Young Star Insurance Policy - STAR HEALTH INSURANCE POLICY
Young Star Insurance Policy
About Star Young Star Health Insurance
The Young Star Health insurance policy provides a wide SUM INSURED option of Rs. 3 Lakh (on individual basis) Rs. 5 Lakh to Rs. 1 Crore (family floater basis).
In case, the INSURANCE plan is issued on a family floater basis, the basic sum insured, cumulative bonus and other benefits of the policy are distributed amongst all the insured members. The policy term is for 1 year/2 year/3 years.
Based upon the requirement the policy buyer can select either a gold plan or silver plan based upon their individual requirements.
The policyholder can pay the premium on a monthly, quarterly and half-yearly basis. It can also be paid annually ( once in a year), biennial( once in two years) and triennial( once in three years).
What am I covered for
Coverage Applicable for both Silver and Gold Plan
1. In-patient Treatment- Covers hospitalisation expenses for period more than 24 hrs.
2. Emergency Road Ambulance - Expenses incurred for transportation of the insured person by private ambulance service to go to the hospital and transportation from one hospital to another hospital.
3. Pre-Hospitalisation- Medical Expenses incurred up to 60 days prior to the date of hospitalisation.
4. Post-Hospitalisation- Medical Expenses incurred up to 90 days from the date of discharge from the hospital
5. All Day care procedures are covered.
6. E-Medical Opinion:The Insured Person is given the facility of obtaining a “E Medical Opinion” from the Company's expert panel.
7. Health check Up -Expenses incurred towards cost of health check-up up to the limits mentioned.
8. Automatic Restoration: Automatic restoration of the Basic Sum Insured by 100% once during the policy period, immediately upon partial/full utilization of the limit of coverage.
9. Additional Basic Sum Insured for Road Traffic Accident (RTA): If the insured person meets with a Road Traffic Accident resulting in inpatient hospitalization, then the Basic Sum Insured shall be increased by 25% subject to a maximum of Rs.10,00,000/-
10. Star Wellness Program:Renewal discount for healthy life style.
Coverage Applicable only for Gold Plan
- Delivery Expenses: Expenses for a Delivery including Delivery by Caesarean section (including pre-natal and post natal expenses) upto Rs.30,000/- per delivery is payable.
- Hospital Cash Benefit: The Company will pay a Cash Benefit of Rs 1000/-for each completed day of hospitalization subject to a maximum of 7 days per hospitalization and 14 days per policy period.
i. Any hospital admission primarily for investigation diagnostic purpose.
ii. Pregnancy, infertility.
iii. Domicilary treatment,treatment outside India.
iv. Circumcision, sex change surgery, cosmetic surgery & plastic surgery.
v. Refractive error correction, hearing impairment correction, corrective & cosmetic dental surgeries.
vi. Substance abuse, self-inflicted injuries.
vii. Hazardous sports, war, terrorism, civil war or breach of law.
viii. Any kind of service charge, surcharge, admission fees, registration fees levied by the hospital.
Waiting Periods
Initial Waiting Period - 30 days
Specific waiting period - 12 months
Pre-existing diseases: - 12 months
Payment basis
Reimbursement of covered expenses up to specified limits
Fixed amount on the occurrence of a covered event
Loss Sharing
In case of a claim, this policy requires you to share the following costs: Expenses exceeding the followings Sublimits
1. Room/ICU charges
2. For the following specified diseases
3. Deductible of one day
4. % of each claim as Co-payment
Renewal Conditions
Lifelong Renewal
Grace period of 30 days for renewing the policy is provided
Renewal Benefits
Health Checkup: Expenses incurred for health check-up up-to the limits mentioned in the table Cumulative Bonus: Cumulative bonus calculated at 20% of basic sum insured for each claim free year subject to a maximum of 100% of the basic sum insured.
