gateway
  • Step 6 - Please note that the proposer will have to pay the necessary amount for undergoing the specified medical examination and such tests shall be valid for a maximum period of 30days only…however, if the policy is issued we will refund you 100% of the cost of the pre-policy medical examination
  • Step 7 - The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form

Exclusions under the Star Health Policy

Some of the major exclusions under the policy are listed below, kindly go through the entire list of exclusion in the policy kit which accompanies the insurance policy:
  • Congenital External Condition / Defects / Anomalies (except to the extent provided under Section specific to a New Born infant).
  • Intentional self injury.
  • Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing.
  • Venereal Disease and Sexually Transmitted Diseases,
  • Injury/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, warlike operations (whether war be declared or not)
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials
  • Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity (except to the extent provided as per “Coverage” of the opted policy variant)
  • Expenses incurred on High Intensity Focused Ultra Sound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain Stimulation, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low level laser therapy, Photodynamic therapy and such other therapies similar to those mentioned under this exclusion
  • Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home. Admission primarily for diagnostic purpose with no positive existence of sickness / disease / ailment / injury and no further treatment is indicated
  • Unconventional, Untested, Unproven, Experimental therapies
  • Stem cell Therapy, Autologous derived Stromal vascular fraction, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy
  • All types of Cosmetic, Aesthetic treatment of any description, all treatment for Priapism and erectile dysfunctions, Change of Sex
  • Plastic surgery (other than as necessitated due to an accident or as a part of any illness)
  • Inoculation or Vaccination (except for post–bite treatment and for medical treatment for therapeutic reasons)
  • Dental treatment or surgery (in excess of what is specifically provided) unless necessitated due to accidental injuries and requiring hospitalization
  • Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these (other than ectopic pregnancy and to the extent covered under polic variant)
  • Medical and / or surgical treatment of Sleep apnea, treatment for genetic and endocrine disorders. Expenses incurred on Lasik Laser or other procedures Refractive Error Correction and its complications, all treatment for disorders of eye requiring intra-vitreal injections
  • Cochlear implants and procedure related hospitalization expenses
  • Cost of spectacles and contact lens (in excess of what is specifically provided), hearing aids, Cochlear implants and procedures, walkers and crutches, wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar aids.

Description of the benefits under the Star Health plans

Please note that all benefits listed below may not be part of all plans offered by Star Health in the market, please go through the benefit coverage on this EIndia website to be acquainted with the coverages under each plan in more detail.
  • Hospitalisation Expenses include
    • Room, Boarding, Nursing Expenses all inclusive as provided by the Hospital / Nursing Home
    • Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees
    • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X-ray, diagnostic imaging modalities, dialysis, chemotherapy, radiotherapy, cost of pacemaker, stent and such other similar expenses.Expenses on Hospitalization for a minimum period of 24 hours only are admissible. However this time limit will not apply for the day care treatments / procedures, where treatment is taken in the Hospital / Nursing Home and the Insured is discharged on the same day.
  • Emergency Ambulance Charges These charges are paid per hospitalization with an overall limitper policy period for transportation of the insured person by private ambulance service when this is needed for medical reasons to go to hospital.
  • Air Ambulance Charges This is paid towardsimmediate and rapid ambulance transportation to the hospital/medical centre that ground transportation cannot provide in the case of life threatening emergency health condition/s of the insured person.
  • PreHospitalization Expenses Medical expenses incurred for a period not exceeding 30/60 days prior to the date of hospitalization, for the disease/illness, injury sustained following an admissible claim for hospitalization under the policy.
  • Post Hospitalization Expenses Medical Expenses incurred for a period of 60/90 days from the date of discharge from the hospital towards Consultant fees, Diagnostic charges, Medicines and Drugs wherever recommended by the Hospital / Medical Practitioner, where the treatment was taken, following hospitalization.
  • Domiciliary Hospitalization Coverage for medical treatment for a period exceeding three days, for an illness/disease/injury, which in the normal course, would require care and treatment at a Hospital but, on the advice of the attending Medical Practitioner, is taken whilst con?ned at home.
  • Organ Donor Expenses Expenses incurred for organ transplantation where the insured person is the recipient are payable provided the claim for transplantation is payable and subject to the availability of the sum insured. Donor screening expenses and postdonation complications of the donor are not payable.
  • Cost of Health Check-up Expenses incurred towards cost of health check-up up to the limits mentioned in the table given below for every claim free year provided the health checkup is done at network hospitals and the policy is in force. Payment under this bene?t does not form part of the sum insured and will not impact the Bonus. If a claim is made by any of the insured persons, the health check up bene?ts will not be available under the policy.
  • Hospitalization expenses for treatment of New Born Baby The coverage for New Born Baby starts from the 16 day after its birth till the expiry date of the policy and is subject to a limit of 10% of the Sum Insured or Rupees Fifty thousand, whichever is less, subject to the availability of the sum insured, provided the mother is insured under the policy for a continuous period of 12 months without break.
  • Emergency Domestic Medical Evacuation Subject to limits, the Company will reimburse reasonable and necessary expenses incurred towards transportation of the insured person from the hospital where the insured person is currently undergoing treatment to another hospital for further treatment provided
  • Compassionate Travel In the event of the insured person being hospitalized for a life threatening emergency at a place away from his usual place of residence as recorded in the policy, the Company will reimburse the transportation expenses by air incurred upto ?5,000/- for one immediate family memberfor travel towards the place where hospital is located, provided the claim for hospitalization is admissible under the policy.
  • Repatriation of Mortal Remains The Company shall reimburse up to ?5,000/- per policy period towards the cost of repatriation of mortal remains of the insured person (including the cost of embalming and cof?n charges) to the residence of the Insured as recorded in the policy.
  • Shared Accommodation If the Insured person occupies, a shared accommodation during in-patient hospitalization, then amount as per policy terms and conditions will be payable for each continuous and completed period of 24 hours of stay in such shared accommodation.
  • AYUSH Treatment Expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in a Government Hospital or in any institute recognized by the government and/or accredited by the Quality Council of India/National Accreditation Board on Health is payable up to the plan limits.
  • Second Medical Opinion The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company's network of Medical Practitioners. All the medical records provided by the Insured Person will be submitted to the Doctor chosen by him/her online and the medical opinion will be made available directly to the Insured by the Doctor.
  • Assisted Reproduction Treatment The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility.
  • Additional Sum Insured for Road Traffic Accident (RTA) If the insured person meets with a Road Traf?c Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of ?5,00,000/-
  • Bonus In respect of a claim free year of Insurance, for the Basic Sum Insured options Rs.3,00,000/- and above, the insured would be entitled to bene?t of bonus of 25% of the expiring Basic Sum Insured in the second year and additional 10% of the expiring Basic sum Insured for the subsequent years. The maximum allowable bonus shall not exceed 100% .
  • Automatic Restoration of Basic Sum Insured There shall be automatic restoration of the Basic Sum Insured immediately upon exhaustion of the limit of coverage, during the policy period.Such Automatic Restoration is available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one.

Star health insurance FAQ's

In a cashless claim/hospitalisation, the insured/hospital intimates us regarding the hospitalization and submits a pre-authorization request. On authorization, the claim is directly settled with the network hospital and the insured is not required to pay any charges except for expenses not covered under the policy. Cashless facility can only be availed at a Star Health Insurance network hospital.

A health card is a card that comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital.

Yes. The scope of Star health insurance coverage shall be restricted to treatment taken in hospitals in India during the policy period.

Brochure

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Proposal form

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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