Star Health HealthGain Insurance

Key features of Health Gain insurance

• Room Rent : Upto 1% of Sum Insured per day
• Co-pay : No co-pay if entry age < 60 yrs / 20% co-pay for ages > 60 yrs
• Restoration Benefit : NIL restoration benefit

Highlights of Health Gain insurance

• It covers both Outpatient & inpatient expenses
• Premium options: Rs.15000, Rs.20,000, Rs.25,000, and Rs.30,000 (applicable GST extra)
• Sum Insured options (for inpatient hospitalization): Rs.1 lakh, Rs.2 lakhs, Rs.3 lakhs, Rs.4 lakhs and Rs.5 lakhs
• Plan is available for both Individual and Floater
• Policy term: One year

Benefits of Health Gain Plan

Hospitalisation Cover

• Hospitalization Cover : Room, Boarding, Nursing Expenses upto 1% of sum insured per day. A proportionate deduction shall happen in hospitalization expenses if room rent limit is exceeded.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs.
• Ambulance charges up to Rs.750/- per hospitalization and Rs.1500/- per policy period.
• Pre-Hospitalization expenses up to 30 days prior to admission in the hospital.
• Post-hospitalization expenses up to 60 days from the date of discharge.
• Expenses incurred for all day-care procedures.
• Treatment for Cataract is subject to limits mentioned in the policy.
• Co-Payment: Co-payment of 20% of each and every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is above 60 years.

Waiting periods

• 30 days (Not applicable for Accidents)
• 24 months for specified illness/ diseases.
• 48 months for treatment of Pre existing diseases

Out Patient Benefits

• Premium option and Sum Insured Option shall be deciding outpatient benefit level. Medical expenses incurred in networked facility shall be reimbursed. There is no waiting period or co-pay applicable. Unutilized benefit in a policy year can be carried forward to immediately succeeding renewal year. No further carry over is permitted.

General terms of Star health insurance plans

Tax Benefit 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 is available for reviewing the policy terms and conditions. In case insured is not satisfied he can seek cancellation of the policy and in such event the Company will allow refund of premium after adjusting the cost of pre- acceptance of medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation. Free look cancellation is not applicable at the time of renewal.

Renewal Lifelong renewal

Grace Period for renewal 30 days from date of expiry of policy.

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.