Star Health Family Health Optima Insurance

Let’s Get To Know The Plan!

The Star Health Family Health Optima is a robust health insurance policy brought to you by Star Health and Allied Insurance Company Limited. This policy is thoughtfully crafted to provide financial security for you and your loved ones when facing unexpected medical crises. The plan even covers your newborn child as early as the 16^th day of their life. With a range of features, benefits, and attractive discounts, Star Family Health Optima ensures that you can safeguard your family's well-being without the burden of excessive medical expenses.

Are You Eligible?

Here is the eligibility criteria for this policy -

• Minimum Age: For adults, the minimum entry age is 18 years. You can also cover your newly born baby, who is less than 16 days old. The coverage for your child will initiate on the 16th day after birth, providing you with peace of mind from the very start.
   
• Maximum Age: For adults, the maximum entry age is 65 years. As for dependent children, they can be included in the policy up to the age of 25.

What are the Benefits and Limitations of the Plan?

The Star Health Family Optima Plan offers extensive coverage for inpatient hospitalisation costs. These include expenses you incur while you are admitted to a hospital for more than 24 hours, encompassing room and board charges, nursing fees, medical practitioner fees, prescribed medications, drugs, ICU fees, and related expenses. Besides that, Star Health Family Optima Plan also covers -

• Pre & Post-Hospitalization Expenses: Expenses you incur before you are admitted to the hospital, such as consultations, tests, checkups, lab reports, etc., are called pre-hospitalisation expenses. After being discharged from the hospital, you may incur certain expenses like medical check-ups, rehabilitation sessions, physiotherapy, etc. These are called post-hospitalisation expenses. The policy extends its coverage for a reasonable duration, encompassing 60 days before hospitalisation and 90 days after discharge. It is essential to note that these expenses are covered by the insurer only if they are directly related to the medical condition for which you were hospitalised and the claim is approved as part of your inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage: Daycare treatment refers to medical procedures or surgeries that once demanded lengthy hospital stays but can now be accomplished within a mere 24 hours because of commendable advancements in the medical field. The Star Health Family Optima Plan includes coverage for all daycare procedures without imposing any limits. This means that your expenses will be covered up to the sum insured, ensuring you receive comprehensive care.
   
• Domiciliary Treatment Coverage: Domiciliary treatments are medical treatments or procedures provided at home for illnesses or injuries that would typically require hospitalisation. This setup may be necessary if the patient is severely ill or injured and cannot safely travel to a hospital or when there are no available hospital beds nearby. The Star Health Family Optima Plan offers coverage for domiciliary treatment expenses, with the exception of 15 specific illnesses, up to the sum insured.
   
• Organ Donor Coverage: The Family Health Optima Plan goes a step further by offering coverage for organ donor expenses, where  you, the insured, are the recipient. This coverage encompasses the costs associated with harvesting organs from the donor for organ transplantation. You can avail of this coverage up to 10% of the sum insured you choose under the policy, with a maximum limit of up to Rs. 10 Lakhs.
   
• Modern Treatment Coverage: Healthcare is advancing swiftly with technological breakthroughs, making treatments once thought impossible  a reality. The Star Health Family Optima Plan is crafted to stay in step with these medical strides. Though sub-limits apply to various modern treatments, choosing an add-on option ensures that your expenses for these cutting-edge treatments are covered up to the sum insured.
   
• Non-Medical Expenses: The Star Health Family Optima Plan goes beyond just medical costs and extends its coverage to non-medical expenses. Non-medical expenses encompass items like gloves, nebulisation kits, oxygen masks, and more. These items can be quite pricey and their cumulative cost can be substantial. By choosing an add-on, this plan offers coverage for these non-medical expenses, up to the sum insured. Thus, easing  the financial strain associated with such expenditures.
   
• Room Rent Limit: This is the maximum amount your insurance company will pay for your hospital room. If you pick a room that fits within your plan's room rent limit, you will not have to cover any extra costs. However, if you go for a costlier room than what your plan allows, you will have to pay a proportionate share of the entire bill, not just the difference in room rent. With Star Health Family Optima, these restrictions are tied to the sum insured you go for.
   

If you decide to include an add-on, you can select  –

• Cumulative Bonus: Staying healthy and not making claims during a policy year can earn you rewards. In the second policy year, you can receive a 25% bonus, and in the following years, an extra 10%. The maximum bonus will not go beyond 100% of your sum insured. And, if you make a claim in the future, the accumulated bonus remains intact when you choose an add-on. The bonus will not decrease if you’ve only used the base sum insured for claims. If you use an already accrued bonus, it will decrease at the rate it accrued.
   
• Restoration Benefit: The Restoration Benefit is a valuable feature that restores your sum insured when it is used up within a policy year. It is available for sum insured options of Rs 3 lakhs and above. The Star Health Family Optima Plan offers 100% restoration of your base sum insured. This benefit kicks in after you have fully used up your base sum insured and any cumulative bonus, if applicable. It is available for subsequent in-patient benefit claims during the policy year. This restoration benefit can be used up to 3 times a policy year for unrelated illnesses.
   

Exploring Key Highlights Of The Product - Star Health Family Health Optima

• New Born Baby Cover: This benefit addresses the unique concerns and needs that arise with the arrival of a new baby. The Star Health Family Optima Plan provides coverage for unforeseen situations that may arise in the early stages of your child's life, as long as the mother has continuous coverage for a year. This coverage kicks in from the 16th day after birth, providing up to 10% of the sum insured, with a maximum limit of Rs 50,000.
   
