Star Health Diabetes Safe

Star Health Diabetes Safe

Star Health Diabetes Safe - Product Overview

Star Health Diabetes Safe stands out as a specialised health insurance policy provided by Star Health and Allied Insurance Company Limited. Tailored to fit the unique needs of people dealing with diabetes, this plan ensures coverage for expenses associated with diabetes and its complications. With a focus on relieving the financial burden, it goes beyond diabetic conditions to encompass a range of hospitalisation costs. The policy is available in two variants, namely Plan A and Plan B.
 

Eligibility Criteria for The Star Health Diabetes Safe

Individuals within the age range of 18 to 65 years, who are currently living with Diabetes Mellitus are eligible to enrol in the Star Health Diabetes Safe Plan.
 

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Benefits And Coverage Overview of The Star Health Diabetes Safe

The Star Health Diabetes Safe Plan provides comprehensive coverage for inpatient hospitalisation costs, encompassing room and board charges, nursing fees, medical practitioner fees, prescribed medications, drugs, ICU fees, and related expenses for hospital stays exceeding 24 hours. Besides that, it also extends its coverage to additional expenses, including

  • Pre & Post-Hospitalization Expenses
    Pre-hospitalisation expenses refer to the costs you incur before hospital admission, encompassing consultations, tests, checkups, lab reports, etc. On the other hand, post-hospitalisation expenses include medical check-ups, rehabilitation sessions, physiotherapy, etc., after discharge. The policy covers expenses up to the sum insured for 30 days before hospitalisation. Post-hospitalisation costs, occurring within 60 days after discharge, are covered up to 7% of hospitalisation costs or Rs 5000 per hospitalisation, whichever is lower. To be eligible for coverage, these expenses must be linked to the medical condition for which you required hospitalisation, and your claim must be approved as part of inpatient hospitalisation coverage.
     
  • Daycare Treatment Coverage
    Daycare treatments denote medical procedures or surgeries that previously required extended hospital stays but now can be done within 24 hours due to unprecedented advancements in the medical field. The Star Health Diabetes Safe Plan provides unrestricted coverage for all daycare procedures without any limit. This ensures these expenses will be fully covered up to the sum insured, guaranteeing comprehensive care for your medical needs.
     
  • Organ Donor Coverage
    When diabetes is inadequately managed, it can substantially affect kidney function, sometimes leading to the need for transplantation. Recognizing the distinctive challenges faced by individuals with diabetes, the Star Health Diabetes Safe Plan offers coverage for expenses related to harvesting the kidney from the organ donor up to the sum insured. This provision aims to ease the financial strain on individuals who choose to contribute the gift of life through transplantation. It's important to note that this coverage is applicable only in cases where transplantation is necessary due to complications arising from diabetes.
     
  • Modern Treatment Coverage
    The healthcare landscape is swiftly progressing, driven by technological advancements that have made once-unthinkable treatments a reality. The Star Health Diabetes Safe Plan is crafted to align with these breakthroughs, providing coverage for expenses linked to modern treatments. It's crucial to be aware that specific sub-limits apply to different treatments within the plan.
     
  • Restoration Benefit
    The restoration benefit is a feature that automatically replenishes your depleted sum insured within a policy year. It activates when the base sum insured is fully utilised and is applicable for subsequent claims in the same policy year. This benefit can be utilised once a year for unrelated illnesses. It's important to note that this benefit is applicable only when you are hospitalised for health conditions other than diabetes.
     
  • Room Rent Limit
    It is the maximum amount paid by your insurance company for the hospital room you choose to stay in during your hospitalisation. Staying within this limit ensures that you won't have any out-of-pocket expenses. However, selecting a room with a rent higher than the eligible limit results in a proportionate deduction. This means you’ll be liable for a proportionate share of the entire medical bill, not just the difference in room rent. The Star Health Diabetes Safe Plan provides a room rent limit that extends coverage up to a single private AC room.
     

