Star Health Super Star Plan

A cashless claim allows you to receive treatment at a hospital within your insurer’s network without settling the full bill yourself. Once approved, the insurer pays the hospital directly for covered expenses.

• Confirm Coverage Eligibility: Check whether your illness or treatment is covered under the policy and whether any waiting period applies. This is critical for conditions with long waiting clauses.
• Verify Hospital Network Status: If a specific hospital is preferred or recommended, confirm that it offers cashless services under your insurer. Network participation can differ across insurers.
• Ensure the Hospital is not Excluded: Treatment at an excluded hospital is not payable under any claim type. If the hospital is not excluded, confirm that it accepts cashless claims for your policy.
• Review Limits and Exclusions: Study your policy terms carefully. Look for room rent caps, ICU limits, disease-wise sub-limits, co-pay clauses, and exclusions on consumables or specific items. This helps estimate out-of-pocket costs in advance.
• Keep Required Documents Ready: Commonly required documents include:
  • Health card or policy copy
  • Past medical records related and unrelated to the current condition
  • KYC documents such as PAN, Aadhaar, and photograph
  • Patient ID proof
  • FIR in accident cases

  Missing documents can result in claim rejection and force reimbursement instead.

• Inform The Hospital and Initiate Pre-Authorisation: For planned admissions, submit the request 3 to 4 days before admission. For emergencies, inform the insurer within 24 hours. The hospital submits the pre-authorisation with policy details, diagnosis, treatment plan, doctor details, and medical history. Incorrect or undisclosed information may lead to rejection.
• Be Ready for Interim Payments: Hospital insurance desks operate on limited hours. Pre-authorisation can take 6 to 24 hours, during which the hospital may seek clarifications or request an advance deposit. Keep emergency funds available and preserve all original bills for expenses incurred before admission.
• Monitor Claim Status Until Discharge: At discharge, the hospital sends the final bill and summary to the insurer. Approval usually takes 2 to 6 hours. Delays may require you to wait, respond to queries, or pay and claim reimbursement later.
• Check the Final Settlement: Review the approval letter against the hospital bill. Payable and non-payable items will be clearly listed. Retain receipts for any retention amount held by the hospital and follow up for refunds.

If deductions occur due to limits, exclusions, or co-payments, you may claim the balance under another policy if available. Pre- and post-hospitalisation expenses must always be claimed separately.