Star Health Diabetes Safe (Plan A)

Star Health Diabetes Safe (Plan A) is a health insurance policy offered by Star Health and Allied Insurance Company Limited. 

It primarily caters to individuals dealing with pre-existing diabetes and its related complications right from day one. However, it is essential to be aware of its limitations. It lacks comprehensive coverage, for instance, it does not include domiciliary treatment coverage. Additionally, there are restrictions on core benefits, like modern treatments, specific treatments like cataract, etc. This can be a concern for those looking for a broad level of coverage. Another downside is that it does not offer the flexibility of monthly premium payments. As per our research, the insurer has received relatively a higher number of complaints related to claim settlement as well as policy purchase processes, indicating a poor track record in terms of both purchase and claims service experience.

What are the benefits offered by the Star Health Diabetes Safe (Plan A) Plan?

• Inpatient Hospitalisation Coverage: The Star Health Diabetes Safe (Plan A) plan covers the expenses associated with inpatient hospitalisation. These are costs incurred when you are admitted in the hospital for more than 24 hours such as medical consultation charges, medicines, ICU charges, and other related expenses.
• Pre-Hospitalisation Coverage: Pre-hospitalisation expenses are charges incurred before hospitalisation, like expenses related to consultations, tests, checkups, etc. The insurer will cover these charges only if they are related to the medical condition that led to the hospitalisation and if they are approved as part of the inpatient hospitalisation coverage. Under the Star Health Diabetes Safe (Plan A) policy, you can get coverage for pre-hospitalisation expenses until 30 days before hospitalisation, up to the sum insured.
• Post-Hospitalisation Coverage: Medical expenses incurred after you are discharged from the hospital are referred to as post-hospitalisation expenses. Such expenses include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related costs. For these expenses to be covered, they must be related to the medical condition that led to the hospitalisation, and be approved as part of inpatient hospitalisation coverage. Under the Star Health Diabetes Safe (Plan A) policy, post-hospitalisation expenses are covered for a period of 60 days up to 7% of the hospitalisation expenses or a maximum of Rs 5,000 per hospitalisation, whichever is lower.
• Daycare Treatment Coverage: Daycare treatments refer to medical procedures or surgeries that used to require a prolonged hospital stay but can now be completed within 24 hours due to advancements in medical technology. The Star Health Diabetes Safe (Plan A) policy covers all daycare procedures up to the sum insured. Meaning, there is no limit on the expenses for daycare treatments. However, you should note that the costs associated with dialysis are covered up to Rs. 1000 per session for a duration of up to 24 months, starting from the month when dialysis is advised - provided the policy remains active. 
• Domiciliary Treatment Coverage: Domiciliary treatments are medical treatments for illnesses or injuries that require urgent medical 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. It is important to know that the Star Health Diabetes Safe (Plan A) policy does not provide coverage for domiciliary treatments.
• Organ Donor Coverage: Health Diabetes Safe (Plan A) policy provides coverage for harvesting expenses of the donor in the event of kidney transplantation, up to the sum insured - where you are the organ recipient.
• Modern Treatment Coverage: With the advent of technology, healthcare is progressing rapidly, and new modern treatments are being developed. These treatments, such as stem cell therapy, radio surgeries, etc. aim to treat diseases that were previously considered untreatable. The Star Health Diabetes Safe (Plan A) policy keeps up with these advancements and provides coverage for various treatments up to sub-limits applicable under the policy.
• Non-Medical Expenses Coverage: Non-medical expenses include the costs of consumables like gloves, nebulization kits, oxygen masks, and other things used during treatment. However, the Star Health Diabetes Safe (Plan A) policy does not cover these expenses.
• No Claim Bonus: A No-Claim Bonus is a reward offered to you if you don't make any claims during a policy year. However, Star Health Diabetes Safe (Plan A) policy does not provide a No-Claim Bonus.
• Super No Claim Bonus: The Super No Claim Bonus functions just like the standard No Claim Bonus, but it is an accelerated version. However, it is essential to understand that the Star Health Diabetes Safe (Plan A) policy does not offer a Super No Claim Bonus.
• Restoration Benefit: The restoration benefit is a helpful feature that restores your sum insured after it has been used up during a policy year. Under the Star Health Diabetes Safe (Plan A) policy, you can avail of this benefit for unrelated illnesses. It becomes active when your entire sum insured is used up. And, it can be used for subsequent claims, but only once per policy year.