Other Important Features of The Product

  • Diabetes Cover
    Diabetes presents a significant global health challenge, impacting millions of individuals. The Star Health Diabetes Safe Plan is designed to provide a comprehensive shield for those navigating the intricacies of both type 1 and type 2 diabetes. This coverage not only addresses complications directly related to diabetes but also extends protection to those unrelated to the condition. A noteworthy feature of this coverage, particularly under Plan A, is the absence of a waiting period for any diabetic conditions, emphasising its dedication to prompt and uncompromised care. Opting for Plan B at the policy commencement necessitates the completion of a waiting period spanning 12 months.

  • OPD Cover
    Recognizing that health needs extend beyond hospitalisation, this plan provides comprehensive coverage outside the traditional hospital setting. It takes care of your Outpatient Department (OPD) expenses, ensuring your well-being is ensured every step of the way. The plan covers costs for diagnostic tests, consultations, medicines, drugs, etc. up to a specified limit, as long as you use services from the insurer's network providers. The maximum limit of this coverage varies based on factors like the plan type (individual/floater), variant, and sum insured you choose when purchasing the policy.
     
  • Personal Accident Cover
    In the event of your unfortunate demise resulting from an accident within the same policy year, your family will receive compensation equivalent to the opted sum insured. Importantly, this coverage knows no geographical limitations. Nevertheless, specific terms and conditions apply under this coverage.
     

Waiting Periods

When you buy health insurance, certain illnesses and conditions will not be covered by your policy right away. This time frame is known as the waiting period and it is of various types –

  • Initial Waiting Period: In the initial 30 days after securing your health insurance, you won't be able to file a claim for any health condition, unless it's related to an accident. So, during the first 30 days, you can only claim for hospitalisation due to accidents.

  • Pre-existing Disease Waiting Period: A pre-existing disease is any medical condition you have had in the 48 months before securing a health insurance policy. In the Star Health Diabetes Safe Plan, a waiting period of 48 months is applicable for pre-existing diseases. This implies that expenses associated with your pre-existing conditions will not be covered by the policy during this period.
     
  • Specific Disease Waiting Period: Apart from pre-existing conditions, insurance providers designate waiting periods for certain specified diseases or conditions, irrespective of whether you have a history of these illnesses or not. These waiting periods are determined by the insurer and are not influenced by your current health status. In the Star Health Diabetes Safe Plan, In the Star Health Diabetes Safe Plan, specific diseases have a 24-month waiting period, while a few listed illnesses have a 12-month waiting period.
     

Exclusions

Certain situations or medical conditions will not be covered by your health insurance policy at any cost. These are known as exclusions, which include –

  1. Standard Permanent Exclusions: All insurance companies in India must adhere to the set of standard permanent exclusions put forth by the Insurance Regulatory and Development Authority of India (IRDAI). Some of them are –

    • Investigation And Evaluation: Admission to a hospital only for observation or monitoring.
    • Rest Cure, Respite Care And Rehabilitation: Admission to a healthcare facility for bed rest, where no active treatment is provided.
    • Obesity/Weight Control: Treatment or surgery intended for weight control or obesity.
    • Change Of Gender Treatment: Treatment designed for altering the body's characteristics to the opposite sex.
    • Plastic/Cosmetic Surgery: Treatment or surgery for modifying body characteristics or appearance.
    • Profession In Hazardous Or Adventure Sports: Injury or illness arising from participating in adventure activities like skydiving, mountaineering, scuba diving, snorkelling, rafting, etc., as a professional.
    • Breach Of Law: Expenses related to treating individuals who have committed or attempted to commit a criminal act.
    • Excluded Providers: Treatment taken from a medical practitioner or hospital not covered by the insurer.
    • Narcotics: Treatment expenses for conditions like alcohol addiction, drug usage, etc.
    • Treatments In Establishments Specifically Arranged For Domestic Purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic purposes.
    • Dietary Supplements, Substances Purchased Without The Prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
    • Refractive Error: Expenses linked with correcting refractive errors of up to 7.5 diopters for better eyesight.
    • Unproven Treatments: Medical procedures, surgeries or treatments which are not proven to be effective.
    • Expenses Related To Birth Control, Infertility, Sterility: Contraception, artificial insemination, sterilisation, advanced reproductive technologies such as ZIFT, IVF, GIFT, ICSI, gestational surrogacy, etc.
    • Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
       
  2. Additional Permanent Exclusions: Besides the aforementioned standard permanent exclusions, insurance companies may impose additional exclusions for certain situations or medical conditions. If you have particular diseases or severe medical conditions considered too risky for coverage, insurers may opt to permanently exclude them from your policy. It's crucial to highlight, though, that insurers are bound by a list of illnesses defined by Insurance Regulatory and Development Authority of India (IRDAI) for the application of permanent exclusions.
     
