Star Health Cardiac Care Insurance

Star Cardiac Care insurance plan deatils

• Key FeaturesBenefitsGeneral termsClaimsHow to buyExclusions
• Key Features

  Key features of Cardiac Care health insurance

  • Room Rent :Capped at ₹5,000 per day
  • Co-pay :NIL for insureds 60 yrs/ 10% co-pay for ages 60 yrs
  • Restoration Benefit: NIL Restoration Benefit

  Highlights of Cardiac Care health Insurance

  • Cardiac cover

  • This policy is specially designed for persons who have existing Cardiac diseases

  • Flexible cover

  • Hospitalization expenses for accident and non cardiac treatments also covered

  • Out patient cover

  • Cover for Out Patient Benefit is available

  • Accident cover

  • Personal Accident Death Cover at no additional cost

  • Silver plan

  • Surgical and Interventional management is covered under Silver plan

  • Gold plan

  • In addition to all the above benefits Gold plan also covers Medical Management for Cardiac Treatments
• Benefits

  Benefits of Cardiac Care health Plan (All Amounts in ₹ INR)

  Benefits	Silver Plan		Gold Plan
  Section Coverages / Medical Screening	No Pre Acceptance Medical Screening but Medical Records to be compulsorily submitted
  Section 1	Hospitalization cover Protects the insured for in patient hospitalisation expenses for a minimum of 24 hrs. These expenses include room, nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Oxygen, Blood,Operation Theatre, Diagnostics, imaging modalities , Cost of Medicines and Drugs. Ambulance charges for emergency transportation to hospital as per specified limits. Pre-Hospitalization expenses up to 30 days prior to admission in the hospital. Post-hospitalisation expenses incurred up to 7% of the hospitalization expenses subject to a maximum of Rs.5,000/- per hospitalization All Day-care treatments covered Pre-Existing Diseases / Illness are covered after 48 months of continuous coverage Cataract Sublimits : Expenses for treatment of Cataract are payable up to Rs.20,000/- per hospitalization and Rs.30,000/- for the entire policy period. Waiting period: (Applicable for both Plans) 30 days (Not applicable for Accidents) 24 months for specified illness/ diseases. 48 months for treatment of Pre existing diseases
  Section 2	Available for Cardiac Ailments & Complications - Covers only Surgical/Interventional Management		Available for Cardiac Ailments & Complications - Covers Surgical/Interventional and Medical Management
  Cardiac Section	After a waiting period of 90 days, this policy covers treatments relating to Cardiac diseases. This waiting period will not apply for renewals.
  Co Payments	10% Co-payment applicable for all insureds above 60 years old and making a claim under Section 1
  Section Coverages / Medical Screening	No Pre Acceptance Medical Screening but Medical Records to be compulsorily submitted
  Section 3	Out-Patient Expenses Expenses reasonably and necessarily incurred at any Networked Facility in India herein defined as an Out-patient Treatment, provided policy is in force. The limit of benefit under this Section is Rs.500/- per event subject to a maximum of Rs.1500/- per policy period. This benefit forms part of the Sum Insured.
  Section 4	Personal Accident - Accidental Death Benefit
  Maximum Sum Insured	3,00,000	4,00,000	3,00,000	4,00,000
  Policy Period	1 year
  Family Definition	Individual Plan
  Hospitalisation - Room Rent, Boarding and Nursing Expenses limit per day	2% of Sum Insured subject to a maximumof 5,000 per day
  Hospitalisation Expenses - Professionals Fees, Anaesthesia , Blood, Operation Theatre, Surgical Appliances, X Rays, Stents etc	Covered as Actuals
  No of Daycare Treatments / Procedures Covered	All 405 Day Care Procedures Covered
  Sub Limits for Treatment of Cataract as Daycare (per episode / per policy period)	Expenses related to treatment of Cataract is limited to 20,000 per eye and 30,000 per policy period
  Emergency Ambulance Charges by Road (per policy period)	Upto 750 per hospitalisation subject to a maximum of 1,500 per policy period
  Coverage for Claims related to Cardio Vascular System	Expenses incurred relating as an Inpatient in repsect of all Cardica Related complications necessitating Surgery / Intervention
  Pre Hospitalisation Expenses incurred	Upto 30 days
  Post Hospitalisation Expenses incurred	Upto 60 days - Upto 7% of Hospitalisation Expenses *** subject to a maximum of 5,000
  Outpatient (OPD) Expenses like Medical Consultation, Diagnostics, Medicines and Durgs	Upto 500 per event subject to a maximum of 1,500 per policy period (subject to treatment beinv availed in a Network Facility
  Personal Accident Cover	Upto 100% of Sum Insured subject to the accident resulting in Death within 12 calendar months
  Waiting Period	Section 1 - Waiting Period of 30 days for any disease ; 24 months waiting period for Specified Illness/Disease / Treatment; 48 months for PED Section 2 - Waiting Period of 90 days for any disease

• General terms

  General terms of Star health insurance plans

  • Tax Benefits:Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.
  • Free Look Period: A free look period of 15 days from the date of receipt of the policy by the insured is available to the insured to review the terms and conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and in such an event the Company may allow refund of premium paid after adjusting the cost of pre-medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Free look Period is not applicable at the time of renewal of the policy
  • Renewal:Lifelong renewal
  • Grace Period for renewal:30 days from date of expiry of policy. NOTE: Renewal premium, terms and conditions are subject to change with prior approval from IRDAI.
    Revision of Sum Insured: Option to Reduce or enhance sum insured is permissible at the time of renewal subject to approval of the Company.
• Claims

  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 to buy

  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

  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.