Star Health Comprehensive is a health insurance policy offered by Star Health and Allied Insurance Company Limited.
Aside from hospitalisation and related expenses, this plan covers maternity expenses, non-medical expenses, outpatient department costs, bariatric surgery costs, etc. Compared to other plans, it is reasonably priced. But, you can't pay your premiums on a monthly basis as it doesn't offer a monthly payment option. According to our research, the insurer has received more complaints regarding claim settlements and policy purchases - making it a less reliable option. So, it is important to be aware of its limitations in order to make an informed decision.
What are the benefits offered by the Star Health Comprehensive Plan?
- Inpatient hospitalisation coverage: Star Health Comprehensive Plan covers the cost of inpatient hospitalisation. These are expenses you incur while you are hospitalised for more than 24 hours such as room boarding and nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges, and other related expenses.
- Pre-hospitalisation coverage: These are medical expenses incurred before getting admitted to the hospital, such as consultations, tests, checkups, lab reports, etc. Your insurer will cover these expenses only if they are related to the medical condition for which you are later hospitalised and approved as part of your inpatient hospitalisation. Pre-hospitalisation expenses incurred up to 60 days before hospitalisation are covered under the Star Health Comprehensive Plan - up to the sum insured.
- Post-hospitalisation coverage: You may incur medical expenses after being discharged from the hospital including follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. These are called post-hospitalisation expenses. These expenses must be related to the condition for which you were admitted to the hospital and your claim must be approved under inpatient hospitalisation to be eligible for coverage. Post-hospitalisation expenses incurred up to 90 days after hospitalisation are covered under the Star Health Comprehensive Plan - up to the sum insured.
- Daycare treatment coverage: A daycare treatment is a medical procedure or surgery that used to require long-term hospitalisation but can now be completed within 24 hours because of technological advancements. The Star Health Comprehensive Plan covers all daycare procedures up to the sum insured.
- Domiciliary treatment coverage: You can obtain medical treatment at home if your medical condition prevents you from seeking treatment at a hospital or medical facility due to its severity or if there is a lack of availability of hospital beds. Star Health Comprehensive Plan covers domiciliary treatment costs up to the sum insured. Please note that a list of over 13 illnesses is excluded from coverage.
- Organ donor coverage: Organ donor expenses are also covered by the Star Health Comprehensive Plan. It covers related inpatient expenses of the organ donor up to the sum insured.
- Modern treatment coverage: Technological advancements in the healthcare field have led to the development of modern treatments. These treatments offer far more effective solutions for a variety of ailments, allowing for a higher quality of life. Radiosurgery, stem cell therapy, etc., are examples of such treatments intended to treat ailments previously considered incurable. Star Health Comprehensive Plan offers modern treatment coverage without any cap. This benefit is available as an add-on.
- Non-medical expenses coverage: Non-medical expenses include the cost of consumables, such as gloves, nebulization kits, oxygen masks, and other items needed for treatment. The policy imposes no limit on non-medical expenses. This benefit is available as an add-on.
- No Claim Bonus: The No-Claim Bonus is a reward given by the insurance company if no claims are made during the policy period. Star Health Comprehensive Plan offers a 100% bonus if you do not make claims during the previous policy year. It is possible to accumulate up to 100% of the sum insured under this plan. On opting for an add-on, your accumulated bonus will not be reduced even if you make a claim during the policy period.
- Super No Claim Bonus: Essentially, this is a boosted version of the No Claim Bonus. Star Health Comprehensive Plan does not offer a Super No Claim Bonus.
- Restoration Benefit: The Restoration Benefit restores your sum insured once it has been exhausted within a policy year. This ensures that you are adequately covered for medical expenses during the entire policy year. Refill benefits are available under the Star Health Comprehensive Plan for unrelated illnesses as well as related illnesses. This benefit kicks in after the sum insured and No Claim Bonus are fully exhausted. Furthermore, the refill will apply once in a policy year and only to 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 Comprehensive: Financial Limits
- Room rent limit: Room rent limit refers to the amount your insurance company will cover for the room in which you are hospitalised. If you select a room within your plan's room rent limit, there will be no out-of-pocket expenses. If you opt for a more expensive room than your eligibility, a proportionate deduction will apply. In this case, you will have to pay a proportionate amount of the entire bill and not just the rent difference. Star Health Comprehensive Plan allows you to choose any type of room - except a suite. This benefit is available as an add-on.
- ICU rent limit: It is the maximum amount an insurer will cover for a stay in the intensive care unit (ICU) of a hospital. Star Health Comprehensive Plan does not have an ICU rent limit.
- Copayment: A copayment is the portion of the claim amount that you are required to pay from your end and the insurance company will cover the remaining amount. Star Health Comprehensive Plan does not have a copayment limit.
- Deductible: A deductible is a specific amount you have to pay out of pocket when you make a claim. Once the deductible limit is crossed, the insurance company will begin to cover medical expenses. As part of the Star Health Comprehensive Plan, you can choose among deductible options of Rs 25,000/ Rs 50,000/ Rs 1,00,000.
- Limits on surgeries/treatments: Some health insurance plans impose limits on the maximum amount covered for a specific medical procedure or treatment. In the Star Health Comprehensive Plan, there are no limits on important surgeries and treatments such as cataract surgery or joint replacement. So, it covers the cost of cataract treatment and joint replacement surgery 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 Comprehensive: Waiting Periods & Exclusions
Some illnesses and diseases may not be covered for a certain period after you purchase a health insurance policy. This is known as the waiting period. These conditions can be claimed after this period ends. The different types of waiting periods are:
- Initial waiting period: All medical conditions have an initial waiting period of 30 days except for accidents.
