Star Health Cancer Care (Platinum)

The Star Health Cancer Care (Platinum) policy is a health insurance policy offered by Star Health and Allied Insurance Company Limited.

It is tailored to provide comprehensive support to individuals facing cancer-related challenges. This policy extends coverage not only to cancer-related treatments but also encompasses non-cancer ailments, rehabilitation, pain management, and compassionate hospice care for those dealing with advanced, life-limiting cancers. One of the noteworthy advantages is the provision for a lump sum payout in the unfortunate event of cancer recurrence or the emergence of a second malignancy. 

On the flip side, this policy does not offer the convenience of a monthly premium payment option. And, as per our research, the insurer has received a higher number of complaints related to claim settlement and policy purchase. This shows that they have a poor track record in terms of both purchase and claims settlement processes.

What are the Benefits Offered by the Star Health Cancer Care (Platinum) Policy?

• Inpatient Hospitalisation Coverage: The Star Health Cancer Care (Platinum) Policy provides coverage for inpatient hospitalisation. These include expenses incurred when you are hospitalised for over 24 hours such as room charges, nursing fees, doctor's fees, prescribed medicines, ICU charges, and other associated costs.
• Pre-Hospitalization Coverage: Pre-hospitalization charges refer to medical expenses you incur before going to the hospital such as consultations, tests, checkups, lab reports, etc. The insurer will cover these costs up to the sum insured, only if they are related to the medical condition that ultimately leads to your hospitalisation and your claim is approved as part of the inpatient hospitalisation coverage. The Star Health Cancer Care (Platinum) Policy offers coverage for pre-hospitalization expenses up to 30 days before your hospitalisation, up to the sum insured.
• Post-Hospitalization Coverage: Post-hospitalization expenses are the medical expenses you incur once you get discharged from the hospital such as doctor's follow-up appointments, medical check-ups, rehabilitation sessions, physiotherapy sessions, etc. To be eligible for coverage, these expenses must be linked to the condition that led to your hospitalisation and your claim should be accepted as part of your inpatient hospitalisation coverage. With the Star Health Cancer Care (Platinum) Policy, your post-hospitalization expenses are covered for a period of 60 days after you leave the hospital up to 2% of the total sum insured for each hospitalisation.
• Daycare Treatment Coverage: Daycare treatment involves medical procedures or surgeries that used to require a lengthy hospital stay but can now be completed within 24 hours, with the help of advancements in medical technology. The Star Health Cancer Care (Platinum) Policy provides coverage for all daycare procedures without placing any cap.
• Domiciliary Treatment Coverage: Domiciliary treatments are medical treatments or procedures that need medical attention at a hospital but can sometimes be provided at home when a patient is too ill or injured to safely travel to a hospital, or if there are no available hospital beds nearby. However, it is important to note that the Star Health Cancer Care (Platinum) Policy does not provide coverage for domiciliary treatments.
• Organ Donor Coverage: The Star Health Cancer Care (Platinum) Policy does not include coverage for organ donor expenses.
• Modern Treatment Coverage: Advancements in technology are rapidly improving healthcare and enabling the development of cutting-edge treatments, such as radio surgeries and stem cell therapy. These treatments are now tackling diseases that were previously thought to be incurable. The Star Health Cancer Care (Platinum) Policy is designed to stay updated with these advancements and offers coverage for the costs of these modern treatments. It is however important to note that there are specific sub-limits that are applicable to various treatments.
• Non-Medical Expenses Coverage: Non-medical expenses are the costs associated with consumables like gloves, nebulization kits, oxygen masks, and other consumables used during treatment. These items can be quite expensive and add up to a big sum. However, the Star Health Cancer Care (Platinum) Policy does not provide coverage for these expenses.
• No Claim Bonus: Under the Star Health Cancer Care (Platinum) Policy, you have the opportunity to earn a No-Claim Bonus as a reward for not making any claims throughout the policy duration. You receive 5% of the sum insured as No Claim Bonus. The maximum bonus you can accumulate through this plan is 50% of the sum insured. However, you should be aware that if you do make a claim during the policy period, the accumulated bonus will decrease.
• Super No Claim Bonus: The Super No Claim Bonus works just like the regular No Claim Bonus, but it is an accelerated version. However, it is important to know that the Star Health Cancer Care (Platinum) Policy does not provide a Super No Claim Bonus.
• Restoration Benefit: The Restoration Benefit is a valuable feature that replenishes your sum insured to its initial amount if it gets depleted within a policy year. However, the Star Health Cancer Care (Platinum) Policy does not include this feature.

