FAQ - Star Health Insurance

Why do I need health insurance?

Health insurance will protect you and your family against any financial risks arising due to a medical emergency. Buying a proper health plan would help you in saving your hard earned savings and other assets

What is a Health Card?

A health card is a card that comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital

What if I want to renew my health insurance policy after one year?

We would be sending you a renewal notice informing you of the expiry of your health policy via courier. However the Company is under no obligation to send renewal notice and its absence thereof shall not tantamount to deficiency in services. Hence Customer has the prime responsibility to renew his policy.

What do you mean by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by Star Health Insurance.

What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.

Is there an Income Tax exemption under Health policy?

Premium paid under the Health insurance Policy is exempted from Income Tax under section 80D of the Income Tax Act up to Rs.15,000 for individual covering his family and dependent Children.

In case the proposer intends to cover his parents under medical insurance, he is eligible for a deduction of another Rs.15,000 under section 80D.

In case the age of parent to be covered is above 65 years, the deduction available is Rs.20,000 under section 80D.

What is the Family Floater Plan?

One single policy takes care of the hospitalisation expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.

Is a medical checkup necessary before buying a Health policy?

A medical checkup is necessary for a new health insurance policy for customers above the age of 50 years. Medical checkup is not required only for Senior citizen policy offered to people between 60 yrs to 69 yrs.

My wife and children are residing at Mysore while I am here in Bangalore. Can I cover all of us in one policy?

Yes, You can cover the entire family under one policy. Your health insurance policy is in force across India.

I am a Foreign Citizen? Can I take a health policy for my child who is continuing further studies in India?

Yes. The scope of coverage shall be restricted to treatment taken in hospitals in India during the policy period.

Are naturopathy and homeopathy treatments covered under a health policy?

Under Medi Classic insurance policy , Non-allopathic treatments covered up to Rs. 25,000/- per occurence, subject to a maximum of 25% of Sum insured per policy period.

Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?

Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc as long they are associated with the patients stay in the hospital for at least 24 hours. Any diagnostic tests which does not lead to treatment or which have been prescribed as Outpatient are generally not covered.

Does any health policy cover expenses on outpatient treatment also?

No, Normally Health policies cover only expenses incurred as Inpatient. But Star Health Gain Policy also covers reimbursement of expenses incurred as Outpatient subject to terms and conditions of the policy.

Does any health policy cover the treatment for existing disease also?

Normally health plans exclude treatment of any pre existing disease / condition. At Star the treatment of any such pre existing disease/ condition is covered after 48 months of continuous renewals with Star.

I am a known diabetic for the past 5 years. Can I take a mediclaim policy with you?

Yes. You can take any individual policy with us in which the existing condition of diabetes would be excluded.At the same time, you can cover yourself with a Diabetes Safe policy which covers the complications arising due to Diabetic Retinopathy, Diabetic Nephropathy and Diabetic Foot Ulcer. However this policy requires a pre medical screening even if the proposer is less than 50 yrs of age.

I intend to cover myself with a mediclaim policy. But is there any provision in your policy which would give me lump sum benefits in case of any occurrence of major critical illness or is only the treatment covered?

Star Criticare Plus provides for both hospitalization benefits under section 1 and lump sum compensation in case of diagnosis of any major critical illness as specified in the policy under section 2.

In case of diagnosis of any one of the major illness as specified in the policy, The lump sum compensation is 100% of the sum insured.

In case of diagnosis of any one of the major illness as specified in the policy, The lump sum compensation is 100% of the sum insured.

Acceptance of the policy is subject to pre medical screening and all other terms and conditions apply.

Is there a policy to cover my mother who is 65 years old and is suffering from Diabetic for the past 10 years?

Yes, You can cover your mother under our Star Senior Citizen policy. If she has not undertaken any IP treatment in the last 12 months, she shall be covered for Diabetic also at 50% co pay

I have an insurance cover provided by my employer for Rs.400000 covering my entire family. Can I still take another family policy from you?

Yes you can take a family policy from us also mentioning about the existing policy details. You could also choose to take our Star super Surplus Policy which provides for hospitalization benefits after a deductible option of Rs.300000 or Rs.500000.This deductible is applicable to each hospitalization.

Can I take a health insurance policy for my child who is 3 yrs old?

Children are not covered individually in our policies but can be covered with either of the parent.

What is a Hospital under Mediclaim Insurance?

Hospital / Nursing Home means any institution in India established for indoor care and treatment of sickness and injuries and which either.

Has been registered either as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner or Should comply with minimum criteria as under:-

It should have at least 15 in-patient beds.

Fully equipped operation theatre of its own wherever surgical operations are carried out.

Fully qualified Nursing Staff under its employment round the clock.

Fully qualified Doctor (s) should be in-charge round the clock. (Note: In class 'C' town condition of number of beds is reduced to 10)

The term 'Hospital / Nursing Home" shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place of alcoholics, a hotel or a similar place.

Can I avail this policy if I am not an Indian National but living in India?

Yes, foreigners living in India can be covered under a health insurance policy. However, the coverage would be restricted to India.

