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Star Health Gain Policy

Due to the modern and fast lifestyle, we all are exposed to different types of health hazards, and we cannot take our health lightly. When it is the time of medical emergency, we cannot delay. Otherwise, it can be life-threatening. But the skyrocketing medical expenses have also put a financial on our shoulders. When the situation is this complex, health insurance policies come to our rescue. And when it comes to health insurance policies, Star Health Insurance Company is worth mentioning because of its customer-dedicated variety of health plans and consumer-friendly approach. The company has come up with a beneficial medical plan, Star Health Gain Insurance Policy, that promises to keep you and your family protected against different types of health risks and thus provides mental peace and financial relief. This policy is flexible enough to allow you to customize the policy according to your convenience. To know more about this policy, have a look at the following mentions.

Eligibility Criteria

ParametersDescriptions
Minimum entry age

Dependent child – 91 days

Adult – 18 years

Maximum entry age

Dependent child – 25 years

Adult – 65 years

RenewalLifelong renewability
Policy year1 year
Policy typeIndividual Policy and Family Floater Policy
Sum insured optionsRs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, and Rs. 5 lakhs
Premium options

Option 1 – Rs. 15000

Option 2 – Rs. 20000

Option 3 – Rs. 25000

Option 4 – Rs. 30000

Grace period30 days
Free look period15 days
Waiting period

Pre-existing diseases – 48 months

Specified ailments and procedures – 24 months

Initial – 30 days, except for the accidental injuries

Inclusions Under Star Health Gain Insurance Policy

This policy has come up with a sack full of benefits and facilities that ensure the protection and security of you and your family. The following table gives you a detailed picture of what you will get with this policy. Have a look.

ParametersDetails
In-patient hospitalization
Room, Boarding, and Nursing Expenses are all-inclusive as provided by the Hospital / Nursing HomeUp to 1% of the sum insured per day
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist fee, Anaesthesia, Blood, Oxygen, Operation Theatre charges, ICU charges, diagnostic materials, Cost of Pacemaker, and other similar expenses, Cost of medicines, drugsCovered, up to a certain limit
Emergency Ambulance charges for transporting the patient to the hospital.Covered up to a sum of Rs.750 per hospitalization and an overall limit of Rs.1500/- per policy period
Day care proceduresAll day care procedures are covered
Modern and advanced treatmentsCovered, up to a certain limit
Pre-hospitalization medical expensesMedical expenses incurred up to 30 days prior to the date of admission to the hospital are payable.
Post-hospitalization medical expensesMedical expenses incurred up to 60 days after discharge from the hospital are payable.
Outpatient expenses
FactorsThe premium option and Sum Insured Option shall be deciding outpatient benefit level.
What will be reimbursedMedical expenses incurred in the network facility shall be reimbursed. There is no waiting period or co-pay applicable.
BenefitUnutilized benefits in a policy year can be carried forward to the immediately succeeding renewal year. No further carry-over is permitted.

What are the key features of Star Health Gain Insurance Policy?

Apart from the above benefits and facilities, this policy has come up with a bundle of special advantages that have made the policy unique and popular among consumers. And the mentions of those advantages are as followings.

Co-payment:

This is applicable only for in-patient hospitalization. This policy is subject to a co-payment of 20% of every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is 61 years and above.

Limits of cataract:

Expenses incurred on treatment of Cataract is subject to the limits as per the following table:

Sum insuredLimits per eyeLimits per policy period
Rs. 1 lakh, and Rs. 2 lakhsUp to Rs. 12000 per eye, per policy period
Rs. 3 lakhsUp to Rs. 25000Up to Rs. 35000
Rs. 4 lakhsUp to Rs. 30000Up to Rs. 45000
Rs. 5 lakhsUp to Rs. 40000Up to Rs. 60000

Cashless hospitalization:

This facility is available with the company. More than 13000 network hospitals of the company are spread all over the country.

Tax Exemption Benefit:

With this plan, you are eligible to avail of tax exemption benefits. Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.