- Waiting period for pre-existing diseases: A pre-existing disease is any medical condition or illness that you have had in the 48 months before applying for the health insurance policy. Pre-existing diseases are subject to a 36-month waiting period under the Star Health Comprehensive Plan. The policy will not cover any expenses associated with pre-existing diseases during this period.
- Waiting period for specific diseases: Insurance companies have a list of medical conditions or illnesses that will entail a waiting period regardless of whether you've had it in the past. The waiting period is determined by the insurer and has no relation to your current health. Specific diseases are subject to a 24-month waiting period under the Star Health Comprehensive Plan.
These are situations that your health insurance policy will not cover at any cost. Here are the type of exclusions -
- Standard permanent exclusions: All insurance companies are required to abide by a set of 'standard permanent exclusions' established by the IRDAI. These include -
- Investigation and evaluation: Admission to the hospital only for observation or monitoring.
- Change of gender treatment: Treatment that alters the body's characteristics to those of the opposite gender.
- Breach of law: Medical expenses for treating a person who has committed or attempted a criminal act.
- Excluded providers: Receiving medical treatment from a doctor or hospital not covered by the insurance plan.
- Narcotics: Addiction treatment, including alcohol and drug abuse.
- Rest cure, rehabilitation, and respite care: Hospitalisation for bed rest with no active treatment.
- Obesity/weight control: Management of obesity or weight loss through treatment or surgery.
- Plastic/cosmetic surgery: Treatment or surgery to change a person's appearance or body characteristics.
- Profession in hazardous or adventure sports: Treatment of injuries/illnesses resulting from professionally participating in risky activities, like rafting, mountaineering, scuba diving, horse racing, etc.
- Refractive error: The cost of correcting refractive errors up to 7.5 diopters for improved vision.
- Unproven treatments: Unproven surgeries, medical procedures, or treatments.
- Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Treatments in establishments arranged for domestic purposes: Treatments undergone in health spas, nursing homes, or similar facilities set up primarily or exclusively for domestic purposes.
- Dietary supplements, substances purchased without prescription: Supplements like vitamins and minerals that have not been prescribed by a physician.
- Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
- Additional permanent exclusions: Insurance companies may also exclude coverage for specific medical conditions or situations in addition to the above standard permanent exclusions if they consider them risky to cover. It is important to note, however, that insurers can apply a permanent exclusion only to a set of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI). It is not possible for them to apply permanent exclusions to illnesses or diseases beyond this list.
- Non-standard exclusions (Specific exclusions): These are exclusions that go above and beyond the standard permanent exclusions outlined by the IRDAI. Depending on the policy terms and conditions, exclusions may vary between insurance companies. The following are some of the top specific exclusions under the Star Health Comprehensive Plan:
- Circumcision except to treat diseases or injuries.
- Treatment of external birth diseases, defects, or anomalies.
- Convalescence, general debility, run-down condition, nutritional deficiency states.
- Treatment of intentional self-inflicted injuries.
- Venereal and sexually transmitted diseases, other than HIV.
- Injuries and diseases resulting from war, invasion, foreign aggression, or warlike operations.
- Injuries or illnesses caused by nuclear weapons or materials.
- The use of specific therapies such as hyperbaric oxygen therapy, laser therapy, photodynamic therapy, etc.
- Untested, unconventional, or experimental therapies.
- Biologicals except when administered as part of an inpatient hospitalisation.
- Erectile dysfunction treatments.
- The cost of vaccinations and inoculations (except for post-animal bite treatment or medical treatment for therapeutic purposes).
- Dental treatments except for accident-related cases.
- Sleep apnea and endocrine disorders treatment.
- Costs associated with spectacles, contact lenses, hearing aids, wheelchairs, crutches, walkers, etc.
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 95.84% of claims in less than 30 days. This is a great achievement and signifies that they are committed to providing a quick and efficient claims process.
- Claim-related complaints: According to our research, Star Health and Allied Insurance Company receives more complaints related to claims than other insurance companies. This indicates that they need to take further steps to ensure customer satisfaction during claim processing.
- Claims incurred ratio: The claims incurred ratio is an indicator of an insurance company's financial health. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. The claims incurred ratio of the Star Health and Allied Insurance Company is 65%.
- Claim settlement ratio: The claim settlement ratio is the percentage of claims that an insurer has settled compared to the total number of claims received by them in a financial year. Star Health and Allied Insurance Company’s claim settlement ratio is 74.90%.
- Network hospitals: Star Health and Allied Insurance Company has over 14,000 hospitals in its network. With this extensive network of hospitals, you can be assured of quality medical care and financial stability at all times.
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 has received 0.04% of complaints related to after-sales service.
- Response on Toll-Free: Compared to other insurance companies, Star Health and Allied Insurance Company's response over the toll-free number is quick.
- Response on Twitter: According to our research, Star Health and Allied Insurance Company responds slowly over Twitter.
About Star Health and Allied Insurance Company Limited
Star Health and Allied Insurance Company Limited is India's first standalone health insurance company. It offers a wide range of products to meet the needs of individuals, families, and corporations. These products are designed to cover a variety of healthcare needs from basic hospitalisation to more comprehensive coverage. Founded in 2006, the company is headquartered in Chennai, Tamil Nadu. The CEO and chairman of the company is Mr V. Jagannathan.