• Assisted Reproduction Treatment: In recent years, there have been remarkable advancements in medical technology, offering new hope for individuals and couples facing infertility challenges. Assisted Reproduction Treatment (ART) is the silver lining, granting the opportunity to make your parenthood dreams come true.
  The Star Health Family Optima plan extends its support to cover the financial aspects of these treatments for sum insured options of Rs 5 Lakhs and above. It is subject to specific terms and conditions –
   
• For a sum insured of Rs 5 lakhs, the maximum limit is Rs 1 lakh.
   
• For a sum insured of Rs 10 lakhs and above, the maximum limit is RS 2 lakhs.
   
• Star Wellness Program: The Star Wellness Program is designed to motivate and acknowledge those who embrace a healthy lifestyle. By engaging in a variety of wellness activities, you can accumulate wellness reward points which can be used to receive discounts on your premiums. The program encompasses condition management options like the chronic condition management program, weight management program, and other value-added services.

Navigating the Different Waiting Periods

When you buy health insurance, you should be aware of the waiting periods that come with it. This period is a specific time frame during which certain illnesses and conditions will not be covered by your policy right after buying a health insurance policy. Here are some of the  types of waiting periods –

1. Initial Waiting Period: During the first 30 days of getting your health insurance, you will not be able to make a claim for any medical condition, except in cases of accidents. This means that the initial 30 days are restricted for non-accident-related hospitalisation claims.
    
2. Pre-existing Disease Waiting Period: A pre-existing disease is any medical condition you have had in the 48 months before applying for your health insurance policy. Under the Star Health Family Optima Plan, there is a 48-month waiting period for pre-existing diseases. During this time, expenses related to your pre-existing conditions will not be covered by the policy.
    
3. Specific Disease Waiting Period: In addition to pre-existing conditions, insurers maintain a list of specific diseases or conditions for which waiting periods apply, regardless of whether you have experienced these diseases before or not. It is decided by the insurer, and is not based on your current health status. For the Star Health Family Optima Plan, there is a 24-month waiting period for specific diseases.
    

Understanding Policy Exclusions

There are certain situations that will not be covered by your health insurance policy. These are known as exclusions, and they include –

• Standard Permanent Exclusions: The Insurance Regulatory and Development Authority of India (IRDAI) has established a set of 'standard permanent exclusions' that all insurance companies are required to enforce. Some of them are –
  •  

1. Investigation and Evaluation: Hospital admission solely for observation or monitoring purposes.
2. Rest Cure, Rehabilitation, and Respite Care: Admission to a facility for bed rest, where no active treatment is provided.
3. Obesity/Weight Control: Treatment or surgery for weight control or obesity.
4. Change of Gender Treatment: Treatment aimed at altering the body's characteristics to those of the opposite sex.
5. Plastic/Cosmetic Surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in Hazardous or Adventure Sports: Treatment expenses incurred while participating as a professional in adventure activities like skydiving, mountaineering, scuba diving, snorkelling, etc.
7. Breach of Law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
8. Excluded Providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in Establishments Arranged for Domestic Purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary Supplements, Substances Purchased Without Prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
12. Refractive Error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
13. Unproven Treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses Related to Birth Control, Sterility, Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
     

• Additional Permanent Exclusions: In addition to the standard permanent exclusions mentioned earlier, insurance companies might add more exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers view as too risky to cover, they could permanently exclude them from your policy.
  However, it is important to note that insurers are restricted to a list of illnesses provided by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply permanent exclusions.
   
• Non-Standard Exclusions: These specific exclusions extend beyond the standard permanent exclusions established by the IRDAI. These exclusions can differ among insurance companies and may hinge on the specific terms and conditions of your policy. Here's a list of  notable specific exclusions under the Star Health Family Optima Plan –
  1. Circumcision procedure, unless deemed necessary for treating a condition not excluded in this policy or required due to an accident. Also, procedures like Preputioplasty, Frenuloplasty, Preputial Dilatation, and Removal of SMEGMA fall under this category.
  2. Congenital external conditions or defects or anomalies.
  3. Convalescence, general debility, run-down condition, nutritional deficiencies
  4. Intentional harm inflicted deliberately upon oneself.
  5. Injury or disease arising from war or nuclear weapons/materials
  6. Medical practices that are unconventional, untested, including experimental therapies.
  7. Biologicals, except when administered as an in-patient and clinically warranted during hospitalisation.
  8. Inoculation or vaccination, excluding post-bite treatment and vaccinations for therapeutic reasons.

A Quick Summary

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

Here’s Your Reading Material!

• Know the Plan in Detail - Brochure: https://web.starhealth.in/sites/default/files/brochure/Family-Health-Optima-Insurance-Plan-New.pdf
   
• Know the Fine Print - Policy Wording: https://web.starhealth.in/sites/default/files/prospectus/FHO-Prospectus.pdf

FAQs

1. What is the maximum health cover you can choose under the Star Health Family Health Optima plan?
   You can select a health cover of up to Rs25 Lakhs with the Star Health Family Optima Plan.
    
2. Can I purchase the Star Health Family Health Optima Plan for an individual?
   Unfortunately, the Star Health Optima Plan is only available as a floater policy and not for individuals.
    
3. Does Star Health Family  Health Optima cover Outpatient Department (OPD) expenses?
   No, OPD expenses are not covered by the Star Health Family Optima Plan.
    
4. Is coverage provided for AYUSH treatments under the Star Health Family  Health Optima Plan?
   Yes, the Star Health Family Optima Plan includes coverage for AYUSH treatments such as Ayurveda, unani, homoeopathy, and more.
    
5. Will the Star Health Family Optima Plan cover medical expenses for a newly born baby?
   Yes, the Star Health Family Optima Plan covers medical expenses for newborns starting from the 16th day after birth.