Star Health Comprehensive Policy

Star Health Comprehensive Policy

Additional information

Star Comprehensive Insurance Policy

Complete healthcare protection for your entire family on individual and floater basis.

No Capping on room rent

Treatment at Private Single A/c Room

Care beyond Cover

Disease management programme for healthy life through Wellness. Attractive premium discounts

Extra cover

Air Ambulance assistance, second medical opinion, Domiciliary hospitalisation, Organ donor expenses, Ayush treatment are covered

Health Checkup

Cost of Health checkup for every claim free years

Cover for maternity

Cover for maternity (normal and Caesarean delivery) and new born baby

Automatic restoration

Automatic restoration by 100% for subsequent hospitalisation even for illness/disease for which claim/s was/were made

Cover on OPD basis

Dental/Ophthalmic cover on OPD basis

Personal accident cover

Personal accident cover against Death and Permanent total disablement (equal to the Health Insurance cover) at no additional cost.

Renewal Benefits

100% Increase in Sum Insured upon a claim free renewal

Buy Back Pre-existing disease

Reduction in waiting period for Pre existing diseases

Covers complex medical procedures

Covers medical expenses incurred on Bariatric surgical procedures and its complications.

Mid term Inclusion

Mid term Inclusion of newly married/wedded spouse and new born baby is permissible on paying additional premium

Section 1: Hospitalization

  • Hospitalization cover protects the insured for in patient hospitalization expenses for a minimum period of 24 hrs. These expenses include room rent (Private Single A/C room), nursing and boarding charges, Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees, Cost of Medicines and Drugs.
  • Road Ambulance charges for emergency transportation to hospital as per specified limits.
  • Air Ambulance Benefit expenses up to Rs.2,50,000/- per hospitalization, not exceeding Rs.5,00,000/- per policy period.
  • Pre hospitalization expenses up to 60 days prior to admission in the hospital
  • Post hospitalization expenses up to 90 days after discharge from the hospital
  • Outpatient consultation (other than dental and ophthal) expenses up to limits mentioned in the table of benefits
  • Coverage for Domiciliary hospitalization for a period exceeding three days.

Section 2: Delivery and New born

  • Expenses incurred as in-patient for Delivery including Delivery by Caesarean section
  • Treatment of the New Born
  • Vaccination expenses for the new born baby are payable up to the limits mentioned in the schedule of Benefits, until the new born baby completes one year of age and is added in the policy on renewal.

Section 3: Out-patient Dental and Ophthalmic Treatment

  • Dental / Ophthalmic treatments as an out-patient – once in a block of every three years.

Section 4: Organ Donor Expenses

  • Expenses incurred for organ transplantation from the Donor to the Recipient Insured Person are payable provided the claim for transplantation is payable.

Section 5: Hospital Cash

  • Hospital cash benefit for each completed day of hospitalization for maximum of 7 days per occurrence is payable.

Section 6: Health Check up

  • Cost of Health checkup is payable after every claim free year

Section 7: Bariatric Surgery

  • Expenses incurred on hospitalization for bariatric surgical procedure and its complications thereof are payable upto the limits mentioned, during the policy period.
  • The maximum limit of Rs.2,50,000/- and Rs.5,00,000/- are inclusive of pre-hospitalization and post hospitalization expenses.

Section 8: Option for Second Medical Opinion

The Insured Person is given the facility of obtaining a Second Medical Opinion in electronic mode from a Doctor in the Company’s network of Medical Practitioners – Medical records can be sent to the mail id e_medicalopinion@starhealth.in

Section 9: AYUSH Treatment

Inpatient Hospitalisation expenses incurred on treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in a Government Hospital or in any institute recognized by the government and/or accredited by the Quality Council of India/National Accreditation Board on Health as in patient is payable up to the limits mentioned in the Schedule of Benefits.

