Star Health Family Health Optima Insurance

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Coverage Type
Coverage Amount
Date of Birth
    OR age    yrs
Policy Duration:
Policy Start Date:
Policy End Date:
  
  
  *Optional
Senior citizens above 60 years need not have to be anxious about health care and financial assistance to pay medical bills. This insurance covers anyone above 60 years and permits entry upto the age of 75 with continuing cover after that.
  • Benefits
  • Eligibility
  • Exclusions
  • Renewal
  • Others

  • Room, Boarding, Nursing Expenses at 2% of the Sum Insured, subject to a maximum of Rs.5,000/- per day in Class "A" Cities, 1% of the Sum Insured, subject to a maximum of Rs.3000/- per day in Class "B" Cities and 1% of the Sum Insured, subject to a maximum of Rs.2,000/- per day in other locations.
  • Insurance covers Surgeon's fees, consultant fees, Anaesthetist's and Specialist's fees, Blood, Oxygen, Operation Theater charges, cost of Pacemaker etc.
  • Cost of medicines and drugs.
  • Emergency ambulance charges for transporting the insured patient to the hospital up to a sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period.

Pre-existing Disease
  • Pre existing diseases are covered after 48 months of continuous insurance with the any Indian Insurance Company.

Pre & Post Hospitalization
  • Pre-hospitalization medical expenses incurred up to 60 days prior to the date of hospitalization are payable
  • Post-hospitalization medical expenses incurred up to 90 days after discharge from the hospital are payable.

Day Care Treatment: 405 day care treatments are allowed.

Limits for cataract surgery
  • Up to Rs.2 Lakhs the limit will be Rs.12,000 for policy period.
  • Above Rs.2 Lakhs up to Rs.5 lakhs. The limit will be Rs.20,000 for one year and Rs.30,000 for entire policy period.
  • Above Rs.5 Lakhs the limit will be Rs.30,000 for one eye and Rs.40,000 for entire policy period.

Health screening
  • All persons proposed for insurance who are above 50 years of age are to undergo Pre acceptance medical screening at the company nominated centers. The cost of such screening will be borne by the Company. The age for screening and the cost are subject to change

Family
  • Proposer, spouse, dependent children from 16 days up to 25 years (those who are economically dependent on their parents).

Tax benefits
  • Payment by any mode other than cash for insurance is eligible for relief under section 80D of the Income Tax Act 1961.

Automatic Restoration of Sum Insured
  • The basic sum insured will be automatically restored once the limit of coverage is exhausted during the policy period subject to limits given below.
Basic Sum Insured (Rs) % of Restoration on the Basic Sum Insured
Up to 20,000 Nil
30,000 and above 100%

Note: The restored some insured can be utilized for any illness/disease unrelated to illness/disease for which claim's was/were made. The restored sum insured cannot be carried forward.

  • Any person aged between 18 years and 65 years, residing in India, can take this insurance.
  • Child from 16th day of age can be covered as part of the family.
  • Beyond 65 years, It can be renewed for life time

  1. All expenses incurred in connection with treatment of any disease/illness/condition which is pre-existing at the time of commencement of insurance.
  2. Treatment of disease/sickness/illness contacted by the Insured Person during the first 30 days from the commencement date of the policy.
  3. Expense incured in the first two years of continuous operation of insurance cover on treatment of Cataract, Hysterectomy for Menorrhagia or Fibromyoma, Knee replacement surgery (other than caused by an accident) Joint Replacement Surgery (other than caused by accident), Prolapse of intervertebral disc (other than caused by accident), Varicose veins and Varcose ulcers.
  4. Expense incured during the first year of operation of the insurance treatment of diseases such as Bengin Prostate Hypertrophy, Hernia, Hydrocele, Fistula in anus, Piles, Sinusitis and related disorders, gallstones and renal stone removal.
  5. War and nuclear perils.
  6. Treatment by any system of medicines other than allopathic.
  7. Naturopathy treatment.
  8. Expenses which are purely diagnostic in nature with no positive existence of any disease.
  9. Circumcision unless necessary for treatment of disease not excluded hereunder or as may be necessitated due to an accident, vaccination (except for post bite treatment.), inoculation or change of life or cosmetic or anesthetic treatment, plastic surgery other than as may be necessitated due to an accident or as part of my illness.
  10. Treatment of Congenital external disease/defects/anomalies.
  11. Cost of spectacles, hearing aids, walkers crutches and similar aids.
  12. Dental treatments unless following accidental injuries.

Lifelong renewal of the policy is offered, except on grounds such as moral hazard, misrepresentation / non disclosure or fraud committed.

A grace period of 30 days from the date of expiry of the policy is available for renewal. If the policy is to be renewed or ported from other Indian Insurance Company for enhanced sum insured, such enhanced sum insured will not be available for an illness, disease, injury already contracted under the preceding policy periods. Further, for illness / disease / sickness already contracted, the sum insured will be restricted to that policy sum insured when the signs or symptoms was diagnosed or received medical treatment.

 
 

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