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Individual Health Insurance Plans
Star Health Premier Insurance Policy
With growing age, we tend to develop certain ailments and diseases, and on top of that, our regular flow of income slows down. We cannot escape proper medications in the face of a medical emergency, and the skyrocketing medical expenses may put a financial burden on our shoulders. To solve this problem, Star Health Insurance Company has come up with a highly beneficial and unique health insurance policy, Star Health Premier Insurance Policy which covers expenses incurred for hospitalization due to Illness or Accident. This indemnity product not only covers medical expenses but also offers coverage for non-medical items and modern treatments, which have made the policy best-suited for one to meet the needs of today and tomorrow. This policy is specially designed to cater to the needs of people who are above 50 years of age, and it is flexible as well. To know more about this policy, have a look at the following mentions.
|Minimum entry age||Dependent child – 91 days, Adult – 50 years|
|Maximum entry age||Dependent child – 25 years, Adult – No upper limit|
|Type of policy||Individual Policy and Family Floater Policy|
|Maximum insured members||5 (2 adults + 3 children)|
|Policy tenure||1, 2, and 3 years|
|Sum insured options||Rs.10 lakhs, Rs. 20 lakhs, Rs. 30 lakhs, Rs. 50 lakhs, Rs. 70 lakhs, and Rs. 1 crore.|
|Special conditions for the sum insured||Sum insured up to Rs. 1 crore is available for persons entering up to 65 years and their renewals. For persons entering the above 65 years, the sum insured is restricted to Rs. 50 lakhs even for renewals.|
|Pre-acceptance medical screening||Not required|
Initial – 30 days
Pre-existing diseases – 24 months
Specified diseases and procedures – 24 months
Benefits That You Will Get With Star Health Premier Policy
This policy has come up with a sack full of benefits and facilities that have promised to keep you and your family healthy, and financially sound. The following table describes those benefits in detail. Have a look.
|Room, Boarding, and Nursing Expenses||Up to 1% of the sum insured, or a maximum of up to Rs.20,000 per day whichever is less as provided by the Hospital/Nursing Home|
|Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Anesthesia, Blood, Oxygen, Operation theatre charges, ICU charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Diagnostic imaging modalities, dialysis, chemotherapy, radiotherapy, cost of a pacemaker, stent, and similar expenses.||Covered, up to a certain limit|
|Day care expenses||All day care procedures are covered|
It is subject to the limit as per the following table:
|Road Ambulance charges||It is available for transportation of the Insured Person at the time of medical emergency, subject to an admissible Hospitalisation Claim.|
|Air ambulance cover||It is covered up to Rs. 2,50,000 per hospitalization and a maximum of up to Rs. 5,00,000 per policy year is payable|
|Pre-hospitalization expenses||It is covered up to 60 days immediately prior to admission to the hospital|
|Post-hospitalization expenses||It is covered for up to 90 days immediately after discharge from the hospital.|
|Organ donor expenses||In-patient hospitalization expenses incurred for organ transplantation from the Donor to the Recipient Insured Person are payable provided the claim for transplantation is payable. The coverage limit under this benefit is over and above the Limit of Coverage and up to the Sum Insured.|
|AYUSH treatment||In-Patient Hospitalizations/day care treatment expenses incurred for the treatment of diseases/illness/accidental injuries by AYUSH treatment (except Yoga and Naturopathy system of medicines) are covered up to the Sum Insured.|
Coverage for medical treatment (Including AYUSH) for a
period exceeding three days is provided.
|Cumulative bonus||The insured person will be eligible for a Cumulative bonus calculated at 20% of the sum insured for each claim-free year subject to a maximum of 100% of the sum insured|
|Automatic restoration of the sum insured|
There will be an automatic restoration of the Sum Insured once by 100% subject to the following;
|Home care treatment||It is payable up to 10% of the sum insured subject to a maximum of Rs.5 lakhs in a policy year, for treatment availed of by the Insured Person at home, only for the specified conditions.|
|Outpatient medical expenses|
Expenses incurred for an Outpatient treatment up to the limits mentioned in the table below are payable from day 1.
|Co-payment||Every claim under the Policy will be subject to a co-payment of 20% applicable to the claim amount admissible and payable as per the terms and conditions of the policy even for renewals. This is applicable for Insured persons whose age at the time of entry is above 65 years.|
Key Highlights of Star Health Premier Policy
Apart from the above benefits and facilities, this plan has come up with a bundle of special advantages that have made the plan unique and popular among consumers. The followings are the mentions of those advantages.