What do you mean by Network /Non-network Hospitalization?

A Hospital, which has an agreement with us for providing Cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those with whom we do not have any agreement and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per reimbursement procedure.

How does Cashless facility work?

Each person covered under the Health Policy will be issued an identity card. Whenever there is a need for hospitalisation the policyholder should obtain a Pre Authorization Letter from the Hospital and also inform to Star Health at 1800 425 2255 / 1800 102 4477/ 044-28263300. The Hospital will have to submit the Pre authorization form to Star Health. Based on the details provided, Star Health processes the cashless request and gives reply to the Hospital.

How does one obtain the Authorization letter?

The Network Hospital can intimation Star Health at 1800 425 2255 / 1800 102 4477 /044-28263300 and fax the Pre authorization form to Star Health at 1800 425 5522/044-28260056. The form is already available with the Hospital or they can download it from the website www.starhealth.in . Star Health doctors will scrutinize the request and send an authorization letter or regret letter.

Can a request for Authorization for cashless be declined?

Yes, a request for authorization for cash less access may be declined if, Inadequate/vague/wrong information is provided and Star Health is unable to get access to further information. The ailment/ disease for which hospitalisation is required is not covered by the scope of the insurance policy. The person does not have adequate insured amount left to cover the hospitalisation costs.

This only means that cashless access is declined, AND IS IN NO WAY TO BE CONSTRUED AS DENIAL OF TREATMENT. The policyholder must obtain the treatment as per his/ her treating doctor's advice. The denial of pre-authorization letter shall not be construed to mean that the policyholder cannot claim under the terms, exclusions and conditions of the policy from Star Health. In such cases you are advised to file your claim for reimbursement. Star Health will settle the claim as per your policy terms and conditions.

Can a request for Authorization for cashless claim be rejected / repudiated?

Yes, a request for authorization for cash less access may be rejected by Star Doctors based on various reasons..Some common reasons are

The ailment/ disease for which hospitalisation is required is not covered at all by insurance policy.

The person does not have insured amount left to cover the hospitalisation costs.

This means that cashless claim access is rejected, AND policy holder cannot come for reimbursement as well.

How does hospitalisation for Planned Hospitalisation work?

a)The request for Pre- Authorization form for planned treatment has to be signed by the customer and sent by Hospital.

b) This request must reach Star Health at least 2 days before hospitalisation.

c) Any change in the date of hospitalisation, Hospital, nature of illness or surgeon who is going to perform the procedure will make the authorization invalid. A fresh authorization will have to be taken.

d) The authorization is valid only for Network Hospitals.

e) The authorization will be addressed and faxed to the hospital.

What are the points one must note while getting hospitalized under cashless access scheme??

In order to secure admission on the appointed day, you are advised to register your name with the hospital well in advance.

Contact the admission desk of the Hospital / Star Health Customer Care

Show your Star identity card and sign the Pre authorization form provided by the hospital

Some network Hospitals may charge you registration fees/ admission fees etc. These will have to be paid by the policyholder. These expenses are not reimbursable under your policy.

How does one get Reimbursement for pre and post hospitalisation expenses under this scheme?

The Mediclaim Policy allows reimbursement of medical expenses incurred towards the ailment/ disease for which hospitalisation was necessitated prior to hospitalisation and up to a certain number of days after discharge.

This is subject to the limits as described in the policy. The medical expenses incurred prior to Hospitalisation are called pre- hospitalisation expenses and those incurred subsequent to discharge as post Hospitalisation expenses.

To claim pre hospitalization expenses , Any expenses incurred on OP treatment which leads to IP hospitalization prior to 30 days prior to the date of hospitalization is settled as Pre hospitalization. All original bills have to be produced.

To claim post hospitalization expenses 7% of the Hospital bill (excluding Room rent) up to a maximum of Rs.5000/ is settled as post hospitalization. This is done based on the recommendation of the doctor and prescriptions along with discharge summary

In case of any non settlement, customer can contact customer service toll free number

How does one get Reimbursements in case of treatment in non- network hospitals?

Cashless Hospitalisation is available only in Network Hospitals. While it's recommended that you choose a network hospital you are at liberty to choose a non-network hospital also. In case you avail of treatment in a Non Network hospital, Star Health will reimburse you the amount of bills subject to the policy taken by the policyholder.

The Policy Holders attention is drawn to the definition of Hospital in the Mediclaim policy. Star Health should be contacted within 24 hours from the time of admission with details of Star Health id card number, nature of illness, name & address of the Hospital/ Nursing Home/ Clinic, Room Number etc. The claim will be registered by Customer Care and a claim number will be provided to the Policy holder. Claim form will be sent to the Policy holder address. This claim form must be filled fully and sent to Star Health office along with the following documents in original.

Main Hospital Bill with Receipt for payment along with the break up.

Doctors prescription and medicine bills.

Discharge summary sheet from the hospital.

Investigation reports along with the X Ray film.

Other relevant details and documents connected to hospitalisation.

Note: Only expenses relating to hospitalisation will be reimbursed as per the policy taken. All non-medical expenses will not be reimbursed.