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Star Health Out Patient Care Insurance Policy

There are certain ailments that do not require hospitalization and they come under outpatient care. In India, most costs incurred for treating such ailments are paid by the people from their own pocket. Assessing the scenario, we at Star Health have devised Star Outpatient Care Insurance Policy. A standalone product that pays for Outpatient Consultation, which starts with doctor fees and can continue including Diagnostic tests, Pharmacy Bills, Physiotherapy, Non-Allopathic Treatments, Dental treatment, and other therapeutic procedures. To know more about this policy, have a look at the below mentions.

Eligibility Criteria

Age at entry for adults

Minimum – 18 years

Maximum – 50 years

Age at entry for economically dependent children

Minimum – 31st day

Maximum – 25 years

Family sizeUp to 6 members
Policy term1 year
Sum insured basisIndividual and floater basis
Plans offeredSilver Plan, Gold Plan, and Platinum Plan
Sum insured optionRs. 25,000, Rs. 50,000, Rs. 75,000, and Rs. 1 lakh
Free look period15 days

Key Highlights of Star Out Patient Care Insurance Policy

This policy has come up with a sack full of benefits and facilities. The important mentions are as below.

Outpatient Consultation expenses incurred at any Networked Facility in IndiaAvailable
Non-Allopathic treatment ExpensesOutpatient medical consultation and treatment expenses incurred under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy systems of medicines in any institute recognized by the Government of India and/or accredited by the Quality Council of India/National Accreditation Board on Health
Diagnostics, Physiotherapy, and PharmacyExpenses incurred at any Networked Facility in India for treatment as an Outpatient.
Dental treatment expensesAvailable – To a natural tooth or teeth arising out of accidents incurred at any Networked Facility in India as an Outpatient
Ophthalmic Treatment expenses

Covered – Arising out of accident incurred at any Networked

The facility in India is an Outpatient

Tax benefitAvailable as per the existing tax laws

What Are The Exclusions of Star Out Patient Care Insurance Policy?

Each policy comes up with certain exclusions for which it does not provide any benefit. Therefore, to avoid future complications and claim denial, here are the general exclusions of Star Out Patient Care Insurance are as follows.

  • If a claim is raised before the waiting period, the insurer will reject the claim.
  • Injury or disease caused by or contributed to by nuclear weapons/materials
  • Unconventional, Untested, Experimental therapies
  • Inoculation or Vaccination (except for post-bite treatment and for medical treatment for therapeutic reasons)
  • Hospital registration charges, admission charges, hospital record charges, telephone charges, and other charges
  • Hearing aids, walkers and crutches, wheelchairs, Nutritional Supplements, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis [CAPD], infusion pumps and other similar aids, Cochlear implants, and procedure-related expenses
  • Existing disease/s, disclosed by the insured and mentioned in the policy schedule (based on the insured’s consent), for specified ICD codes.
  • Medical treatment expenses traceable to childbirth (including complicated deliveries and cesarean sections incurred during hospitalization) except ectopic pregnancy
  • Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, and ICSI.
  • 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.
  • Expenses for cosmetic or plastic surgery or any treatment to change appearance.
  • Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

Premium Illustration Of Star Out Patient Care Insurance Policy

For a better understanding, here is an example. Mr. Ankit, Ankush and Sam (of different ages) were eager to buy Star Out Patient Care Insurance Policy. Here’s how much premium they will have to pay according to their chosen sum insured.

NameAgePlan typeSum insuredPremium amount including tax
Ankit36 yearsSilverRs. 50,000Rs. 7865
Ankush35 yearsRs. 75,000Rs, 10,484
Sam33 yearsRs. 1 lakhRs. 12,231

Buying Process of Star Out Patient Care Insurance Policy

One can buy this policy online by following the below steps.

  • Go to the official website of Star Health Insurance Company.
  • Click on the Plan option and view all the plans.
  • Among those plans, look for the Star OutPatient Care Insurance Policy, and click on that.
  • After that, on the landing page, there will be the Buy Now option at the extreme right side of the page. click on that.
  • Put the required details such as name, phone number, and pin code.
  • Put other required policy-related details such as sum insured option, address, date of birth of the policy-seeker, etc.
  • On the basis of the given data, a premium amount will be displayed.
  • Check the details twice.
  • If satisfied, pay the premium amount by choosing the most convenient payment option available with the insurer.
  • Upon successful payment, a notification will be sent to the registered email ID and/or phone number.
  • Download the policy details. Or else, take a printout of the same for better convenience.

Claim Procedure of Star Out Patient Care Insurance Policy

Under Star Out Patient Care Insurance Policy, you can avail of both cashless and reimbursement claims. Here lie the steps of each process.

Cashless Claim Settlement Process:

  • One can avail of the benefit of a cashless claim if he/she has taken medical treatments in any network hospital of the company.
  • At the time of a medical emergency, intimate the insurer as early as possible and inform the hospital authority and submit a copy of the health identity card.
  • One can download the pre-authorization form from the company’s official website. Submit the duly filled and signed form.
  • Once this form is submitted, the further verification process will be started on behalf of the company.
  • If it is required, the company may assign a field doctor to evaluate the situation.
  • If the claim is accepted, the company will pay for the bills.

Reimbursement Claim Settlement Process:

  • If the insured has taken medical treatments in any non-network hospital, then he/she can claim reimbursement settlement.
  • In case of any medical eventuality, inform your insurer at least within 24 hours of the occurrence.
  • Upon the completion of the treatment, submit all the required documents like hospital and medical bills, discharge certificates, and original necessary documents to the insurer.
  • Submit the duly filled and signed claim form.
  • The company will start the process and verify the provided information.
  • If approved, you will be notified and paid the amount of reimbursement.

Required Documents For Claim Settlement:

  • Duly filled and signed claim form.
  • Original copy of the policy.
  • Original bills, receipts, and certificates received from the hospital.
  • The company assigned a field doctor’s report (if any).
  • Treating doctor/surgeon/ medical practitioner’s bills/certificates.
  • Self-declaration/FIR/ MLC in case of an accident.
  • NEFT and KYC details.
  • Any other document as demanded by the company.

What Is The Renewal Process of The Star Out Patient Care Insurance Policy?

Follow the below steps.

  • Visit the company’s official website.
  • There one will find the ‘Renewals’ option at the top. Click on that.
  • Then the insured person will be asked to provide some information such as Policy Number and Date of Birth.
  • After that, click on the ‘Renew Now’ option and pay the premium.
  • Once he/she pays it, the policy details will be sent to the registered email ID.

Frequently Asked Questions

At the time of renewal, the insured person is eligible for a discount of 25% of the premium after every block of two continuous claim-free years.

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.

No, this will fall under the category of exclusions.

This policy can automatically expire under the following circumstances.

  • Upon the death of the insured person.
  • Upon exhaustion of the sum insured under the plan.

The insured person may at any time cancel this policy and in such event, the Company shall allow a refund after retaining the premium at Company’s short Period rate only (as per the table given) provided no claim has occurred up to the date of cancellation.

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