Star Health and Allied Insurance

Star Health Cardiac Care Platinum Plan

Star Health Cardiac Care Platinum Plan

Let’s Know The Star Cardiac Care Platinum Plan Better!

If you have a history of cardiac ailments, you can explore the Star Health Cardiac Care Platinum Plan. This insurance policy, crafted by Star Health and Allied Insurance Company Limited, is designed specifically for individuals with pre-existing heart conditions, offering coverage from day 31 onwards.

Eligibility

Individuals aged between 7 and 70 years diagnosed with a cardiac ailment or disorder, having undergone a cardiac surgical intervention, are eligible for the policy.
 

An Overview of the Plan’s Benefits & Limits

In addition to comprehensive coverage for inpatient hospitalisation expenses, encompassing room boarding, nursing charges, medical practitioner’s fees, prescribed medicines, drugs, ICU charges, and related costs, the Star Cardiac Care Platinum Plan includes an array of other valuable benefits.

  • Pre & Post Hospitalisation Expenses
    The policy goes beyond hospitalisation, covering diagnostic tests and other pre and post-hospitalization expenses 30 days before admission and 60 days after discharge. It's essential to note that these expenses are eligible for coverage only if directly related to the medical condition leading to hospitalisation and must be approved as part of inpatient hospitalisation coverage.
  • Daycare Treatment Coverage
    Daycare treatment refers to a medical procedure or surgery that traditionally demanded a prolonged hospital stay but can now be accomplished within 24 hours, thanks to advancements in medical technology. The Star Cardiac Care Platinum Plan comprehensively covers all daycare procedures. Importantly, it sets no limit on any daycare treatment, ensuring that associated expenses are covered up to the sum insured.
  • Organ Donor Coverage (Heart Transplantation): The plan provides coverage for heart transplantation expenses, including the harvesting and transportation of the heart. This coverage extends up to 200% of the base sum insured. However, a waiting period of 24 months is applicable before accessing this benefit.
     
  • Modern Treatment Coverage: As healthcare evolves with technological advancements, the Star Health Cardiac Care (Platinum) Plan ensures coverage for modern treatments. However, specific limits are set for various treatments under this coverage
     
  • Cumulative Bonus (No Claim Bonus): A noteworthy feature is the No Claim Bonus, rewarding you with 10% of the sum insured for each claim-free policy year. However, it's crucial to understand that making a claim within the policy period results in a decrease in the accumulated bonus, mirroring the rate at which it was accrued. The maximum bonus achievable under this plan is 100% of the sum insured.
     
  • Restoration Benefit: The Restoration Benefit is a unique feature where the sum insured is replenished once depleted within a policy year. Activated upon complete utilisation of the Base Sum Insured and Cumulative Bonus (if any), it is available for subsequent claims under in-patient benefit during the policy year. Importantly, the Restoration Benefit can be utilised once in every policy year for a lifetime, provided the policy is renewed. Having said this, it should be kept in mind that if the sum insured is partly used up for any non-cardiac ailments, this benefit will not get triggered.
     
  • Room Rent Limit: The policy introduces a room rent limit, defining the maximum coverage for hospital room expenses. Opting for a room within this limit ensures no out-of-pocket expenses. However, choosing a room with a higher rent than the eligibility results in a proportionate deduction. This implies responsibility for a share of the entire bill, not just the difference in room rent. Star Cardiac Care Platinum specifies a room rent limit of up to a Single Private AC room.
     

Noteworthy Features Under The Star Cardiac Care Platinum Plan You Should Be Aware Of:

  • Cardiac Devices Coverage: Within the Star Cardiac Care Platinum Plan, a distinctive feature caters to the specific needs of individuals requiring cardiac devices. This ensures that individuals dealing with cardiac conditions can benefit from technological advancements without being burdened by financial concerns. The plan covers expenses for crucial devices such as AICD, CRT-D, Pacemaker, and more, up to 50% of the sum insured.

  • Rehabilitation and Pain Management: Whether recuperating from surgery, managing chronic pain, or undergoing therapy for improved mobility, this coverage provides a supportive framework for individuals on their journey to recovery. The maximum limit for this cover is either up to the applicable sub-limits on various treatments or 10% of the sum insured, whichever is lower, per policy year. This ensures comprehensive care without a substantial financial burden, although certain terms and conditions may apply.
     
  • Out-Patient Expenses (including vaccination): Recognizing that health concerns extend beyond the confines of a hospital room, this plan covers OPD expenses, supporting your wellness journey at every step. From routine check-ups to essential vaccinations, this feature provides financial assistance for various medical needs outside the hospital. Depending on your chosen sum insured, the Star Cardiac Care Platinum Plan covers Out-Patient Expenses up to a specified limit, offering an additional layer of support beyond the sum insured.
     
  • Wellness Services: This unique initiative goes beyond traditional coverage boundaries to promote, incentivize, and reward healthy lifestyles. It includes services such as nutrition & diet consultation, counselling for stress management, and unlimited tele-consultation and E-pharmacy facility. Additionally, submitting specified test reports at least 3 months before the policy renewal date can earn you up to a 10% discount on your renewal premium, encouraging proactive health monitoring.

