Star Health Assure Plan

Let’s take a closer look at the plan!

Star Health Assure is a health insurance plan provided by Star Health and Allied Insurance Company Limited. Its main purpose is to offer individuals and families crucial financial protection against ever-rising healthcare costs. By choosing the Star Health Assure Plan, you can have peace of mind knowing that you are well-covered for a wide range of medical expenses, helping you avoid any financial difficulties that may arise.

The Star Health Assure Plan offers a range of appealing features, add-ons, and discounts that can be tailored to suit your individual healthcare requirements.

Are You Eligible?

• Family Floater Policy
  • Minimum Entry Age
    • Adults: 18 years
    • Dependent Children: 16 days
       
  • Maximum Entry Age
    • Adults: 75 years
    • Dependent Children: 17 years

Note: When dependent children turn 18 years old during the renewal process, they will be considered adults. They can still be covered under the floater plan until they get married.

• Individual Policy
  • Minimum Entry Age: 91 Days
  • Maximum Entry Age: 75 years
     

An Overview Of The Plan’s Benefits & Limits

Star Health Assure Plan provides coverage for inpatient hospitalisation expenses. These expenses arise when you are admitted to a hospital for more than 24 hours and include charges for room boarding and nursing services, fees for medical practitioners, the cost of prescribed medications and drugs, charges for ICU facilities, and any other associated expenses.

Besides that, here is a list of other expenses that are covered in the Star Health Assure Plan:

• Pre & Post Hospitalisation Coverage
  You might have to undergo some tests before or after you get admitted to the hospital. Worry not! Star Health Assure Plan has got you covered. It covers these expenses up to a certain amount for a reasonable time - 60 days before you are admitted into the hospital and 180 days after you’re discharged. It's important to know that the plan will only cover these costs if they are related to the medical condition that led to your hospitalisation and your claim is approved under inpatient hospitalisation coverage.

• Daycare Treatment Coverage
  A daycare treatment refers to a medical procedure or surgery that necessitated a prolonged hospital stay years back, but can now be completed within 24 hours due to advancements in medical technology. The Star Health Assure Plan provides coverage for all daycare procedures, without any limit. This means that all expenses related to daycare treatments are covered up to the sum insured.

• Domiciliary treatment coverage
  Domiciliary treatments are medical treatments for illnesses or injuries that necessitate immediate attention in a hospital but are administered at home if you are too sick to move to the hospital or if there is an unavailability of hospital beds in the nearby area. The Star Health Assure Plan offers coverage for domiciliary treatment expenses up to the sum insured.

• Organ Donor Coverage
  The Star Health Assure Plan also covers the donor’s inpatient expenses incurred in the event of an organ transplantation surgery up to the sum insured - where you are the organ recipient.

• Modern Treatment Coverage
  The field of healthcare is experiencing rapid evolution due to technological advancements. As a result, modern treatments that were once deemed impossible are now becoming a reality. These treatments are aimed at curing ailments that were previously considered incurable. The Star Health Assure Plan is specifically designed to keep up with these advancements by providing coverage for the expenses associated with modern treatments up to the sum insured.

• Non-Medical Expenses Coverage
  The Star Health Assure Plan offers coverage not only for medical expenses but also for non-medical expenses. These non-medical expenses include the cost of essential consumables like gloves, nebulization kits, oxygen masks, and other items required for treatment. These consumables can often be quite costly and can accumulate to a substantial amount. Fortunately, this plan provides coverage for such expenses up to the sum insured, thereby easing your financial strain.

• Room Rent Limit
  The maximum amount that your health insurance policy will cover for the room you are hospitalised in is referred to as the room rent limit. By choosing a room that falls within the limit, you can avoid any additional expenses. However, if you decide to select an expensive room than what they are eligible for, a proportionate deduction will apply. This means you will be accountable for paying a proportionate share of the entire bill, rather than covering the difference in room rent.  In Star Health Assure, the room rent limit depends on the sum insured you choose -
  • Rs 5 Lakhs - Up to 1% of the sum insured each day
  • Rs 10/15/20/25 Lakhs - Any room (except Suite or above)
  • Rs 50/75/100/200 Lakhs - Any room

• Cumulative Bonus
  The Cumulative Bonus is a reward provided by the insurance company if you don't file any claims during a policy year. Under the Star Health Assure Plan, you are entitled to a bonus amounting to 25% of the sum insured if you make no claims during a policy year. The maximum bonus that can be accumulated under this plan is 100% of the sum insured. However, it's important to note that if a claim is made during the policy year, the accumulated bonus will decrease.

• Restoration Benefit
  The Restoration Benefit is a feature in the Star Health Assure Plan that restores the sum insured once it has been depleted within a policy year. This benefit is applicable to related and unrelated illnesses. It will activate when both the sum insured and no claim bonus are partially exhausted. The refill benefit can be used unlimited times in a policy year and is applicable for subsequent claims only.

Noteworthy Features You Should Be Aware Of

• Mid-term Inclusion Facility
  With the Star Health Assure plan, you have the flexibility to include your newly wedded spouse, newborn baby, or legally adopted child in the middle of the policy year by paying a proportionate premium. To ensure their coverage, you will have to notify the insurer about the marriage, birth, or adoption within 45 days from the respective event date.
• The Star Health Assure plan offers coverage for childbirth expenses, including normal delivery and caesarean section. The benefit includes both prenatal and postnatal expenses up to 10% of the sum insured. Additionally, the Star Health Assure Plan covers expenses for newborn babies from day 1, up to specific limits each year. Please note that certain terms and conditions are applicable to this benefit.
• Star Wellness Program
  The Star Wellness Program aims to motivate and reward you for choosing a healthy lifestyle. The Star Health Assure Plan encourages you to adopt healthier habits that can improve your overall well-being. Participate in wellness activities like chronic condition management program, weight management program, preventive risk assessment, etc. and earn reward points that can be used to get discounts on your premiums.