This policy offers the discounts:
- Younger age discount – For Adults aged 50 years and above, if the spouse is aged less than 50 years, a family floater cover can be offered by considering the premium of age 50 years discounted by 10% for the spouse. This discount is not applicable once Spouse attains 50 years of age.
- Floater discount – A Floater discount of 40% is available on the premium for the younger member when 2 adults are covered under the same policy on a Floater sum insured basis.
- Long-term policy discount – If the policy term opted is 2 years, the discount available is 10% on the 2nd-year premium and if the policy term opted is 3 years, the discount available is 11.25% on the 2nd and 3rd-year premium.
- Discount in premium for submitting health check-up reports: If the following medical records of the person proposed for insurance are submitted, the Company may offer a discount of 10% on the applicable premium, subject to the findings in the submitted reports.
- Stress ECHO Report /TMT (done under guidance)
- BP Report (3 readings)
- Fasting Blood Sugar (FBS) and HbA1C
- Blood urea & creatinine
- Complete Urine Examination (CUE)
You can avail of a discount of up to a certain percentage if you buy the policy directly from the website of the insurer, through an online mode.
Premium can be paid in Quarterly and Half-yearly Installments. Premium can also be paid in Annual, Biennial, and Triennial modes. For installment mode of payment, there will be loading on annual premium as stated here – Quarterly: 3%, and Half-Yearly: 2%. However, an installment facility is not available for long-term (2-year and 3-year) policies.
It is permissible on payment of proportionate premium subject to the following;
- Newly Married or Wedded spouse: Intimation about the marriage should be given within 45 days from the date of marriage.
- Special conditions: Waiting periods, as stated in the policy, will be applicable from the date of inclusion of such newly married/wedded spouse. Such midterm inclusion will be subject to the underwriter’s approval.
Star Wellness Program:
This program intends to promote, incentivize, and reward Insured Persons’ healthy life style through various wellness activities. The wellness activities are designed to help the Insured person 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 a discount on the premium. This Wellness Program is enabled and administered online through the Star Wellness Platform through the Star Health Customer Mobile app ‘Star Power’ and the ‘Star Health Customer Portal.’
Coverage for non-medical items (Consumables):
It is covered, but subject to an admissible claim under the policy. This policy offers compensation for 68 non-medical items.
Hospitalisation Expenses incurred for bariatric surgical procedures and their complications thereof are payable subject to the limits mentioned in the table given below (inclusive of pre-hospitalization and post-hospitalization expenses) after a waiting period of 24 months.
|Sum insured||Limit per policy period|
|Rs. 10 lakhs and Rs. 20 lakhs||Rs. 2,50,000|
|Above Rs. 20 lakhs||Rs. 5,00,000|
Coverage For Modern Treatment:
The following modern treatments are covered up to 50% of the Sum Insured.
- 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
- The vaporization of the prostate (Green laser treatment or holmium laser treatment)
- IONM – (Intra Operative Neuro Monitoring)
- Stem cell therapy: Hematopoietic stem cells for bone
- marrow transplant for hematological conditions
Rehabilitation and Pain Management:
The Company will pay the medical expenses for Rehabilitation and Pain Management up to the sub-limit, or a maximum of up to 10% of the sum insured whichever is less, per policy year.
It is payable up to 10% of the sum insured subject to a maximum of Rs.5 lakhs, once in a lifetime for each Insured person. This facility is available after a waiting period of 24 months from the policy’s inception.