Cancellation
The Company may cancel this policy on grounds of misrepresentation, fraud, moral hazard, non disclosure of material fact as declared in the proposal form and/or claim form at the time of claim and non co-operation of the insured by sending the Insured 30 days notice
Claims
For Cashless Service
For Reimbursement of claim
Policy servicing /Grievances /Complaints
Company Officials
IRDAI/(IGMS/Call Centre)
Ombudsman (Note: Please provide the contact details Toll free number/e-mail)
Insured's Right
Free Look
Implied renewability
Migration and Portability
Increase in SI during policy term
Turn Around Time (TAT) for issue of Pre-Auth and Settlement of Reimbursement
Instalment Option
Insured has the option to pay the premium in instalments. Relaxation period of 7 days is applicable for the policy issued on instalment basis.
Insured's Obligations
Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure may result in claim not being paid.
Disclosure of Material Information during the policy period such as change in occupation (Note: If applicable, please provide details of the format & to whom the form is to be sent)
COVERAGE:(Applicable for both Silver and Gold Plan)
A. Room (Single Private A/C room), Boarding and Nursing Expenses as provided by the Hospital. Important Note: Hospitalisation expenses which vary based on the room rent occupied by the insured person will be considered in proportion to the room rent limit / room category stated in the policy or actuals whichever is less.
B. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees.
C. Anesthesia, Blood, Oxygen, Operation Theatre charges, ICU charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, diagnostic imaging modalities, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker, stent and such other similar expenses. With regard to coronary stenting, the Company will pay cost of stent as per the Drug Price Control Order (DPCO) / National Pharmaceuticals Pricing Authority (NPPA) Capping.
D. Emergency Road Ambulance: Subject to an admissible hospitalization claim, Emergency Road Ambulance expenses incurred for the following are payable :- i. for transportation of the insured person by private ambulance service to go to hospital when this is needed for medical reasons or ii. for transportation of the insured person by private ambulance service from one hospital to another hospital for better medical treatment
E. Pre-hospitalization Expenses: Medical expenses incurred up to 60 days immediately before the insured person is hospitalized.
F. Post Hospitalization Expenses: Medical expenses incurred up to 90 days immediately after the insured person is discharged from the hospital
G. All Day care procedures are covered.
H. E-Medical Opinion: The Insured Person is given the facility of obtaining “E Medical Opinion” from the Company's expert panel. Subject to the following conditions :- · This should be specifically requested for by the Insured Person · This opinion is given without examining the patient, based only on the medical records submitted. · The opinion should be only for medical reasons and not for medico-legal purposes. · Any liability due to any errors or omission or consequences of any action taken in reliance of the opinion provided by the Medical Practitioner is outside the scope of this policy. · Utilizing this facility alone will not amount to making a claim.
I. Cost of Health Check up: Expenses incurred towards Cost of Health check-up up to the limits mentioned in the table below on completion of each policy year (irrespective of claim), provided health check up is done at a Networked facility. Note :
1. This benefit is payable on renewal and when the renewed policy is in force.
2. The maximum limit for this benefit shall not exceed the limit applicable for the renewed sum insured.
3. Payment under this benefit does not form part of the Basic Sum Insured.
4. Payment of expenses towards cost of health checkup will not prejudice the Company's right to deal with the claim in case of non-disclosure of material fact and /or pre existing diseases in terms of the policy
5. The unutilized amount under this benefit cannot be carried forward
J. Automatic Restoration of Basic Sum Insured: There shall be automatic restoration of the Basic Sum Insured once by 100% subject to the following :-
