Star Health Assure

Star Health Assure is a health insurance policy that is offered by Star Health and Allied Insurance Company Limited.

This health insurance plan provides extensive coverage, encompassing maternity, infertility treatment, and consumable expenses, along with hospitalisation-related costs. However, it lacks the option for monthly premium payments. Our research indicates a relatively higher volume of complaints regarding both claim settlement and policy purchase processes, suggesting a less favourable track record in terms of both policy purchase and claims service experience.

What are the benefits offered by the Star Health Assure Plan?

• Inpatient hospitalisation coverage: Star Health Assure Plan provides coverage for inpatient hospitalisation expenses which includes costs you incur when you are hospitalised for more than 24 hours. These include room boarding and nursing charges, the cost of prescribed medications and drugs, medical practitioner fees, ICU charges, and other associated expenses.
• Pre-hospitalisation coverage: Medical expenses you incur prior to hospital admission are called pre-hospitalisation expenses. These expenses include the fees for consultations, tests, checkups, lab reports, etc. To be eligible for coverage, the expenses should be related to the medical condition that leads to hospitalisation and your claim for these expenses must be approved as part of inpatient hospitalisation coverage. In the Star Health Assure Plan, pre-hospitalisation expenses are covered for 60 days before hospitalisation up to the sum insured.                         
• Post-hospitalisation coverage: Medical costs you incur after you are discharged from the hospital are called post-hospitalisation expenses. These costs include the expenses related to follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, etc. To be eligible for coverage, these expenses must be related to the condition that led to your hospitalisation, and your claim must be approved under inpatient hospitalisation coverage. In the Star Health Assure Plan, post-hospitalisation expenses are covered for 180 days after your hospitalisation up to the sum insured.
• Daycare treatment coverage: These are essentially medical procedures or surgeries that once required prolonged hospital stay but can now be accomplished within 24 hours due to groundbreaking advancements in the healthcare field. In the Star Health Assure Plan, all daycare procedures are covered up to the specific sum insured you choose.
• Domiciliary treatment coverage: These are essentially medical treatments for illnesses or injuries that necessitate immediate attention at the hospital but are administered at home because of the severity of the patient’s medical situation or the unavailability of beds in nearby hospitals. In the Star Health Assure Plan, domiciliary treatments (except for 14 illnesses) are covered up to the sum insured.
• Organ donor coverage: Star Health Assure Plan covers the inpatient costs of the organ donor up to the specific sum insured – where you are the organ recipient. It also covers expenses for treating complications arising from a donor's surgery. You can opt for an additional cover beyond the sum insured as well. 
• Modern treatment coverage: In the ever-changing landscape of healthcare, advancements are breaking barriers, turning treatments once deemed impossible into a reality. Cutting-edge interventions, including radio surgeries, stem cell treatments, etc. are fostering hope and holding the promise of potential cures for conditions that were previously considered beyond the scope of medical capabilities. The Star Health Assure Plan provides coverage for such modern treatments up to the sum insured.
• Non-medical expenses coverage: The Star Health Assure Plan provides coverage for non-medical expenses. These are costs related to consumables, such as gloves, nebulization kits, and other items that are necessary for treatment and are covered up to the sum insured without any limit. 
• No Claim Bonus: No Claim Bonus is a reward offered to you if you do not file any claims during a policy year. Star Health Assure Plan provides 25% of the sum insured as a No Claim Bonus. You can accumulate a maximum bonus of up to 100% of the sum insured. Please note that your accumulated bonus will reduce at the rate it was earned if you make claims. 

However, you can keep your accumulated bonus amount intact in case only the base sum insured is utilised for claim settlement by opting for an add-on. In case the No Claim bonus is used for claims, it will reduce at the rate it was earned. Also, the No Claim Bonus used for a claim will not be refilled on renewal.

