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Star Health Insurance Claim

Since medical expenses are aggressively increasing, you need to consider the right health insurance plan that would serve in sudden medical emergencies. With the market flooded with abundant health insurance plans, you may need to choose the right one that caters to your medical needs.

With a high claim settlement ratio, quick customer service, and market value, Star Health offers a health insurance plan for customers looking to secure themselves and their loved ones. Though buying a health insurance plan is relatively common among natives, they tend to forget about the most important aspect, i.e., none other than filing a claim. What if any medical emergency arises out of nowhere and you are requested to file a claim? What would you do? As a matter of fact, you cannot do anything until you know the right process to file a claim. 

Let’s discuss the types of claim processes and their procedures.

Types of Star Health Claim Process

Here are the types of Star Health claim processes that you should know:

1. Star Health Cashless Claim Process

During hospitalisation, the insurer, i.e., the company, pays directly to the Network hospital for the care of the Insured (you as a policyholder) following the Policy Conditions.

  • Approach a network hospital’s insurance desk.
  • You can give notice by calling the company at 1800 425 2255 / 1800 102 4477 or sending an email at support@starhealth.in.
  • Make a claim and get a claim number.
    • Hospitalization might be scheduled seven to ten days in advance.
    • Within 24 hours after admission, notification of an emergency hospitalisation.
  • The hospital’s insurance desk will send the necessary documentation for a cashless request to Star via the Hospital Portal.
  • You will be notified of the approval, and the company will pay the hospital directly.

If it is denied, you may be required to pay the payment yourself.

2. Start Health Reimbursement Claim Process

A reimbursement claim is when you pay your hospital bill out of pocket and then file a claim with your insurance company for reimbursement.

  • Pay all hospital bills and gather all original papers of treatment and expenses incurred upon release.
  • The claim form must be completed and submitted to the local Star Office, together with all applicable original papers.
  • The company is to settle the claim in accordance with the policy’s terms and conditions.
  • Non-payable things would be the insured’s responsibility to cover.

Tips to Remember:

  • All claims must be submitted within 24 hours after being admitted to the hospital.
  • The reimbursement facility is available at both network and non-network institutions.
  • Take advantage of therapy, pay all costs, and submit a reimbursement claim.
  • Within 15 days of being discharged, submit the claim documentation to the company.
  • In order to acquire a claim form, provide your insurance number and inform Star Health that you have been admitted to the hospital.

Documents To Be Submitted For Reimbursement Claims

  • A properly filled-out claim form
  • Investigations and treatment papers completed before admission
  • The hospital’s discharge summary and the final bill
  • Receipts from hospitals, pharmacies, and other businesses.
  • Receipts for money and reports for testing performed
  • Doctors’, surgeons’, and anaesthetists’ receipts
  • A diagnostic certificate from the attending physician
  • A copy of your PAN card, a cancelled check, or your NEFT account information

After you’ve been discharged, make sure to submit all of the necessary documents to Star Health as soon as possible. Once the claim is approved, a direct amount will be credited to your account.

Reasons Your Claim Can be Rejected

Listed below are the scenarios under which your Star Health claim can be rejected.

  1. Ignoring the Illnesses Excluded

There are various conditions for which most health insurance plans do not provide coverage. These are listed as ‘not covered in the policies. These are diseases for which you are unable to register a claim and are referred to as exclusions. However, if specific plans or policies cover such diseases, there would be a waiting period. If you submit a cashless claim for a disease or medical condition that isn’t covered, you’ll almost certainly be denied.

  1. Providing incorrect information

Any disparity, whether it is a legitimate mistake on the form, such as a spelling error, or a genuine attempt to conceal information such as age, annual income, lifestyle, and family health details, will result in the claim being denied and the policy is terminated. The sum insured is frequently determined by annual income, and supplying false income information to obtain a bigger sum insured can result in claim denial.

  1. Exceeding the Sum Insured Limit

Have you heard of the term “sum insured”? There is an insured sum when you choose a health insurance policy or a personal accident policy, whether it is a family floater or an individual health cover. The sum insured is the amount available to you or your family on an annual basis, depending on the plan you choose. If you have used up all of your allowance for a given year, your subsequent cashless claims will be denied.

  1. Neglecting the Time Limit

You must apply for reimbursement within a particular time frame if you have health insurance coverage. In the case of emergency admission, the time offered is 24 hours after the patient has been admitted; however, it may vary depending on the type of policy you have chosen and the treatment you are receiving. Your claim may be rejected if you do not apply within the stipulated time frame.

  1. Pre-existing diseases

Some health insurance policies exclude coverage for any diseases you may have at the time of purchase. Your health insurance provider will not be able to cover the expense of therapy if you become unwell as a result of certain conditions and require hospitalization. As a result, there is a good risk that your health insurance claim may be denied.

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