 

Understanding Waiting Periods

In simple terms, after acquiring the policy, there's a waiting period during which certain illnesses are not covered, this is your waiting period. Key waiting periods include:

  • Initial Waiting Period: A 30-day wait for all medical conditions, excluding accidents. No claims for hospitalisation are accepted within the first 30 days, unless due to accidents.
  • Pre-existing Diseases Waiting Period: A 48-month waiting period for pre-existing diseases and 30 days for cardiac conditions. A pre-existing medical condition is any illness/disease you had in the 48 months before applying for the plan.
  • Specific Diseases Waiting Period: A 24-month waiting period for specific diseases, as determined by the insurer. This applies irrespective of whether you had those diseases before or not, as per the Star Cardiac Care Platinum Plan.
     

What is not Covered Under The Plan?

In the realm of health insurance , exclusions are scenarios where your policy won't provide coverage. They fall into various categories:

1. Standard Permanent Exclusions:

  • Mandated by the IRDAI, these exclusions are universal across insurers. Notable standard exclusions include:
    • Hospitalisation for observation or monitoring purposes.
    • Admission for rest cure, rehabilitation, or respite care without active treatment.
    • Procedures for weight control, obesity, or altering gender characteristics (gender change surgeries).
    • Plastic/cosmetic surgeries for appearance modification.
    • Adventure sport injuries-related treatments for professionals in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
    • Treatment linked to criminal law breaches. Basically of a person who has committed or attempted to commit a breach of law with criminal intent.
    • Services from medical practitioners or hospitals excluded by the insurance company.
    • Conditions related to addiction like alcohol addiction, drug usage, etc.
    • Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
    • Dietary supplements or substances purchased without prescription.
    • Correcting refractive errors up to 7.5 diopters.
    • Unproven treatments, surgeries, or medical procedures lacking proven effectiveness.
    • Expenses related to birth control, sterility, infertility such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
    •  Expenses related to pre/post-natal costs, childbirth etc.

2. Additional Permanent Exclusions:
Insurers may add exclusions based on specific situations or medical conditions. If you have high-risk diseases, insurers may permanently exclude them. It's crucial to note that insurers need to adhere to an IRDAI-provided list for permanent exclusions.

3. Non-Standard Exclusions (Specific Exclusions) under the Star Cardiac Care Platinum Plan:

  • Unique to the Star Cardiac Care Platinum Plan, specific exclusions extend beyond standard ones outlined by the IRDAI. Notable exclusions include:

 

    • Congenital external conditions, defects, anomalies.
    • Convalescence, general debility, run-down condition, and nutritional deficiency states.
    • Intentional self-injury.
    • Injury or disease attributed to nuclear weapons/material.
    • Unconventional, untested, experimental therapies.
    • Biologicals (except when administered as an in-patient and clinically indicated).
    • Treatment for priapism and erectile dysfunctions.
    • Inoculation or vaccination (except for post-bite treatment and therapeutic reasons).
    • Medical and/or surgical treatment of sleep apnea, endocrine disorders.
    • Expenses for treatment by non-allopathic systems of medicine.

Gaining insight into these exclusions is pivotal for making well-informed decisions regarding your health insurance coverage.

 

The OG Reading Material for Your Reference

Summary

Here’s a snapshot of the Product benefits and Limits

Product Benefits

Coverage Limits

Pre-Hospitalisation Coverage

Covered up to the sum insured for 30 days before hospitalisation.

Post-Hospitalisation Coverage

Covered up to the sum insured for 60 days after hospitalisation.

Daycare Treatment Coverage

All  daycare treatments are covered up to the sum insured.

Organ Donor Coverage (Heart Transplant)

Heart transplantation expenses covered up to 200% of the base sum insured, including the harvesting and transportation - after a waiting period of 24 months.

Modern Treatment Coverage

Specific limits set for various treatments under this coverage.

 

Restoration Benefit

Restores 100% of the base sum insured once it is completely depleted during a policy year. Benefit not triggered if sum insured is partly used up for non-cardiac ailments.

Room Rent Limit

Room rent limit of up to a Single Private AC room.

 

Waiting Period for Pre-existing Diseases

Covered after a 48-month waiting period.

Waiting Period for Specific Diseases

Covered after a 24-month waiting period.

 

Frequently Asked Questions (FAQs) - Star Cardiac Care Platinum Plan:

  1. Does the Star Cardiac Care Platinum Plan cover domiciliary treatments?
    Unfortunately, no. The plan does not cover expenses associated with domiciliary treatments.

  2. Does the Star Cardiac Care Platinum Plan provide coverage for non-cardiac ailments?
    Yes, the Star Cardiac Care Platinum Plan not only covers expenses related to cardiac conditions but also extends coverage to non-cardiac ailments.
     
  3. Are pre-acceptance medical tests required under the Star Cardiac Care Platinum Plan?
    No, there's no need for pre-acceptance medical tests, regardless of age. While upfront medical screening is not required, you may need to submit past medical records to provide insights into your health history.
     
  4. Does Star Cardiac Care Platinum have room rent restrictions?
    Yes, there is a room rent limit, up to a Single Private AC Room.
     
  5. Under the Star Cardiac Care Platinum Plan, what is the maximum cover one can opt for?
    The Star Cardiac Care Platinum Plan offers a health cover of up to INR 15 Lakhs.