1. The automatic restoration shall be immediately upon partial/full utilization of the limit of coverage.
2. Such Restored basic sum insured can be utilized for all claims during the policy period.
3. The maximum liability of the Company in a Single claim under a policy year shall not exceed the limit of coverage.
4. The unutilized restored sum insured cannot be carried forward
K. Cumulative Bonus The insured person will be eligible for Cumulative bonus calculated at 20% of basic sum insured for each claim free year subject to a maximum of 100% of the basic sum insured. Special Conditions 1. The Cumulative bonus will be calculated on the expiring Basic Sum Insured 2. If the insured opts to reduce the Basic Sum Insured at the subsequent renewal, the limit of indemnity by way of such Cumulative bonus shall not exceed such reduced basic sum insured 3. In the event of a claim resulting in a. Partial utilization of Basic Sum Insured, such cumulative bonus so granted will be reduced at the same rate at which it has accrued. b. Full utilization of Basic Sum Insured and nil utilization of cumulative bonus accrued, such cumulative bonus so granted will be reduced at the same rate at which it has accrued. c. Full utilization of Basic Sum Insured and partial utilization of cumulative bonus accrued, the cumulative bonus granted on renewal will be the balance cumulative bonus available and will be reduced at the same rate at which it has accrued d. Full utilization of Basic Sum Insured and full utilization of cumulative bonus accrued, the cumulative bonus on renewal will be “nil”.
L. Additional Basic Sum Insured for Road Traffic Accident (RTA): If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic Sum Insured shall be increased by 25% subject to a maximum of Rs.10,00,000/- and subject to the following: · It is evidenced that the insured person was wearing helmet and was either riding or travelling as pillion rider in a two wheeler at the time of accident as evidenced by Police record and Hospital record. · The additional Basic Sum Insured shall be available only once during the policy period. · The additional Basic Sum Insured shall be available after exhaustion of the limit of coverage. · The additional Basic Sum Insured can be utilized only for that particular hospitalization following the Road Traffic Accident · Automatic Restoration of Basic Sum Insured shall not apply for this benefit · This benefit shall not be applicable for day care treatment · The unutilized balance cannot be carried forward for the remaining policy period or for renewal · Claim under this benefit will impact the Cumulative bonus
M. Star Wellness Program: This program intends to promote, incentivize and to reward the Insured Persons' healthy life style through various wellness activities. The wellness activities as mentioned below are designed to help the Insured person to earn wellness reward points which will be tracked and monitored by the Company. The wellness points earned by the Insured Person(s) under the wellness program, can be utilized to get discount in premium. This Wellness Program is enabled and administered online through Star Wellness Platform (digital platform). Note: The Wellness Activates mentioned in the table below (from Serial Number 1 to 5) are applicable for the Insured person(s) aged 18 years and above only.
Virtual Consultation Service
'Medical Consultation' is available through our inhouse Medical Practitioners/Empanelled Service providers round the clock to the insured through an online portal, mobile application as a chat service, voice call or a call back service. Consultations including on 'Diet & Nutrition' and 'Second Medical Opinion' is available.
Medical Concierge Services
The Insured can also contact Star Health to avail the following services: - Emergency assistance information such as nearest ambulance / hospital / blood bank etc.
Period & Fertility Tracker
The online easy tracking program helps every woman with their period health and fertility care. The program gives access to trackers for period and ovulation which maps out cycles for months. This helps in planning for conception prevention and tracks peak ovulation if planning pregnancy.
Digital Health Vault
A secured Personal Health records system for Insured to store/access and share health data with trusted recipients. Using this portal, Insured can store their health documents (prescriptions, lab reports, discharge summaries etc.), track health data add family members.
Wellness Content
The wellness portal provides rich collection of health articles, blogs, tips and other health and wellness content. The contents have been written by experts drawn from various fields. Insured will benefit from having one single and reliable source for learning about various health aspects and incorporating positive health changes
Health Quiz & Gamification
The wellness portal provides a host of Health & Wellness Quizzes. The wellness quizzes are geared towards helping the Insured to be more aware of various health choices. - Gamification helps in creating fun and engaging health & wellness experiences. It helps to create a sense of achievement in users and increases motivation levels.
Post-Operative Care
It is done through follow up phone calls (primarily for surgical cases) for resolving their medical queries.
Discounts from Network Providers
The Insured can avail discounts on the services offered by our network providers which will be displayed in our website.
Terms and conditions under wellness activity ·
Any information provided by the Insured in this regard shall be kept confidential
There will not be any cash redemption against the wellness reward points.