Cancellation:

The policyholder may cancel this policy by giving 15 days’ written notice and in such an event, the Company shall refund the premium for the unexpired policy period as detailed below:

Period on riskRate of premium to be retained
Up to 1 month25% of the annual premium
Exceeding one month and up to 3 months40% of the annual premium
Exceeding 3 months and up to 6 months60% of the annual premium
Exceeding 6 months and up to 9 months80% of the annual premium
Exceeding 9 monthsFull annual premium

Exclusions of the Star Health Gain Insurance Policy

Understanding a plan entirely is not completed if you do not go through the exclusions of it thoroughly. Therefore, to avoid future complications, and to provide you with a clearer picture of the policy, here are the general exclusions of Star Health Gain Insurance Policy:

  • If you raise any claim against any ailment or procedure that is still within its waiting period, the company will not approve your claim.
  • If there is any kind of breach of law with criminal intent, the company will not reimburse the claim amount.
  • Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
  • Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
  • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment will not be reimbursed.
  • Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex are excluded from the policy.
  • Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, burn(s), or Cancer or as part of medically necessary treatment, will be permanently excluded from the policy.
  • If you take part in any hazardous activities, or adventurous sports such as scuba diving, mountaineering, paragliding, etc., and receive injury from that, the company will not be liable for that.
  • If any injury is incurred due to the consumption of drugs, alcohol, or any other intoxicating substances, the company will not reimburse for the medical expenses.
  • If you receive any treatment which is not recognized, or unproven, that will also fall under the category of exclusions.
  • Treatments received in health hydros, nature cure clinics, spas, or similar establishments, or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons, are not covered by the policy.
  • Dietary supplements and substances that can be purchased without a prescription, including but not limited to Vitamins, minerals, and organic substances unless prescribed by a medical practitioner as part of a hospitalization claim or day care procedure will be excluded as well.
  • Maternity expenses, costs related to sterility, and infertility will not be covered by the policy.
  • The cost of dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization will not be paid by the company.
  • Hospital registration charges, admission charges, record charges, telephone charges, and other charges have to be borne by the policyholder only.
  • Any hospitalizations which are not Medically Necessary will not be covered.

Premium Calculation of Star Health Gain Insurance Policy

Once you get to know about the inclusions and exclusions of the policy, the next important thing is to know how much premium amount you have to pay to purchase the policy. Therefore, to offer you a better idea of the plan here is an example.

Suppose, Mr. Nayak, a 36-year-old, Kolkata-based businessman, bought Star Health Gain Insurance Policy for himself. Not, let us find out how much premium amount he has to pay to avail of the benefits of the policy for the given criteria.

ParametersCredentials
Age36 years
Policy typeIndividual
Premium option excluding taxOption 2 – Rs. 20000
Sum insuredRs. 4 lakhs
Gross premiumRs. 20000
Total premiumRs. 23600

Now, the same Mr. Nayak wants to include his wife under the same policy. The credentials and the criteria will certainly change. Therefore, now we have to find out the premium value for the given data.

ParametersCredentials
AgeSelf – 36 years, Spouse – 34 years
Policy typeFamily floater
Covered membersSelf, and spouse
A premium option, excluding taxOption 3 – Rs. 25000
Sum insuredRs. 5 lakhs
Gross premiumRs. 25000
Total premiumRs. 29500

Frequently Asked Questions

Any revision in the sum insured is permissible only at the time of renewal. The Insured Person can propose such revision and may be allowed subject to the Company’s approval and payment of the appropriate premium.

With this plan, you do not have to go through any Third Party Administrator (TPA). The direct claim is available here.

The insured person will have the option to port the policy to other insurers by applying to a such insurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability.

The insured person will have the option to migrate the policy to other health insurance products/plans offered by the company by applying for migration of the Policy at least 30 days before the policy renewal date as per IRDAI guidelines on migration.

The coverage of the policy is not available during the grace period.

After completion of eight continuous years under the policy, no look back is to be applied. This period of eight years is called a moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently, completion of 8 continuous years would be applicable from the date of enhancement of sums insured only on the enhanced limits. After the expiry of the Moratorium Period, no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would, however, be subject to all limits, sub-limits, co-payments, and deductibles as per the policy contract.

The covered modern and advanced treatments are as follows:

  • Uterine artery embolization and HIFU
  • Balloon sinuplasty
  • Deep brain stimulation
  • Oral chemotherapy
  • Immunotherapy – Monoclonal antibody to be given as an injection
  • Intra vitreal injections
  • Robotic surgeries
  • Stereotactic radio surgeries
  • Bronchial thermoplasty
  • Vaporization of the prostate
  • IONM (Intra Operative Neuro Monitoring)
  • Stem cell therapy – Hematopoietic stem cells for bone marrow transplant for hematological conditions

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