Star Health Cardiac Care (Platinum)

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

The Star Health Cardiac Care (Platinum) plan is designed to cater to individuals with pre-existing heart conditions and offers coverage from day 31. This plan offers coverage not only for heart-related expenses but also encompasses various other hospitalisation costs. However, the plan, while delivering valuable coverage, does have certain limitations. It lacks coverage for domestic treatments. Moreover, its core benefits, including modern treatment coverage, come with certain restrictions. Also, the plan does not offer the option for monthly premium payments, which might be a concern for some. As per our research, the insurer has received a higher number of complaints related to claim settlement as well as policy purchase, indicating a poor track record in terms of both purchase and claims service experience.

What are the benefits offered by the Star Health Cardiac Care (Platinum) Plan?

• Inpatient hospitalisation coverage: The Star Health Cardiac Care (Platinum) Plan offers coverage for inpatient hospitalisation. This means it takes care of expenses you incur when you are hospitalised for more than 24 hours including room fees, nursing expenses, doctor's fees, prescribed medications, ICU costs, and other associated costs.
• Pre-hospitalisation coverage: Before you are admitted to the hospital, you may incur certain medical costs called pre-hospitalisation charges. These include fees for consultations, tests, checkups, lab reports, etc. The insurer will pay for these costs only if they are related to the medical condition that eventually leads to your hospital stay and your claim is accepted as part of the coverage for inpatient hospitalisation. Star Health Cardiac Care (Platinum) Plan takes care of pre-hospitalisation expenses incurred up to 30 days prior to your hospital admission up to the sum insured.
• Post-hospitalisation coverage: Once you get discharged from the hospital, there might still be medical expenses to manage, called post-hospitalisation expenses. These expenses could involve follow-up visits to your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and similar services. For these expenses to be covered, they must be related to the same condition for which you were hospitalised, and your claim needs to be approved as part of the coverage for inpatient hospitalisation. With the Star Health Cardiac Care (Platinum) Plan, you can get coverage for post-hospitalisation costs for 60 days after your hospital stay up to the sum insured specified in the plan. 
• Daycare treatment coverage: Daycare treatment refers to medical procedures or surgeries that used to demand a long hospital stay but can now be done within 24 hours due to groundbreaking advancements in the medical field. The Star Health Cardiac Care (Platinum) Plan takes care of all such daycare procedures with no cap. Meaning, that all expenses for these procedures will be covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments are medical treatments for illnesses or injuries that require urgent attention at the hospital but are carried out at home due to the severity of a patient’s condition or if no hospital beds are available nearby. Unfortunately, the Star Health Cardiac Care (Platinum) Plan does not include coverage for the expenses of domiciliary treatments. 
• Organ donor coverage: The Star Health Cardiac Care (Platinum) Plan provides coverage for the expenses incurred for harvesting the heart from the organ donor up to 200% of the sum insured - where you are the organ recipient. Also, the organ donor cover includes a waiting period of 24 months for heart transplantation.
• Modern treatment coverage: The field of healthcare is rapidly progressing, introducing new and advanced treatments that were once thought impossible. Procedures like radio surgeries, stem cell therapy, etc. now have the potential to treat diseases that were previously believed to be incurable. Star Health Cardiac Care (Platinum) Plan provides coverage for these modern treatments. However, there are specific limits set for various treatments under this coverage. And, please note that modern treatments and cardiac ailments are not eligible for the restoration benefit. 
• Non-medical expenses coverage: Non-medical expenses are costs related to necessary items used during treatment, like gloves, nebulization kits, oxygen masks, and other vital supplies. These consumables can be expensive and accumulate to a hefty sum. Unfortunately, the Star Health Cardiac Care (Platinum) Plan does not include coverage for non-medical expenses. 
• No Claim Bonus: A No-Claim Bonus is a reward offered by the insurer if you do not file any claims during a policy year. Under the policy, you will receive 10% of the sum insured as a No Claim Bonus. However, if you do make a claim within the policy period, the accrued bonus will decrease. The maximum bonus you can accumulate under this plan is 100% of the sum insured. 
• Super No Claim Bonus: The Super No Claim Bonus operates much like the standard No Claim Bonus, but it is an accelerated version of it. However, it is important to note that the Star Health Cardiac Care (Platinum) Plan does not include the Super No Claim Bonus feature.  
• Restoration Benefit: Restoration Benefit is an exceptional feature that can help you replenish your base sum insured if it is used up in a policy year. This benefit is available for unrelated illnesses and can be utilised when your sum insured and No Claim Bonus have been completely used up. The restoration benefit is available once in a policy year for subsequent claims.

