Star Health Super Surplus Insurance

Key features of Individual Super Surplus health insurance

• Room Rent : At ₹4,000 per day for Silver / Single A/c Standard Room for Gold
• Co-pay : NIL for Silver & Gold < 60 yrs/ 10% co-pay for ages > 60 yrs in Gold plan
• Restoration Benefit: NIL Restoration Benefit

Benefits of Super Surplus Insurance Policy - Individual Basis

Benefits	Silver Plan	Gold Plan
Sum Insured	Sum Insured on Individual Basis	Sum Insured on Individual Basis
In-Patient Hospitalization Expenses	Room, Boarding and Nursing expenses subject to a maximum of Rs.4,000/- per day Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees. Anesthesia, Blood, Oxygen, and Operation Theatre charges, Cost of Pacemakers.	Room (Single Standard A/C Room), Boarding and Nursing expenses Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees. Anesthesia, Blood, Oxygen, and Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials, X-ray and Cost of Pacemakers.
Pre and Post Hospitalization	30 days and 60 days	60 days and 90 days
Waiting period for Specific diseases	24 months	12 months
Claims & Renewals	Deductible applied for each and every claim	The Proposer can opt at the beginning of 6th year before renewal of this policy or later during any successive renewal , for an Indemnity Health Insurance policy without defined limit offered by the Company with continuity of benefits for the average sum insured of immediately preceding 5 years period subject to the following All the Insured Persons are insured with the Company under this policy before the age of 50 years and have been continuously renewed without any break No claim has been made during the immediately preceding 5 years. The proposer should exercise this option for all the insured persons. This policy shall not be further renewed if the option is exercised
Delivery Expenses	Expenses for a Delivery including Delivery by Caesarean section (including pre-natal, post-natal expenses and lawful medical termination of pregnancy) up-to Rs.50,000/- per policy period, subject to a maximum of 2 deliveries in the entire life time of the insured person are payable while the policy is in force.
Organ Donor Expenses	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 post-donation complications of the donor are not payable.
Recharge Benefit	If the sum insured under the policy is exhausted/ exceeded during the policy period, additional indemnity up to the limits
Emergency ambulance	Emergency ambulance charges for transporting the insured patient to the hospital up to Rs.3,000/- per hospitalization
Air Ambulance cover	Up to 10% of the sum insured per policy period for Sum Insured of Rs.7 lacs and above.
Co-pay	Co-pay of 10% of each and every where the age at entry is above 60 years

Key features of Floater Super Surplus health insurance

• Room Rent : At ₹4,000 per day for Silver / Single A/c Standard Room for Gold
• Co-pay : NIL for Silver & Gold < 60 yrs/ 10% co-pay for ages >60 yrs in Gold plan
• Restoration Benefit: NIL Restoration Benefit

Benefits of Super Surplus insurance policy - Family Floater Basis

Benefits	Silver Plan	Gold Plan
Sum Insured	Sum Insured on Floater Basis	Sum Insured on Floater Basis
In-Patient Hospitalization Expenses	Room, Boarding and Nursing expenses subject to a maximum of Rs.4,000/- per day Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees. Anesthesia, Blood, Oxygen, and Operation Theatre charges, Cost of Pacemakers.	Room (Single Standard A/C Room), Boarding and Nursing expenses Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees. Anesthesia, Blood, Oxygen, and Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials, X-ray and Cost of Pacemakers.
Pre and Post Hospitalization	30 days and 60 days	60 days and 90 days
Waiting period for Specific diseases	24 months	12 months
Pre-Existing Diseases	Covered after 36 months of continuous Insurance without break with any Non Life Indian Insurance Company.	Pre Existing Diseases as defined in the policy until 12 consecutive months of continuous coverage have elapsed; since inception of the first policy with any Indian Insurer.
Claims & Renewals	Deductible applied for each and every claim	The Proposer can opt at the beginning of 6th year before renewal of this policy or later during any successive renewal , for an Indemnity Health Insurance policy without defined limit offered by the Company with continuity of benefits for the average sum insured of immediately preceding 5 years period subject to the following All the Insured Persons are insured with the Company under this policy before the age of 50 years and have been continuously renewed without any break No claim has been made during the immediately preceding 5 years. The proposer should exercise this option for all the insured persons. This policy shall not be further renewed if the option is exercised
Delivery Expenses	Expenses for a Delivery including Delivery by Caesarean section (including pre-natal, post-natal expenses and lawful medical termination of pregnancy) up-to Rs.50,000/- per policy period, subject to a maximum of 2 deliveries in the entire life time of the insured person are payable while the policy is in force.
Organ Donor Expenses	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 post-donation complications of the donor are not payable.
Recharge Benefit	If the sum insured under the policy is exhausted/ exceeded during the policy period, additional indemnity up to the limits
Emergency ambulance	Emergency ambulance charges for transporting the insured patient to the hospital up to Rs.3,000/- per hospitalization
Air Ambulance cover	Up to 10% of the sum insured per policy period for Sum Insured of Rs.10 lacs and above.
Co-pay	Co-pay of 10% of each and every where the age at entry is above 60 years

Highlights of Super Surplus insurance

• No pre-acceptance medical screening.
• Maternity Expenses covered upto specified limits.
• Air Ambulance facility covered up to 10% of the sum insured.
• Plan is available for both Individual and Floater
• The policy offers two plans - Silver Plan and Gold Plan.

General terms of Star health insurance plans

• No pre-acceptance medical screening.
• Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.
• A free look period of 15 days from the date of receipt of the policy is available for reviewing the policy terms and conditions (Not Applicable for Renewals).

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.