Section 10: Accidental Death and Permanent Total Disablement

  1. Accidental Death
  2. Permanent Total Disability following an accident
  3. Dependent Children and persons above 70 years can be covered under Accidental Death and Permanent Total Disablement up to the sum insured of Rs.10,00,000.

Section 11: Star Wellness Program

  • Discount in the Renewal premium for healthy life style through wellness activities.

Section 12: Buyback PED (Optional Cover)

  • The Buyback PED waiting period will be reduced from 36 to 12 months on payment of additional premium.

Automatic Restoration of Sum Insured (Applicable for Section 1 Only)

Upon exhaustion of Basic sum insured and the Bonus, sum insured will be automatically restored by 100% once during policy period. Such restored Sum Insured can be utilized for illness /disease unrelated to the illness / diseases for which claim/s was / were already made.

Such restoration will be available for section 1 other than outpatient medical consultation.

Cumulative Bonus -maximum benefit of bonus is 100% of the basic sum insured.
Midterm inclusion of newly married / wedded spouse and New Born Baby is permissible on paying additional premium. The intimation about the marriage / new born should be given within 60 days from the date of marriage or new born

Waiting Period: The Company shall not be liable under this policy directly or indirectly for

  • First 30 days for illness/disease (other than accidents)
  • 24 months for specified illness/disease/treatments
  • 36 months for pre-existing diseases
Pre-Acceptance Medical Screening: Only for Buyback PED (Optional Cover).

Pre-Existing Diseases/Illness: Are covered after 36 months of continuous Insurance without break. If insured opts Buyback PED then Pre-Existing Diseases covered after 12 months of continuous coverage from the inception of this policy

Coverage for Modern Treatment please click here

Benefit/Premium illustration for Individual and Floater basis please click here

Instalment Facility: Premium can be paid Quarterly and Half Yearly. Premium can also be paid Annually, Biennial (once in 2 years) and Triennial (once in 3 years).

Star Wellness Program

This program intends to promote, incentivize and to reward the Insured Persons’ healthy life style through various wellness activities. The wellness activities as mentioned below are designed to help the Insured person to earn wellness reward points which will be tracked and monitored by the Company. The wellness points earned by the Insured Person(s) under the wellness program, can be utilized to get discount in premium.
This Wellness Program is enabled and administered online through Star Wellness Platform (digital platform)
Note: The Wellness Activities mentioned in the table below (from Serial Number 1 to 5) are applicable for the Insured person(s) aged 18 years and above only.
The following table shows the discount on renewal premium available under the Wellness Program:
Wellness Points Earned Discount in Premium
200 to 350 2%
351 to 600 5%
601 to 750 7%
751 to 1000 10%
*In case of floater policy the weightage is given as per the following table :
Family Size Weightage
Self, Spouse 1:1
Self, Spouse and Dependent Children (up to 18 years) 1:1:0:0:0
Self, Spouse and Dependent Children (aged above 18 years) 2:2:1:1:1
Note: In case of two year policy, total number of wellness points earned in two year period will be divided by two.
Each Insured Person will be given an Individual log-in facility, which will be linked to his/ her policy.
*Please refer the Illustrations to understand the calculation of discount in premium, weightage and the calculation in case of two year policy
The wellness services and activities are categorized as below:
Sr. No. Activity Maximum number of Wellness Points that can be earned under each policy in a policy year
1. Manage and Track Health
a) Online Health Risk Assessment (HRA) 50
b) Preventive Risk Assessment 200
2. Affinity to Wellness
a) Participating in Walkathon, Marathon, Cyclothon and similar activities 100
b) Membership in a health club (for 1 year or more) 100
3. Stay Active – If the Insured member achieves the step count target on mobile app 200
4. a) Weight Management Program (for the Insured who is Overweight / Obese) 100
b) Sharing Insured Fitness Success Story through adoption of Star Wellness Program (for the Insured who is not Overweight / Obese) 50
5. a) Chronic Condition Management Program (for the Insured who is suffering from Chronic Condition/s – Diabetes, Hypertension, Cardiovascular Disease or Asthma) 250
b) On Completion of De-Stress & Mind Body Healing Program (for the Insured who is not suffering from Chronic Condition/s – Diabetes, Hypertension, Cardiovascular Disease or Asthma) 125
Additional Wellness Services
6. Online Chat with Doctor
7. Medical Concierge Services
8. Period & Fertility Tracker
9. Digital Health Vault
10. Wellness Content
11. Health Quiz & Gamification
12. Post-Operative Care
13. Discounts from Network Providers
  1. Manage and Track Health:

    a) Completion of Health Risk Assessment (HRA):

    The Health Risk Assessment (HRA) questionnaire is an online tool for evaluation of health and quality of life of the Insured. It helps the Insured to introspect his/ her personal lifestyle. The Insured can log into his/her account on the website www.starhealth.in and complete the HRA questionnaire. The Insured can undertake this once per policy year. On Completion of online HRA questionnaire, the Insured earns 50 wellness points. Note: To get the wellness points mentioned under HRA, the Insured has to complete the entire HRA within one month from the time he/she started HRA Activity.

    b) Preventive Risk Assessment:

    The Insured can also earn wellness points by undergoing diagnostic / preventive tests during the policy year. These tests should include the five mandatory tests mentioned below. Insured can take these tests at any diagnostic centre at Insured’s own expenses.

    • – If all the results of the submitted test reports are within the normal range, Insured earns 200 wellness points.
    • – If the result of any one test is not within the normal range as specified in the lab report, Insured earns 150 wellness points.
    • – If two or more test results are not within the normal range, Insured earns 100 wellness points only.

    Note: These tests reports should be submitted together and within 30 days from the date of undergoing such Health Check-Up.

    List of mandatory tests under Preventive Risk Assessment
    1. Complete Haemogram Test
    2. Blood Sugar (Fasting Blood Sugar (FBS) + Postprandial (PP) [or] HbA1c)
    3. Lipid profile (Total cholesterol, HDL, LDL, Triglycerides, Total Cholesterol / HDL Cholesterol Ratio)
    4. Serum Creatinine
  2. Affinity towards wellness: Insured earns wellness points for undertaking any of the fitness and health related activities as given below.List of Fitness Initiatives and Wellness points:
    Initiative Wellness Points
    a. Participating in Walkathon, Marathon, Cyclothon and similar activities 100
    – On submission of BIB Number along with the details of the entry ticket taken to 100 participate in the event.
    b. Membership in a health club (for 1 year or more) – In a Gym / Yoga Centre / Zumba Classes / Aerobic Exercise/ Sports Club/ Pilates Classes/ Swimming / Tai Chi/ Martial Arts / Gymnastics/ Dance Classes 100
    Note: In case if Insured is not a member of any health club, he/she should join into club within 3 months from the date of the policy risk commencement date. Insured person should submit the health club membership.
  3. Stay Active: Insured earns wellness points on achieving the step count target on star mobile application as mentioned below:
    Average number of steps per day in a policy year Wellness Points
    • If the average number of steps per day in a policy year are between – 5000 and 7999
    100
    • If the average number of steps per day in a policy year are between – 8000 and 9999
    150
    • If the average number of steps per day in a policy year are – 10000 and above
    200
    Note:

    • First month and last month in each policy year will not be taken into consideration for calculation of average number of steps per day under Stay Active
    • The mobile app must be downloaded within 30 days of the policy risk start date to avail this benefit.
    • The average step count completed by an Insured member would be tracked on star wellness mobile application.
  4. Weight Management Program:
    • a) This Program will help the Insured persons with Over Weight and Obesity to manage their Body Mass Index (BMI) through the empanelled wellness experts who will guide the Insured in losing excess weight and maintain their BMI.
      • On acceptance of the Weight Management Program, Insured earns 50 wellness points.
      • An additional 50 wellness points will be awarded in case if the results are achieved and maintained as mentioned below.
      Sr. No. Name of the Ailment Values to submitted Criteria to get the Wellness points
      1. Obesity (If BMI is above 29) Height & Weight (to calculate BMI) Achieving and maintaining the BMI between 18 and 29
      2. Overweight (If BMI is between 25 and 29) Height & Weight (to calculate BMI) Reducing BMI by two points and maintaining the same BMI in the policy year
      – Values (for BMI) shall be submitted for every 2 months (up to 5 times in each policy year)
    • b) Incase if the Insured is not Overweight / Obese, the Insured can submit his/her Fitness Success Story through adoption of Star Wellness Activities with us. On submission of the Fitness Success Story through adoption of Star Wellness Activities, Insured earns 50 wellness points.
  5. Chronic Condition Management Program:
    • a) This Program will help the Insured suffering from Diabetes, Hypertension, Cardiovascular Disease or Asthma to track their health through the empanelled wellness experts who will guide the insured in maintaining/ improving the health condition.
      • On acceptance of the Chronic Condition Management Program, Insured earns 100 wellness points
      • The Insured has to submit the test result values for every 3 months maximum up to 3 times in a policy year
      • If the test result values are within +/- 10% range of the values given below, for at least 2 times in a policy year, an additional 150 wellness points will be awarded.
      • These tests reports to be submitted within 1 month from the date of undergoing the Health Check-Up
      Sr. No. Name of the Ailment Test to be submitted Values Criteria to get the additional Wellness points
      1. Diabetes(Insured can submit either HbA1c test value (or) Fasting Blood Sugar (FBS) Range and Postprandial test value) HbA1c ≤ 6.5
      Fasting Blood Sugar (FBS) Range and Postprandial test value 100 to 125 mg/dl below 160 mg/dl
      2. Hypertension Measured with – BP apparatus Systolic Range – 110 to 140 mmHg Diastolic Range – 70 to 90 mmHg
      3. Cardiovascular Disease LDL Cholesterol and Total Cholesterol / HDL Cholesterol Ratio 100 to 159 mg/dl ≤ 4.0
      4. Asthma PFT (Pulmonary Function Test) FEV1 (PFC) is 75% or more FEV1/ FVC is 70% or more
    • b) In case if the Insured is not suffering from Chronic Condition/s (Diabetes, Hypertension, Cardiovascular Disease or Asthma) he/she can opt for “De-Stress & Mind Body Healing Program”. This program helps the Insured to reduce stress caused due to internal (self-generated) & external factors and increases the ability to handle stress.
      • – On acceptance of De-stress & Mind Body Healing Program Insured earns 50 wellness points.
      • – On completion of De-stress & Mind Body Healing Program Insured earns an additional 75 wellness points.

      Note: This is a 10 weeks program which insured needs to complete without any break.

  6. Online Chat with Doctor:

    Insured can consult qualified healthcare professionals at their convenience. The Doctor Chat feature allows Insured to “Chat” with qualified Doctors, available from Monday to Friday between 9.00 AM and 6.00 PM to help Insured with advice and quick consultations including on Diet & Nutrition and Second Medical Opinion. They do not prescribe any medications or diagnose any health issues.

  7. Medical Concierge Services:

    The Insured can also contact Star Health to avail the following services:- Emergency assistance information such as nearest ambulance / hospital / blood bank etc.

  8. Period & Fertility Tracker:

    The online easy tracking program helps every woman with their period health and fertility care. The program gives access to trackers for period and ovulation which maps out cycles for months. This helps in planning for conception prevention and tracks peak ovulation if planning pregnancy.

  9. Digital Health Vault:

    A secured Personal Health records system for Insured to store/access and share health data with trusted recipients. Using this portal, Insured can store their health documents (prescriptions, lab reports, discharge summaries etc.), track health data add family members.