Insured should notify and submit relevant documents, reports, receipts etc for various wellness activities within 1 month of undertaking such activity/test.
No activity, report, document, receipt can be submitted in the last month of each policy year.
For services that are provided through empanelled service provider, Star Health is only acting as a facilitator; hence would not be liable for any incremental costs or the services.
All medical services are being provided by empanelled health care service provider. We ensure full due diligence before empanelment. However Insured should consult his/her doctor before availing/taking the medical advices/services. The decision to utilize these advices/services is solely at Insured person's discretion.
We reserve the right to remove the wellness reward points if found to be achieved in unfair manner
Star Health, its group entities, or affiliates, their respective directors, officers, employees, agents, vendors, are not responsible or liable for, any actions, claims, demands, losses, damages, costs, charges and expenses which a Member claims to have suffered, sustained or incurred, by way of and / or on account of the Wellness Program.
Services offered are subject to guidelines issued by IRDAI from time to time
Coverage available only under Gold Plan
Delivery Expenses
Expenses for a Delivery including Delivery by Caesarean section (including pre-natal and post natal expenses) up-to Rs.30,000/- per delivery is payable,
subject to the following :- 1. This benefit is available only for a maximum of 2 deliveries in the life time under this policy.
2. This Benefit is subject to a waiting period of 36 months from the date of first commencement of Young Star Insurance Policy and its continuous renewal thereof with the Company.
3. A waiting period of 24 months will apply afresh following a claim under this benefit.
4. Pre-hospitalisation and Post Hospitalization expenses and Hospital Cash Benefit are not applicable for this section.
5. This cover is available only when
i. both Self and Spouse are covered under this policy either on floater basis or on individual basis and both Self and Spouse have been covered for a continuous period of 36 months under Young Star Insurance Policy.
ii. the policy covering the self and spouse are in force when this benefit becomes payable.
6. Claims under this section will not reduce the Sum Insured
7. Claim under this section will impact the Cumulative bonus
Hospital Cash Benefit
The Company will pay a Cash Benefit of Rs 1000/-for each completed day of hospitalization subject to a maximum of 7 days per hospitalization and 14 days per policy period, provided, there is a valid claim for hospitalization under this policy Note:
1. This benefit is subject to 1 day Deductible.
2. Payment under this benefit does not form part of the Basic sum insured
3. Claim under this section will impact the Cumulative bonus
Waiting periods (Applicable for both Silver and Gold Plan)
The Company shall not be liable to make any payment under this policy if the hospitalization is directly or indirectly for
I. any disease contracted by the insured person during the first 30 days from the commencement date of this policy. This waiting period is not applicable for Accidents.
II. the following specified ailments / illnesses / diseases for 12 consecutive months from the inception date of this policy:- A. Diseases of ENTand Thyroid
B. All types of Hydrocele, Hernia, Varicocele, Piles, Fistula, and Fissure In Ano.
C. Diseases of Female Reproductive System
D. Calculus diseases of the Gall Bladder, Kidney and Urinary Tract III.
Pre Existing Diseases as defined in the policy until 12 consecutive months of continuous coverage have elapsed since inception of the first policy with any Indian General/Health Insurer. The above mentioned waiting periods are subject to Portability Regulations.
Free Look Period
At the time of inception of the policy, the Insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the policy if not acceptable. In such a case , the premium refund shall be as follows : If the Insured has not made any claim during the free look period, the Insured shall be entitled to –
1) a refund of the premium paid less any expenses incurred by the Insurer on medical examination of the insured persons and the stamp duty charges.
2) where the risk has already commenced and the option of return of the policy is exercised by the policy holder, a deduction towards the proportionate risk premium for period on cover.
3) where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period.
Free look period shall not be applicable at the time of renewal.
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| 78.62% | ||||
| Yes | ||||
| Available | ||||
| 9,900+ | ||||
| 37,34,365 | ||||
| Lifelong |      |
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