Case study

Star health

Benefits of senior citizen health insurance plans offered by Star Health and Allied Insurance:

 Senior citizens aged 60 to 75 years can apply for the plan.

 No-pre insurance medical test is required.
 Insurance covers pre-existing diseases from 2nd year onwards.
 Policy comes with a guaranteed lifetime renewability option.
 Medical consultations can be availed as an outpatient in a network hospital.

The following features/terms are common to all plans on offer:

In-patient hospitalization/treatment which includes hospital expenses* incurred for a minimum of 24

hrs. (unless otherwise mentioned).

Pre-hospitalization Expenses: Generally up to 30 days.

Post-hospitalization Expenses: Generally up to 60 days; usually met through a lump sum payment @7%
of the expenses or Rs.5,000, whichever is less.

Pre-existing diseases are included subject to prior coverage by a domestic insurer; usually for the four
years preceding policy inception (2 or 3 years where specified).

Floater Basis: Family includes the primary policyholder, husband/wife and children who are dependent
on the parent (generally subject to an age cap of 25 years); Sum assured is equally apportioned among
insured members.

Individual Basis: The sum assured is per person insured

Reinstatement of sum assured: Normally allowed after a specified number of claim-free years

*(Room, Nursing, Boarding, Surgery, Anaesthetist, Medical Practitioner, Consultation, Specialists,

Oxygen, OT charges, X-ray, Dialysis, Chemotherapy, Diagnostic Materials, Blood, Medicine, Drugs etc.
depending on the plan chosen. This is not a restrictive list)

Star Health and Allied Insurance Mediclaim Premium Calculator:

The online premium calculator available on the insurer’s website makes it easy for insurance premium
calculation of your chosen health insurance policy. Visit the official website of Star Health Insurance and
click on the chosen plan. For instance, if you have chosen a family insurance plan, enter how many adults
and children you want to insure under the scheme, enter the sum insured amount, the date of birth of
the eldest member of your family, your mobile number and email ID. Click on Proceed To Buy. You will
get an instant quote of the insurance premium for the chosen policy.

Star Health and Allied Insurance Policy Document:

It is important to go through the policy document for inclusions and exclusions when buying an
insurance plan so as to avoid any hassle when making a claim. Star Health and Allied Insurance
application form, policy document, brochures, pre-authorisation form, and KYC form are available on the
insurer’s website. You can download the forms, fill it, and submit it at the nearest Star Health Insurance
branch office.

Star Health and Allied Insurance Customer ID:

A new health insurance scheme was launched by the Tamil Nadu state government in partnership with
the stand-alone health insurance company, Star Health and Allied Insurance to provide health cover for
government employees. The insurance company issued identity cards to the employees and the
beneficiaries covered under the new health insurance scheme through the respective pay drawing
officers within a period of 60 days from the date of commencement of the scheme.

Star Health and Allied Insurance Network Hospitals:

Star Health and Allied Insurance has tie-ups with over 8,200 hospitals across the country where
policyholders with a Star Health Insurance policy can avail cashless hospitalisation as well as
reimbursement facility. It is one of the largest base of network hospitals in India. The insurer also offers a
hassle-free claim settlement process without the intervention of a Third-Party Administrator (TPA).

To locate a network hospital near your home, select your state and city from the drop-down box on the
online Network Hospital Locator. You will get a list of network hospitals with contact details instantly.
Star Health also has tie-ups with Agreed Network Hospitals where the insured members can avail
cashless transactions and get package rates for identified procedures.

How to File a Claim with Star Health?

Cashless Claim: Visit a network hospital of the insurer to avail cashless treatment. Intimate the insurer
within 24 hours of unplanned hospitalisation and 48 hours prior to your planned hospitalisation by
calling the toll-free number of Star Health Insurance.
Display your Star Health ID at the network hospital help desk. The hospital will verify your identity details
and submit a duly-filled and signed pre-authorisation request form to the insurance company.

Star Health will appoint a doctor to verify the pre-authorisation request and send an approval letter to
the hospital.

The hospital will proceed with the cashless treatment for the insured member.

If the cashless claim is denied, the insured member can get treated and file for a reimbursement claim
after discharge.

Reimbursement Claim: A field doctor will be assigned by Star Health to make hospitalisation easier for
the insured. All claim intimations have to be made within 24 hours of hospitalisation. Reimbursement
facility can be availed at network as well as non-network hospitals.

Settle all the hospital bills at the time of discharge and collect all the original documents such as
discharge summary, prescription, medical bills, hospital bills, pharmacy bills, etc.

Submit a reimbursement claim form along with the original medical documents at the nearest Star
Health branch office within 30 days of discharge.

Upon successful verification and approval, the claim amount will be sent to the insured.

Senior Citizen's Red Carpet:

Senior citizens are an oft-ignored segment of the health insurance industry given their limited incomes
and high susceptibility to age-related illnesses. Star Health has addressed this group's protection needs
through this Star senior citizen's red carpet plan which provides affordable and adequate coverage along
with attractive features

Entry Age 60 to 75 years

Renewals Guaranteed after 75 years

Sum assured Rs.1 lakh to Rs.10 lakhs

Premium charges Rs.4,450 to Rs.22,500 depending on sum assured

chosen

Discount 5% (based on meeting certain criteria)

Medical screening Not required.

Treatment Provided at any network hospital

Co-payment 50% for pre-existing disease claims; 30% for other

claims

Covers All types of pre-existing diseases effective from first

policy year or from the second year if treatment
was availed in the year preceding inception,
ICU/Nurse/Specialist/Consultation/Surgeon
charges (as per limits), Cardiovascular
diseases/Cancer/Bone breakage/Cerebrovascular
accidents/Renal Complications and other major
surgeries, Post-hospitalization expenses,
Ambulance charges