  10. Wellness Content:

    The wellness portal provides rich collection of health articles, blogs, tips and other health and wellness content. The contents have been written by experts drawn from various fields. Insured will benefit from having one single and reliable source for learning about various health aspects and incorporating positive health changes.

  11. Health Quiz & Gamification:
    • – The wellness portal provides a host of Health & Wellness Quizzes. The wellness quizzes are geared towards helping the Insured to be more aware of various health choices.
    • – Gamification helps in creating fun and engaging health & wellness experiences. It helps to create a sense of achievement in users and increases motivation levels.
  12. Post Operative Care:

    It is done through follow up phone calls (primarily for surgical cases) for resolving their medical queries.

  13. Discounts from Network Providers:

    The Insured can avail discounts on the services offered by our ` network providers which will be displayed in our website.

Terms and conditions under wellness activity
  • Any information provided by the Insured in this regard shall be kept confidential.
  • There will not be any cash redemption against the wellness reward points.
  • Insured should notify and submit relevant documents, reports, receipts etc for various wellness activities within 1 month of undertaking such activity/test.
  • No activity, report, document, receipt can be submitted in the last month of each policy year.
  • For services that are provided through empanelled service provider, Star Health is only acting as a facilitator; hence would not be liable for any incremental costs or the services.
  • All medical services are being provided by empanelled health care service provider. We ensure full due diligence before empanelment. However Insured should consult his/her doctor before availing/taking the medical advices/services. The decision to utilize these advices/services is solely at Insured person’s discretion.
  • We reserve the right to remove the wellness reward points if found to be achieved in unfair manner.
  • Star Health, its group entities, or affiliates, their respective directors, officers, employees, agents, vendors, are not responsible or liable for, anyactions, claims, demands, losses, damages, costs, charges and expenses which a Member claims to have suffered, sustained or incurred, by way ofand / or on account of the Wellness Program.
  • Services offered are subject to guidelines issued by IRDA from time to time.

ILLUSTRATION OF BENEFITS:

Lets look how the Insured can avail discount on premium through the “Star Wellness Program”

Scenario – 1

A 40 year old Individual Ramesh buys Star Comprehensive Insurance Policy (Individual Sum Insured) on 15th March, 2019 on payment of Rs.17,615/- per year (excluding taxes), with Sum Insured 25 Lacs, let’s understand how he can earn Wellness Points by doing different wellness activities. Ramesh has declared that his Body Mass Index (BMI) as 24 and he is a Diabetic. Ramesh enrolled under the Star Wellness Program and completed the following wellness activities.

Sr.No Name of the wellness activity taken up during the policy year Wellness Points Earned
1 Completed Online Health Risk Assessment (HRA) 50
2 Submitted Health Check-Up Report (two test results are not within normal values) 100
3 Participated in Walkathon 100
4 Attended to Gym 100
5 Achieved 10,000 average number of steps per day during the policy year 200
6 Shared his fitness success story 50
7 Managed Diabetes through Chronic Condition Management Program 250
Total Number of Wellness Points earned 850
Based on the number of Wellness Points earned Ramesh is eligible to get 10% discount on renewal premium.

ILLUSTRATION OF BENEFITS:

Lets look how the Insured can avail discount on premium through the “Star Wellness Program”

Scenario – 2

A 42 year old Individual Suresh and his wife Lakshmi along with their two dependent children (aged below 18 yrs) buy a Star Comprehensive Insurance Policy (Floater Sum Insured) on 20th, March, 2019 on payment of Rs.34,220/- per year (excluding taxes), with Sum Insured 25 Lacs, let’s understand how they can earn Wellness Points under the Floater Policy. Suresh has declared that he is suffering from Diabetes & Hypertension. Suresh has declared his Body Mass Index (BMI) as 30 & Lakshmi has declared her BMI as 25

Suresh and Lakshmi enrolled under the Star wellness program and completed the following wellness activities.

