Star Health Family Health Optima Insurance, Star Family Health Optima

Star Health Optima insurance quotes

Coverage type
Coverage amount
Date of Birth
  or age      years
Policy Duration
Start Date
End Date

Key Features of Star family health optima insurance policy

  • Policy coverage : Rs. 3,00,000 to Rs. 25,00,000.
  • Eligibility: Policy is available for age between 18 years and 65 years of age
  • Renewal: Policy can be renewed up to 65 years of age
  • 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.

Star Health Insurance Review

Sum Insured
1 lac − 100 lacs options available
Tenure Options
1, 2, 3 years options available
Claims Incurred Ratio *
63.00%
Claims Settlement Ratio **
81.62%
List of Network Hospitals
9,900+ hospitals
Number of Policies issued *
3,734,365
Number of Lives Covered *
11,617,000
Maximum Family Floater Coverage
Self, Spouse + 3 dependent children
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

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Star Family Health Optima insurance plan deatils, Star health insurance Family Health Optima

  • 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, Star family health optima insurance plan details (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 family health optima insurance policy

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 family health optima insurance plan

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.
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