• Limits on surgeries/treatments
  If your insurer has not specifically excluded coverage for any particular illness, you can make a claim for the full amount up to the sum insured, regardless of the specific disease you are dealing with. Star Health Assure Plan, provides coverage for treatments/surgeries like cataract treatment, joint replacement surgery, etc. up to the sum insured without imposing any sub-limits.

Star Health Assure Plan: Waiting Periods & Exclusions

Understanding Waiting Periods

Certain illnesses and diseases may not be covered for a specific period of time right after buying a health insurance policy. This timeframe is known as the waiting period. Once this waiting period is served, you can make claims for these specific conditions.

Here are some of the types of waiting periods -

• Initial waiting period
  An initial waiting period of 30 days applies for all medical conditions. However, this waiting period does not apply to accidents, allowing immediate claims in such cases.
   
• Waiting period for pre-existing diseases
  A pre-existing disease refers to any medical condition or illness that you have experienced within the last 48 months prior to applying for a health insurance policy. In the case of the Star Health Assure Plan, there is a waiting period of 36 months for pre-existing diseases. During this period, the policy will not provide coverage for any expenses related to your pre-existing diseases.
   
• Waiting period for specific diseases
  Insurers maintain a designated list of medical conditions or illnesses that are subject to a waiting period, apart from any pre-existing conditions, irrespective of whether you have experienced those diseases before or not. This waiting period is solely determined by the insurer and is not influenced by your present health status. The Star Health Assure Plan imposes a waiting period of 24 months for specific diseases.

What The Plan Does Not Cover?

Exclusions are situations that are not covered under your health insurance policy. Some of the types of exclusions include -    

1. Standard permanent exclusions:
   The Insurance Regulatory and Development Authority of India (IRDAI) has implemented a series of 'standard permanent exclusions' that must be adhered to by all insurance companies. Among these exclusions are -

• Obesity/weight control: Treatments or surgeries for weight control or obesity.
• Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities like mountaineering, surfing, paragliding, etc. as a professional.
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
• Investigation and evaluation: Hospital admissions for observation or monitoring purposes.
• Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, without any active treatment.
• Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
• Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
• Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
• Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that haven’t been prescribed by a medical practitioner.
• Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
• Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
• Maternity expenses: Pre/post-natal costs, expenses related to childbirth, and more.
• Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
• Expenses related to birth control, sterility, and infertility: Treatments like contraception, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.

2. Additional permanent exclusions
   In addition to the standard permanent exclusions mentioned above, insurance companies impose additional exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers deem risky to cover, they may permanently exclude them from your policy.
   It is important to note that insurers are bound by the list of illnesses provided by the Insurance Regulatory and Development Authority of India (IRDAI) when applying permanent exclusions. They cannot apply permanent exclusions to illnesses or diseases that are outside of this list.
    
3. Non-standard exclusions (Specific exclusions)
   There are specific exclusions that may be imposed by the insurer other than the standard permanent exclusions outlined by the IRDAI. These exclusions may differ among insurance providers and are subject to the terms and conditions of your policy. Here are some of the specific exclusions stipulated in the Star Health Assure Plan -

• Circumcision unless it is required to treat a disease or injury.
• Treatment for external birth diseases, defects, or anomalies.
• Convalescence, general weakness, feeling run-down, and nutritional deficiencies.
• Treatment for intentional self-inflicted injuries.
• Injuries or diseases caused by war, invasion, acts of foreign enemies, and warlike operations.
• Injuries or illnesses caused by nuclear weapons or materials.
• Different types of therapies, including hyperbaric oxygen therapy, low-level laser therapy, photodynamic therapy, and more.
• Therapies that have not been thoroughly tested, are unconventional, or experimental.
• Biological treatments, unless they are administered during a hospital stay as an inpatient.
• Costs related to vaccinations and inoculations, except for treatment after an animal bite or for medical reasons.

A Quick Recap Of The Benefits & Limits

The OG Reading Material for Your Reference

• Brochure: https://web.starhealth.in/sites/default/files/brochure/StarHealthAssureInsurancePolicy-Brochure.pdf
   
• Policy Wording: https://web.starhealth.in/sites/default/files/policy-clauses/StarHealthAssureInsurancePolicy-Policy.pdf
   

FAQs

1. What is the maximum coverage available under the Star Health Assure Plan?

With the Star Health Assure Plan, you can opt for a health cover of up to Rs 2 Crore.

2. Are there room rent restrictions under the plan?

Yes, the Star Health Assure Plan does have room rent restrictions. The specific limit depends on the sum insured that you opt for -

• • Rs 5 Lakhs - Up to 1% of the sum insured each day
  • Rs 10/15/20/25 Lakhs - Any room (except Suite or above)
  • Rs 50/75/100/200 Lakhs - Any room

3. Are outpatient department (OPD) expenses included in the coverage provided by the Star Health Assure Plan?

Yes, OPD costs associated with dental and ophthalmic treatment are covered under Star Health Assure Plan.

4. Is AYUSH treatment covered by Star Health Assure?

Certainly! Star Health Assure provides coverage for AYUSH treatments such as Ayurveda, Unani, Siddha, and Homoeopathy.

5. Is it possible to add family members to the Star Health Assure policy during the mid-term?

The policy allows for the inclusion of the recently married spouse, newborn baby, and legally adopted child by paying an extra premium. Please note that the waiting periods will apply from the date when these new members are added to the policy.