Health Check-up Benefit:
Expenses incurred towards health check-ups up to the limits mentioned in the table given below for every claim-free year are payable on renewal.
|Sum insured||Limit up to|
|Individual sum insured||Family floater sum insured|
|Rs. 10 lakhs||Rs. 3000||Rs. 4000|
|Rs. 20 lakhs||Rs. 4000||Rs. 6000|
|Rs. 30 lakhs||Rs. 4500||Rs. 6500|
|Rs. 50 lakhs||Rs. 5000||Rs. 7500|
|Rs. 75 lakhs||Rs. 7000||Rs. 10000|
|Rs. 1 crore|
General Exclusions of Star Health Premier Policy
Understanding a policy is not completed if you do not go through its exclusions thoroughly. Therefore, to offer you a better picture of the plan, and to avoid future complications, here are the exclusions of Star Health Premier Policy:
- if you raise any claim against any ailment or disease, that is still within its waiting period, the company will not approve your claim.
- If there is any breach of law with criminal intent, the policy will immediately stop its coverage.
- If you take part in any hazardous activities, adventurous sports such as ballooning, scuba diving, paragliding, etc., and receive injuries from there, the company will not compensate for those medical expenses.
- If you receive any injuries incurred due to the consumption of drugs, alcohol, or any other intoxicating substances, the policy will not reimburse those expenses.
- 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 are not included.
- Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex will be permanently excluded from the policy.
- Expenses related to the surgical treatment of obesity, sterility, and fertility that does not fulfill all the terms and conditions of the policy will be excluded.
- If you receive the policy from the excluded providers, or if you receive the treatments which are unauthorized, or unrecognized, the company will not reimburse you for those expenses.
- Expenses for cosmetic, 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 not be compensated.
- 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 not be covered.
- 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, will also fall under the category of exclusions.
- Self-inflicted injury, suicide, or suicide attempts are permanently excluded from the policy.
Premium Illustration- How Does the Plan Work?
Once you get to know the inclusions and exclusions of the policy, the next important thing is to know, how much premium amount you have to pay to purchase this policy. Therefore, to provide you with a clearer picture of the policy here is an example.
Suppose, Mr. Khanna, a 51 years old, Kolkata-based businessman, bought Star Health Premier Insurance Policy for himself. Now, we have to find out how much premium value he has to pay to avail of the benefits of the policy for the given details.
|Policy type||Individual policy|
|Policy period||1 year|
|Sum insured||Rs. 50 lakhs|
|Payment option||Full payment|
|Premium amount, including tax||Rs. 32,951|
Now, the same Mr. Khanna wants to include his wife under the same policy. Certainly, the data and criteria will change according to the new situation. Therefore, let us find out the new premium amount for the given details.
|Age||Self – 51 years, Spouse – 48 years|
|Policy type||Family floater policy|
|Policy period||3 years|
|Sum insured||Rs. 50 lakhs|
|Premium amount, including taxes||Rs. 148,494|
Frequently Asked Questions
The tests should have been taken within 45 days prior to the date of the proposal. If the prospect submits the above-mentioned documents at the time of inception of this policy, the discount will be given for all subsequent renewals also, if the policy is renewed continuously without break.
For this, follow the below table:
|Wellness points earned||Discount on premium value|
|200 to 350||2%|
|351 to 600||5%|
|601 to 750||7%|
|751 to 1000||10%|
In the case of the family floater policy, the weightage is given as per the following table;
|Self and 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|
In the case of a two-year policy, the total number of wellness points earned in a two-year period will be divided by two.
The following wellness programs are available under this policy:
- Preventive risk assessment
- Completion of health risk assessment
- Affinity towards wellness
- Stay active
- Weight management program
- Chronic condition management program
- Star telehealth services
- Digital health vault
- Medical concierge services
- Post-operative care
- Wellness content
- Discounts from network hospitals
The Company will pay the expenses for rehabilitation, if availed at authorized centers as an In-patient/Out-patient, and if there is an admissible claim for Inpatient hospitalization for an injury, disease, or illness specified below.
- Poly Trauma
- Head injury
- Diseases of the spine
Reduction or enhancement of the Sum Insured is permissible only at the time of renewal. The acceptance for enhancement and the amount of enhancement will be at the discretion of the Company and subject to the terms and conditions of the policy.
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.
After completion of 8 continuous years under the policy no look back to be applied. This period of 8 years is called as 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 will 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 insured person will have the option to port the policy to other insurers by applying to 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.