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

Star Health Cardiac Care (Platinum) Plan: Financial Limits

• Room rent limit: The room rent limit is the highest amount your insurance provider will cover for your chosen hospital room during your stay in the hospital. If you select a room within this limit, you will not have to pay extra costs. But, if you go for a room that is more expensive than what you are eligible for, you will face a proportional deduction. This implies that you will be accountable for a proportionate portion of the entire bill, not just the difference in room rent. Star Health Cardiac Care (Platinum) Plan includes a room rent limit covering up to a single private AC room. 
• ICU rent limit: The ICU rent limit is the highest amount that your health insurance policy will pay for your stay in the Intensive Care Unit (ICU) of a hospital.  It is worth noting that there is no ICU rent limit under the Star Health Cardiac Care (Platinum) Plan. 
• Copayment: A copayment, also called a copay, is the portion of the approved claim amount that you are required to pay from your end. Once you make the payment, the insurance company will handle the rest of the claim amount. Under the Star Health Cardiac Care (Platinum) Plan, there is no copay.  
• Deductible: A deductible is a certain amount you have to pay from your end before your health insurance starts covering your medical costs. In the Star Health Cardiac Care (Platinum) Plan, there is no deductible. 
• Limits on surgeries/treatments: It is the highest amount that your health insurance plan will pay for particular medical procedures or treatments. Some policies may set specific limits for certain procedures, while others may not. Under the Star Health Cardiac Care (Platinum) Plan, there is a cap of 40,000/- per eye per policy year (maximum up to 60,000 per policy year) for cataract treatment. However, joint replacement surgery is covered 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 Cardiac Care (Platinum) Plan: Waiting Periods & Exclusions

👉Waiting period:

After buying a health insurance policy, you need to wait a certain period of time before you can avail of coverage for certain illnesses or medical conditions. Once you serve this waiting period, you can claim for these conditions. Here are some of the waiting periods -

• Initial waiting period: There's a 30-day waiting period for all medical conditions except for accidents. This means that you cannot claim for hospitalisation expenses in the first 30 days unless it is due to an accident. 
• Waiting period for pre-existing diseases: A pre-existing disease refers to any medical condition or illness you had in the last 36 months before buying your health insurance. With the Star Health Cardiac Care (Platinum) Plan, there is a waiting period of 36  months for pre-existing diseases and 30 days for cardiac-related conditions. This means that during this period, the policy will not pay for any expenses related to your pre-existing medical conditions. 
• Waiting period for specific diseases: Insurers have a list of medical conditions or illnesses that entails waiting periods, apart from your pre-existing conditions. This waiting period is set by the insurer and is not influenced by your current health status. The Star Health Cardiac Care (Platinum) Plan has a waiting period of 24 months for specific diseases.

👉Exclusions: 

Exclusions in your health insurance policy are particular situations or conditions that the policy does not cover. These include -

• Standard permanent exclusions: All insurance companies in India must adhere to a list of 'standard permanent exclusions' mandated by the IRDAI (Insurance Regulatory and Development Authority of India). Some of them include -

1. Investigation and evaluation: Admission to the hospital just for observation or monitoring.
2. Rest cure, rehabilitation, and respite care: Admitted to a facility for bed rest without active medical treatment.
3. Obesity/weight control: Any treatment or surgery related to weight control or obesity.
4. Change of gender treatment: Treatments to change your body's characteristics to those of the opposite sex.
5. Plastic/cosmetic surgery: Procedures to alter your body's appearance or features.
6. Profession in hazardous or adventure sports: Treatment expenses resulting from participating as a professional in risky activities like mountaineering, scuba diving, etc.
7. Breach of law: Medical costs for a person involved in illegal activities with criminal intent.
8. Excluded providers: Treatment from a hospital facility or medical practitioner not covered by the insurer.
9.  Narcotics: Treatment for conditions like alcohol, drug addiction, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses for treatment in health spas, nursing homes, or similar places primarily used for non-medical reasons.
11. Dietary supplements, substances purchased without prescription: Costs of vitamins, minerals, etc., not prescribed by a doctor.
12. Refractive error: Expenses for correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Medical procedures that are not proven to be effective.
14. Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Expenses related to both pre/post-natal care and hospitalisation during childbirth.