  3. Non-Standard Exclusions (Specific Exclusions): These particular exclusions go beyond the standard permanent exclusions set by the IRDAI. They may vary among insurance companies and depend on the specific terms and conditions as outlined in your policy. Here's a list of some specific exclusions applicable under the Star Health Diabetes Safe Plan –
    • Circumcision unless required for treatment of a disease not excluded under this policy or needed due to an accident, preputioplasty, frenuloplasty, preputial dilatation and removal of SMEGMA.
    • Treatment for congenital external conditions / defects / anomalies.
    • Treatment expenses related to convalescence, general debility, run-down condition, nutritional deficiency states.
    • Treatment expenses for intentional self-injury.
    • Expenses for treating an injury or disease arising from war, act of foreign enemy, invasion, warlike operations (whether declared or not), etc.
    • Treatment expenses for injury or disease resulting from nuclear weapons/ materials.
    • Expenses related to unconventional, untested and experimental therapies.
    • Expenses related to artificial pancreas, chondrocyte implantation, intra articular injection therapy and procedures using platelet rich plasma.
    • Expenses associated with biologicals, except in cases where it is given as an in-patient, when clinically indicated and hospitalisation is deemed necessary.
    • Expenses related to inoculation or vaccination except in cases of post–bite treatment and medical treatment for therapeutic reasons.
    • Hospital registration charges, admission charges, record charges, telephone charges and related charges.
    • Expenses for treating diseases/illness/accidental injuries by systems of medicine other than allopathy.
       

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Summary

Here’s a snapshot of all the specifications of the plan –

Product Benefits

Coverage Limits

Pre and Post Hospitalisation Expenses

  • Pre-hospitalisation expenses are covered for 30 days up to the sum insured.
  • Post-hospitalisation expenses are covered for 60 days up to either 7% of the hospitalisation costs or Rs 5000 for each hospitalisation, whichever is less.

Daycare Treatment Coverage

All treatments are covered up to the sum insured.

Organ Donor Coverage

Harvesting expenses incurred forkidney transplantation associated with the organ donor are covered up to the sum insured. Applicable only if a transplantation is needed due to complications of diabetes.

Modern Treatment Coverage

Sub-limits are applicable for various treatments

Room Rent Limit

Coverage up to a Single Private AC room.

Restoration Benefit

Activates on complete utilisation of base sum insured for subsequent claims which can be utilised once in a policy year for unrelated illnesses. Applicable only for health conditions other than diabetes.

Pre-existing Diseases

Covered after a 48-month waiting period

Specific Diseases

Covered after a 24-month waiting period. And 12-month waiting period for a few other listed illnesses

 

Know More About The Star Health Diabetes Safe Plan

FAQs

  1. Under the Star Health Diabetes Safe Plan, what is the maximum health insurance cover you can opt for?
    Star Health Diabetes Safe Plan provides you a maximum health cover of up to Rs 10 Lakhs.
     
  2. Are consumables included under the Star Health Diabetes Safe Plan?
    No, the costs associated with consumables like gloves, masks, syringes, etc are not covered under Star Health Diabetes Safe Plan.
     
  3. Does Star Health Diabetes Safe Plan come with room rent restrictions?
    Yes, the Star Health Diabetes Safe Plan has a room rent limit of up to a single private AC room.
     
  4. Are OPD expenses included by the Star Health Diabetes Safe Plan?
    Yes, OPD expenses like diagnostic tests, medicines, drugs, consultations, etc. are covered up to a specific limit as outlined in the policy.
     
  5. Does the Star Health Diabetes Safe Plan include coverage for AYUSH treatments?
    No, AYUSH treatments are not covered under the Star Health Diabetes Safe Plan.