Star Family Health Optima Insurance Plan

What is the Plan all About?

This plan is a perfect health proposition for you and your family. It provides comprehensive coverage at the best premium prices. This plan offers financial assistance to you and your family on floater basis during the policy year. A perfect plan to strengthen the family bond by opting for this plan.

Key Features

Single policy, wider coverage for whole family at an affordable premium
Get extra sum insured (auto recharge) at no extra cost
Health Checkup benefit for every claim free year
3 times Automatic restoration of Sum insured by 100% each time
Cover for Assisted Reproductive Treatment
New-born baby cover from 16th day
Donor expenses for organ transplantation
Domiciliary Hospitalization Expenses for treatment exceeding 3 days
Cover for all day care procedures
Coverage for Ayush related expenses
Grace period for 120 days
Cashless Treatment in network of 7800 hospitals

Policy Benefits

In-patient hospitalization expenses like room rent, boarding and nursing charges, etc. are covered under the policy benefits.
Surgeon, Anesthetist, Consultant fees is also covered as per the specified limits mentioned in the policy.
Cost of Pacemaker, medicines and drugs related to the illness/disease is also covered.
Pre hospitalization expenses are covered upto 60 days before the admission in the hospitalization.
Post hospitalization expenses are covered upto 90 days after discharge from the hospital.
All the day care procedures are covered under this plan.
Domiciliary Hospitalization Expenses for treatment exceeding 3 days are covered under this plan.
Donor expenses for organ transplant are covered.

Value Added Benefits

Emergency Ambulance service expenses are covered under this plan.
Automatic restoration of sum insured by 100% where the sum insured is 3 lacs and above.
Expenses incurred towards the cost of health check up are covered.
Hospitalization expenses for the treatment of newborn baby born during the policy period are covered.
Insured is entitled to the bonus of 25% of the expiring sum insured in the 2nd year and 10%
from the 3rd year onwards for sum insured 3 lacs and above. This bonus can be availed up to a maximum of 100% of the sum insured.
Recharge Benefit is applicable under the policy.
Emergency Domestic Medical Evacuation is payable under the policy
Expenses incurred for Compassionate Travel for one immediate family member is covered.
Repatriation of Mortal Remains is reimbursed, under this policy.
You can avail benefit in case of Treatment in Preferred Network Hospitals
Shared Accommodation benefit is applicable, as specified under the sub-limits
AYUSH Treatment expenses are covered, up to the limit specified.
Second Medical Opinion can be availed by the insured person.
Assisted Reproduction Treatment expenses are covered, up to the limits specified.
Additional Sum Insured is applicable for Road Traffic Accident.
Cataract Treatment expenses are covered.
Annual Health check-up in every claim free year.
Facility for maintaining personal health records in electronic format.
Tax Benefit under section 80D of IT Act,1961.

Sub Limits

For sum insured 1 lac & 2 lacs, room rent is capped up to Rs 2,000 per day. For sum insured 3 lacs & 4 lacs, room rent is capped up to Rs 5,000 per day. For sum insured 5 lacs & above, Single standard A/C Room can be taken by insured.
This plan covers donor’s expenses up to 10% of the Sum Insured or Rs 1 lakh (whichever is lower). This benefit is payable, subject to availability of the sum insured and claim for transplantation is payable.
Cost of health check up is payable up to a maximum of Rs 3,500 depends on the Sum Insured chosen. This benefit is available for sum insured of 3 Lacs and above.
Emergency ambulance charges are covered up to a sum of Rs 750 per hospitalization and overall limit of Rs 1500 per policy period.
Expenses incurred for air ambulance are covered up to 10% of the Basic sum insured per policy period. This benefit is available for Sum Insured of Rs. 5 Lakhs and above only.
The coverage for New Born Baby commences from the 16th day of its birth till the expiry date of the policy and it is capped up to a limit of 10% of the Sum Insured or Rs 50,000 whichever is less. This cover is applicable, provided the mother is insured for a continuous period of 12 months under the policy.
If the coverage under the policy is exhausted during the policy period, Recharge Benefit with a cap of Rs 1,50,000 is provided once for the remaining policy period.
Expenses incurred towards transportation of the insured from one hospital to another hospital for further treatment, are reimbursed. In case of emergency medical evacuation, up to a maximum of Rs 10,000 is payable under the policy.
In case of hospitalization for a life threatening medical condition at a place other than his usual place of residence, transportation expenses by air are reimbursed up to Rs 5,000 for one immediate family member.
Expenses incurred towards the repatriation of mortal remains of the insured is reimbursed up to Rs 5,000 during the policy period.
In the event of hospitalization with one of the network hospitals, a lump sum amount equal to 1% of Basic Sum Insured with a cap of Rs 5,000 per policy period is payable. This benefit is applicable for sum insured of Rs 3 lakh and above.
If the insured person opts for a shared accommodation during in-patient hospitalization, Rs 800 per day is payable for SI of Rs 3 lakh to 15 lakh and Rs 1,000 per day is payable for SI of Rs 20 lakh and 25 lakh.
Expenses incurred for treatment under Ayurveda, Unani, Sidha and Homeopathy is payable up to a maximum of Rs 20,000 is payable, depending on the sum insured chosen.
Medical expenses incurred towards Assisted Reproduction Treatment are reimbursed up to a limit of Rs 1 lakh for SI of Rs 5 lakh and 2 lakh for SI of Rs 10 lakh & above.
In the event of road traffic accident resulting to in-patient hospitalization, the basic sum insured will be increased by 25% up to a maximum of Rs 5 lakh. The additional sum insured will be available once during the policy period.
For cataract surgery, limit per eye is up to Rs 50,000 and limit per policy period is up to Rs 75,000, depending on the sum insured chosen under the policy.
A co-payment of 20% of the admissible claim amount of the insured persons whose age at the time of entry is above 60 years.

Waiting Period Clause

Initial waiting period: An initial waiting period of 30 days from the commencement of the policy is to be followed for any hospitalization except for the accident claims.
Specific Waiting Period: Specific waiting period of 2 years is applicable for the list of specified treatments/surgeries under the policy contract.
Pre-existing waiting period: 48 months waiting period is applicable for covering pre-existing diseases.
Assisted Reproduction Treatment Waiting Period: Claim towards Assisted Reproduction Treatment is not admissible during the first 36 months of policy coverage.

Who can Buy the Plan?

Factor	Minimum	Maximum
Age (as on last birthday)	Adult: 18 Years, Children: 16 Days	Adult: 65 Years, Children: 25 Years
Sum Assured	3 Lacs	25 Lacs
Cover Type	Family Floater	-
Policy Tenure	1 Year	1 Year
Grace Period	30 Days	-
Free Look Period	15 Days	-
Riders	Nil	-