• Super No Claim Bonus: The Super No Claim Bonus is an enhanced version of the standard No Claim Bonus and operates in the same way. However, the Star Health Assure Plan does not offer the Super No Claim Bonus feature.
• Restoration Benefit: The Restoration Benefit is a valuable feature that restores your sum insured once it is used up during a policy year. The Star Health Assure Plan offers this benefit for both related and unrelated illnesses. It becomes active when both the sum insured and the No-Claim Bonus are partially exhausted. You can utilise this benefit unlimited times in a policy year for subsequent claims.

Please note that the limits and conditions mentioned in the above benefits and features are for a sum insured of Rs. 10 Lakhs

Star Health Assure Plan: Financial Limits

• Room rent limit: It is the maximum limit that your insurance company will pay for the room you stay in while being hospitalised. Opting for a room that falls within your plan's room rent limit will not lead to any out-of-pocket expenses. But, if you opt for an expensive room more than what you are eligible for, you will face a proportionate deduction. This means that you will have to bear a proportionate share of the entire hospital bill, rather than just the room rent difference. Star Health Assure Plan offers you the freedom to select any room type except suite and above category without imposing any limit.
• ICU rent limit: It is the maximum amount that a health insurance policy covers for the cost of your stay in the ICU of a hospital. The Star Health Assure Plan does not have an ICU rent limit. Meaning, that the insurer covers the entire cost of an ICU stay without any limit.
• Copayment: It is a portion of the approved claim amount that you need to pay from your end. And, the insurer will step in and cover the remaining amount. The Star Health Assure Plan entails a copayment limit of 10% for individuals aged 61 years and above at the time of enrolment.
• Deductible: A deductible is a certain amount that you have to pay from your end before your policy steps in to cover the rest of your medical expenses. The Star Health Assure Plan offers you the freedom to select your deductible limit from two options - Rs 50,000, or Rs 1,00,000.
• Limits on surgeries/treatments: It is the maximum amount that your insurer will pay for certain medical procedures or treatments. Some policies may place a cap on the amount that they will cover for specific procedures, while others may not. Star Health Assure Plan covers cataract treatments and joint replacement surgeries up to the sum insured without any limit.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs.

Star Health Assure Plan: Waiting Periods & Exclusions

👉Waiting period
Some illnesses and diseases may not be covered for a certain duration after you purchase a health insurance policy. This time frame is referred to as the waiting period. You can claim these conditions once the waiting period ends. Here are some types of waiting periods -

• Initial waiting period: Star Health Assure Plan has an initial waiting period of 30 days for all medical conditions, except for accidents. So, you will not be eligible to claim any hospitalisation expenses, unless it is a result of an accident.
• Waiting period for pre-existing diseases: Essentially, a pre-existing disease is any illness or medical condition that you have experienced within 36 months prior to securing a health insurance policy. Star Health Assure Plan has a waiting period of 36 months for pre-existing diseases. During this period, you cannot file any claim for expenses related to pre-existing diseases.
• Waiting period for specific diseases: Insurance companies may apply waiting periods on certain medical conditions or illnesses apart from your pre-existing diseases. These waiting periods are decided by the insurer and are not based on your current state of health. The Star Health Assure Plan has a waiting period of 24 months for specific diseases.

👉Exclusions
There are certain situations that your insurer will not cover at any cost which are referred to as exclusions. These include –

• Standard permanent exclusions: All insurance companies must stick to a set of “standard permanent exclusions” stipulated by the IRDAI or Insurance Regulatory and Development Authority of India. These exclusions include –  

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes.
2. Rest cure, rehabilitation, and respite care: Hospital admission to a facility for bed rest where no active medical treatment is administered.
3. Obesity/weight control: Any treatment or surgery designed for weight control or obesity.
4. Change of gender treatment: Any medical treatment designed to alter the characteristics of the body to that of the opposite gender.
5. Plastic/cosmetic surgery: Any surgical or medical procedures for the modification of appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while you are engaging as a professional in adventure activities such as skydiving, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses incurred for treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment that is received from a medical practitioner or hospital excluded by the insurance company.
9. Narcotics: Treatment meant for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged specifically for domestic purposes: Expenses related to receiving treatments from health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances bought without prescription: Vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses related to correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses associated with birth control, sterility infertility: Contraception, artificial insemination, sterilisation, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Expenses related to pre/post-natal care, childbirth, hospitalisation, etc.