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

Star Health Cancer Care (Platinum) Policy: Financial Limits

• Room Rent Limit: The room rent limit is the highest amount your insurance company will pay for the hospital room you pick during your hospital stay. If your chosen room falls within this limit, you will not incur any extra expenses. However, if you opt for a room that costs more than your allowed limit, you will need to pay a proportional deduction i.e., pay a portion of the total bill, not just the difference in room rent. The Star Health Cancer Care (Platinum) Policy includes a room rent limit covering up to a single private AC room.
• ICU Rent Limit: The ICU rent limit is the maximum amount that your health insurance policy will pay for your stay in the Intensive Care Unit (ICU) at a hospital. The Star Health Cancer Care (Platinum) Policy imposes no limit on the ICU rent.
• Copayment: A copayment, or copay for short, is part of the approved claim amount that you need to cover from your end. After you make the payment, the insurance company will handle the remaining claim amount. In the case of the Star Health Cancer Care (Platinum) Policy, there's a copayment limit of 10% for individuals aged 61 years and above at the time of policy entry.
• Deductible: A deductible is the amount you need to pay out of your own pocket before your health insurance kicks in to cover your medical costs. In the Star Health Cancer Care (Platinum) Policy, there is no deductible limit.
• Limits on Surgeries/Treatments: This is the maximum amount your health insurance policy will pay for specific medical procedures or treatments. Some policies might have limits for certain procedures, while others may not. In the Star Health Cancer Care (Platinum) Policy, cataract treatment costs are covered, up to Rs. 40,000/- per eye per policy year subject to maximum of Rs. 60,000 per policy year). For joint replacement surgery, expenses are covered up to the sum insured.

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 Cancer Care (Platinum) Policy: Waiting Periods & Exclusions

👉Waiting period

Certain illnesses and diseases will not be covered for a specific period of time right after purchasing your health insurance policy. This timeframe is known as the waiting period. After this waiting period ends, you can make claims for these conditions. There are various types of waiting periods, including –

• Initial Waiting Period: For all medical conditions except accidents, there is a 30-day waiting period. During this time, you cannot make any hospitalisation claims, unless it is due to accidents.
• Waiting Period for Pre-Existing Diseases: A pre-existing disease is a medical condition or illness you had in the past 36 months before getting your health insurance policy. With the Star Health Cancer Care (Platinum) Policy, there is a 30-month waiting period for pre-existing diseases. This means that during this time, the policy will not cover any costs related to your pre-existing conditions.
• Waiting Period for Specific Diseases: Apart from pre-existing conditions, insurance companies may have a list of medical conditions or illnesses that come with their own waiting period. This waiting period is determined by the insurer and is not related to your current health status. Under the Star Health Cancer Care (Platinum) Policy, the waiting period for specific diseases is 24 months. 

👉Exclusions

Exclusions are specific situations that your health insurance policy will not cover. These situations may include –

• Standard Permanent Exclusions: The IRDAI (Insurance Regulatory and Development Authority of India) has established a list of 'standard permanent exclusions' that all insurance companies must follow. Some of these exclusions includes –

1. Investigation and Evaluation: Hospital admission for observation or monitoring purposes only.
2. Rest Cure, Rehabilitation, and Respite Care: Admission to a facility for bed rest without any active medical treatment.
3. Obesity/Weight Control: Treatments or surgeries intended for weight control or managing obesity.
4. Profession in Hazardous or Adventure Sports: Treatment expenses incurred while participating professionally in risky activities like mountaineering, river rafting, snorkelling, scuba diving, horse racing, etc.
5. Breach of Law: Expenses related to the treatment of a person who has committed or attempted to commit a criminal violation of the law.
6. Excluded Providers: Treatment received from a medical practitioner or hospital.
7. Narcotics: Treatment for addictive conditions such as alcohol addiction and drug usage.
8. Change of Gender Treatment: Treatment aimed at changing the body's characteristics to those of the opposite sex.
9. Plastic/Cosmetic Surgery: Treatment or surgery for altering body characteristics or appearance.
10. Dietary Supplements, Substances Purchased Without Prescription: Vitamins, minerals, etc., that are not prescribed by a medical practitioner.
11. Refractive Error: Expenses associated with correcting refractive errors up to 7.5 diopters for vision improvement.
12. Unproven Treatments: Surgeries, medical procedures, or treatments that are not proven to be successful.
13. Expenses Related to Birth Control, Sterility, and Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
14. Treatments in Establishments Arranged for Domestic Purposes: Expenses for treatment administered in health spas, nursing homes, or similar establishments primarily or partially for domestic reasons.
15. Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, and related treatments.