• Additional permanent exclusions: Apart from the standard permanent exclusions mentioned earlier, insurance companies might also have additional exclusions for certain situations or health conditions. If you have particular diseases or serious medical conditions that insurers consider too risky to cover, they might decide to permanently exclude them from your policy. However, it is important to note that insurers are restricted to a list of illnesses outlined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion. They cannot impose permanent exclusions to illnesses or diseases beyond this list.
• Non-standard exclusions (Specific exclusions): These are specific exclusions that extend beyond the standard permanent exclusions set by the IRDAI. They can differ between insurance companies and depend on the terms and conditions of the policy. Here's a list of specific exclusions under the Star Health Cardiac Care (Platinum) Plan -

1. Circumcision unless it is necessary to treat a disease or injury.
2. Treatment expenses for external birth defects.
3. Treatment for general weakness, recovery, nutritional deficiency, or rundown conditions.
4. Intentionally self-inflicted injuries or attempted suicide.
5. Injuries or illnesses caused by war, foreign invasion, war operations, or warlike activities.
6. Diseases or injuries resulting from nuclear weapons or materials
7. Specific therapies like hyperbaric oxygen therapy, low-level laser therapy, and photodynamic therapy.
8. Biological treatments unless given during in-patient hospitalisation.
9. Treatment for erectile dysfunction.
10. Costs of vaccinations and inoculations, except for post-animal bite and therapeutic treatments.
11. Dental treatment, unless it is needed due to an accident.
12. Sleep apnea and endocrine disorder treatments.
13. Expenses for spectacles, contact lenses (beyond what is specified), hearing aids, walkers, crutches, wheelchairs, and similar items.
14. Treatments using medical systems other than allopathy.

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 in less than 30 days. This shows that your claims will be handled promptly and smoothly, without any unnecessary delays.
• Claim-related complaints: Based on our research, Star Health and Allied Insurance Company Limited has received a higher number of complaints regarding claims, when compared to other insurance companies, accounting to 0.56%.
• Claims incurred ratio: The claims incurred ratio is a metric used to gauge the financial performance of an insurer. It is the ratio of the overall claims paid by the insurer in relation to the total premiums they have collected. Star Health and Allied Insurance Company Limited has a claims incurred ratio of 66.47%. 
• Claim settlement ratio: The claim settlement ratio is the proportion of total number of claims resolved by an insurer in relation to the overall number of claims received in a financial year. Star Health and Allied Insurance Company Limited has a claim settlement ratio of 85.32%.
• Network hospitals: With a broad network encompassing more than 14,000+ hospitals, Star Health and Allied Insurance Company Limited ensures widespread access to healthcare facilities. This extensive network allows you to seek cashless treatments from various providers across different locations. 

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

• Policy purchase-related complaints: Our research highlights that Star Health and Allied Insurance Company Limited has received a higher number of complaints related to post-sales service, as compared to other insurers, accounting for 0.06%.
• Response on Toll-Free: As per our research, Star Health and Allied Insurance Company Limited’s toll-free response rate is quick as compared to other insurance providers. 
• Response on Twitter: According to our research, Star Health and Allied Insurance Company Limited's response time on Twitter is relatively slower, when compared to other insurance companies.

About Star Health and Allied Insurance Company Limited 

Star Health and Allied Insurance Company Limited holds the distinction of being India's first Standalone Health Insurance provider. Their range of products caters to various segments, including individuals, families, and corporations. Established in 2006, the company is headquartered in Chennai, Tamil Nadu. Mr. V. Jagannathan serves as the company's chairman and CEO.