• Additional permanent exclusions: Besides the list of standard permanent exclusions defined by the IRDAI, insurance companies can also apply “specific exclusions'' based on certain medical conditions or situations. If the insurer regards certain diseases or severe medical conditions as too risky, they may permanently exclude them from coverage under your policy. It is important to note that insurers can only apply permanent exclusions to a list of pre-approved illnesses outlined by the IRDAI. They cannot permanently exclude any disease or medical condition beyond this list.
• Non-standard exclusions (Specific exclusions): These exclusions extend beyond the standard permanent exclusions established by the IRDAI and can differ across insurers based on their individual policies and conditions. Here are some of the specific exclusions under the Star Health Assure Plan –

1. Circumcision unless required due to accident, preputial dilatation, removal of SMEGMA, etc.
2. Expenses associated with treating external birth diseases, defects or anomalies.
3. Treatment related to convalescence, general debility, run-down condition, and nutritional deficiency states.
4. Treatment expenses related to intentional self-inflicted injury.
5. Injury or disease resulting from war, invasion, act of a foreign enemy, warlike operations, etc.
6. Injury or illness resulting from nuclear weapons or materials.
7. Expenses related to specific therapies such as hyperbaric oxygen therapy, low-level laser therapy, photodynamic therapy, etc.
8. Treatments that are untested, unconventional, or experimental.
9. Expenses related to procedures like Platelet-Rich Plasma (PRP) treatments, intra-articular injection therapy,  chondrocyte implantation, etc.
10. Expenses related to biologicals unless administered for in-patient hospitalisation
11. Expenses associated with vaccination and inoculation costs except in the case of post-animal bite treatment and medical treatment for therapeutic reasons.

What to expect in terms of claims experience if you buy from Star Health and Allied Insurance Company Limited?

• Speed of claims: Star Health and Allied Insurance Company has settled 98.86% of claims, within 30 days. This indicates that they provide a prompt and efficient claim settlement process.
• Claim-related complaints: According to our research, Star Health and Allied Insurance Company Limited has received a higher number of complaints related to claims, as compared to other insurers, accounting for 0.56%.
• Claims incurred ratio: It is a measure of the financial performance of an insurer. It is the ratio of the total claims incurred by the insurer to the total premiums collected in a financial year. Star Health and Allied Insurance Company’s claims incurred ratio is 66.47%.
• Claim settlement ratio Star Health and Allied Insurance Company’s claim settlement ratio of 85.32%. It is the percentage of claims settled by the health insurer compared to the total claims received in a financial year.
• Network hospitals: Star Health and Allied Insurance Company offers a vast network of over 14,000+ hospitals. The extensive network ensures that customers can access cashless treatments from a diverse range of healthcare providers across various locations without any financial burdens.

How is the customer service of Star Health and Allied Insurance Company Limited?

• Policy purchase-related complaints: According to our research, Star Health and Allied Insurance Company have received a higher number of complaints related to their after-sales service, as compared to other insurers, accounting for 0.06%.
• Response on toll-free: As per our research, we found that the response rate on Star Health and Allied Insurance Company's toll-free number is quick, as compared to other insurers. 
• Response on Twitter: As per our research, Star Health and Allied Insurance Company’s response time on Twitter is slow.

About Star Health and Allied Insurance Company Limited

India's pioneer standalone health insurance provider, Star Health and Allied Insurance Company Limited, was established in 2006.  The company delivers a range of products catered to the unique needs of individuals, families, as well as corporations. Headquartered in Tamil Nadu, the company is led by Mr. V. Jagannathan, who serves as both the chairman and CEO.