• Additional Permanent Exclusions: In addition to the standard permanent exclusions, we discussed earlier, insurance companies may also exclude certain situations or specific medical conditions from coverage. If you have particular diseases or severe medical conditions that insurers view as too risky to cover, they might permanently exclude them from your policy. However, it is crucial to understand that insurers are limited to a list of illnesses outlined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can impose a permanent exclusion. They cannot apply permanent exclusions to illnesses or diseases that are not on the list.
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that extend beyond the standard permanent exclusions established by the IRDAI. These exclusions can vary from one insurance company to another and are dependent on the policy's specific terms and conditions. Here are some of the specific exclusions outlined in the Star Health Cancer Care (Platinum) Policy –

1. Circumcision, unless necessary for treating a disease or injury.
2. Expenses for treatment related to external birth defects.
3. Convalescence, general debility, a run-down condition, and nutritional deficiency states.
4. Treatment related to intentional self-inflicted injury or attempted suicide by any means.
5. Venereal and sexually transmitted diseases, except for HIV.
6. Injury or disease due to war, invasion, acts of foreign enemies, and warlike operations.
7. Injury or illness due to nuclear weapons or materials.
8. Specific therapies such as hyperbaric oxygen therapy, low-level laser therapy, photodynamic therapy, etc.
9. Therapies that are untested, unconventional, or experimental.
10. Biologicals, unless administered for in-patient hospitalisation.
11. Treatments related to erectile dysfunction.
12. Vaccination and inoculation costs, except for post-animal bite treatment and medical treatment for therapeutic reasons.
13. Dental treatment, except when required due to an accident.
14. Treatment for sleep apnea and endocrine disorders.
15. The cost of spectacles and contact lenses (beyond what is specifically provided), hearing aids, walkers, crutches, wheelchairs, and similar equipment.
16. Treatment by systems of medicine other than allopathy.
17. Expenses related to naturopathy.

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 Limited has settled 98.86% of claims within 30 days. This means there is a higher chance that you will receive your claim amount promptly.
• Claim-Related Complaints: Our research indicates that Star Health and Allied Insurance Company Limited has received only 0.56% of complaints related to overall claims. This is a remarkably higher number compared to other insurance companies.
• Claims Incurred Ratio: The claims incurred ratio is a financial performance metric for insurance companies. It is the percentage of total claims paid out by the insurer in relation to the total premiums they collected. Star Health and Allied Insurance Company Limited boasts a claims incurred ratio of 66.47%.
• Claim Settlement Ratio: The claim settlement ratio represents the percentage of claims an insurer has successfully settled compared to the total number of claims received in a financial year. Star Health and Allied Insurance Company Limited maintains a commendable claim settlement ratio of 85.32%.
• Network Hospitals: Star Health and Allied Insurance Company Limited has established an extensive network of over 14,000+ hospitals. This vast network allows you to take advantage of cashless treatments at various healthcare facilities in diverse locations.

How is the Customer Service of Star Health and Allied Insurance Company Limited?

• Policy Purchase-Related Complaints: Our research reveals that Star Health and Allied Insurance Company Limited has received a higher number of complaint rates compared to other insurance companies at 0.06%. 
• Response on Toll-Free: As per our research, Star Health and Allied Insurance Company Limited delivers quick responses when contacted through their toll-free number.
• Response on Twitter: Star Health and Allied Insurance Company Limited’s response time on Twitter tends to be relatively slower in comparison to other insurers.

About Star Health and Allied Insurance Company Limited 

Star Health and Allied Insurance Company Limited is India's pioneer Standalone Health Insurance provider. Since its establishment in 2006, the company has been dedicated to serving a diverse clientele, including individuals, families, and corporations. Headquartered in Chennai, Tamil Nadu, the company is led by Mr. V. Jagannathan, who serves as both the chairman and CEO.