Sr.No Name of the wellness activity taken up during the policy year Wellness Points Earned by Ramesh Wellness Points Earned by Lakshmi
1 Completed Online Health Risk Assessment (HRA) 50 50
2 Submitted Health Check-Up Report 200 200
3 Participation in Marathon 100 0
4 Attended to Gym 100 100
5 Achieved 10,000 average number of steps per day during the policy year 200 200
6 Suresh accepted the Weight management program and reached 27 BMI <br /> <br /> Lakshmi accepted the Weight management program and reached 23 BMI 100 100
7 Suresh Managed Diabetes & Hypertension through Chronic Condition Management Program; <br /><br /> <br /><br /> Lakshmi has completed De-stress & Mind Body Healing Program 250 125
Total Number of Wellness Points earned 1000 775
No of wellness points based upon weightage – 1:1 500

(1000X1/2)

388

(900X1/2)

Total Number of Wellness Points earned by Suresh and Lakshmi = 888 (500+388)

Based on the no of Wellness Points earned, Suresh & Lakshmi are eligible to get 10% discount on renewal premium

ILLUSTRATION OF BENEFITS:

Lets look how the Insured can avail discount on premium through the “Star Wellness Program”

Scenario – 3

A 27 year old Individual Umesh buys Star Comprehensive Insurance Policy (Individual Sum Insured) for two year period, with Sum Insured 25 Lacs, let’s understand how he can earn Wellness Points by doing different wellness activities. Umesh has declared that his Body Mass Index (BMI) is 24 and he is not suffering with any Chronic Condition. Umesh enrolled under the Star Wellness Program and completed the following wellness activities.

Sr.No Name of the wellness activity taken up during the policy year Wellness Points Earned in the First Year Wellness Points Earned in the Second Year
1 Completed Online Health Risk Assessment (HRA) 50 50
2 Submitted Health Check-Up Report 200 200
3 Participated in Walkathon 100 100
4 Attended to Yoga Classes 100 100
5 Achieved 10,000 average number of steps per day during the policy year 200 200
6 Submitted his fitness success story 50 50
7 Completed De-stress & Mind Body Healing Program 125 125
Total Number of Wellness Points earned 825 825
Total Number of Wellness Points earned by Umesh = 2000 (1000+1000)

Calculation of Wellness Points as per two year policy condition = 1000 (2000/2)

Based on the number of Wellness Points earned, Umesh is eligible to get 10% discount on renewal premium.

ELIGIBILITY :

  • Persons between 18 years and 65 years of age at the time of entry can take this Insurance. Dependent children can be covered from 3 months and up to 25 years of age. There is no upper age limit for continuous renewals.
  • This policy is both on Individual basis and on Family Floater basis. Family for the purpose of this policy means self, spouse and dependent children, not exceeding

Co-Payment:

10% of each and every claim for persons above 60 years at entry level and their subsequent renewals.

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:

At the time of inception of the policy, the Insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the policy if not acceptable. In such a case, the premium refund shall be as follows :

If the Insured has not made any claim during the free look period, the Insured shall be entitled to –

  1. a refund of the premium paid less any expenses incurred by the Insurer on medical examination of the insured persons and the stamp duty chargesor
  2. where the risk has already commenced and the option of return of the policy is exercised by the policy holder, a deduction towards the proportionate risk premium for period on coveror
  3. where only a part of the insurance coverage has commenced , such proportionate premium commensurate with the insurance coverage during such period. Free look period shall not be applicable at the time of renewal

NOTE: Renewal premium, terms and conditions are subject to change with prior approval from IRDAI.

STAR ADVANTAGE :

  • No third Party Administrator, direct in-house claim settlement.
  • Faster & hassle-free claim settlement.
  • Cashless hospitalization wherever possible.

NOTE: The benefits mentioned herein are only an outline of the policy. For details please contact your nearest Star Health office or call  to no – +91 9990190909 or wrire to support@agindiaonline.com

 

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