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 Diabetes Safe (Plan A) Plan: Financial Limits

• Room Rent Limit: The room rent limit is the maximum amount your insurance company covers for the hospital room you choose to stay in while you are hospitalised. If your selected room fits within this limit, you will not have to bear any additional costs. However, if you go for a room that exceeds your allowed limit, a proportionate deduction will apply. This means you will have to cover a proportionate portion of the total bill, not just the difference in the room rent. Star Health Diabetes Safe (Plan A) plan comes with a room rent limit of up to a single private AC room.
• ICU Rent Limit: The ICU rent limit is the maximum amount your health insurance will cover for your stay in the Intensive Care Unit (ICU) of a hospital. Under the Star Health Diabetes Safe (Plan A) Plan, there is no limit on the ICU rent and the associated expenses are covered up to the sum insured.
• Copayment: A co-payment or copay is a portion of the approved claim amount that you are responsible for paying out of your pocket. After you pay the copay, the insurance company will cover the remaining amount. There is no co-payment limit in the Star Health Diabetes Safe (Plan A) plan.
• Deductible: A deductible is a certain amount you have to pay from your end before your health insurance starts paying for your medical expenses. The Star Health Diabetes Safe (Plan A) plan does not have a deductible.
• Limits on Surgeries/Treatments: It refers to the maximum amount that the health insurance policy will cover for specific medical procedures or treatments. While some policies may have specific limits on the amount that they will cover for certain procedures, others may not. In the Star Health Diabetes Safe (Plan A) plan, cataract treatment costs are covered, with a limit of Rs 30,000/- per eye per hospitalisation and Rs 40,000/- per policy period. For joint replacement surgery, expenses related to artificial limbs due to amputation are covered up to 10% of 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 Diabetes Safe (Plan A) Plan: Waiting Periods & Exclusions

👉Waiting period

After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period. This timeframe is known as the waiting period. Once this period is over, you will be able to claim for these conditions. There are different types of waiting periods, including –

• Initial Waiting Period: All medical conditions have an initial waiting period of 30 days except for accidents. During this period, you cannot make hospitalisation claims unless it is due to an accident.
• Waiting Period for Pre-Existing Diseases: A pre-existing disease is a health condition or illness you had in the last 36 months before obtaining your health insurance policy. Under the Star Health Diabetes Safe (Plan A) plan, there's a 36-month waiting period for pre-existing diseases (except diabetes). This means that during this period, the policy will not cover any expenses associated with your pre-existing conditions.
• Waiting Period for Specific Diseases: Insurance companies have a specific list of medical conditions or illnesses, other than your pre-existing conditions, for which they impose waiting periods regardless of whether you have had those diseases in the past or not. These waiting periods are set by the insurer and aren't based on your current health. Star Health Diabetes Safe (Plan A) plan applies a waiting period of 24 months for specific diseases. 

👉Exclusions

Exclusions are particular situations that your health insurance policy won't cover. Here are some of the types of exclusions –

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

1. Investigation and evaluation: Hospital admission for diagnostics or evaluation purposes only.
2. Rest, rehabilitation and respite care: Admission to a facility for bed rest where no active treatment is provided.
3. Obesity/weight control: Treatment or surgery for controlling weight or obesity.
4. Gender reassignment: Treatments crafted to change the body’s characteristics to those of the opposite sex.
5. Plastic/Cosmetic surgery: Treatments to modify appearances and body characteristics.
6. Profession in hazardous or adventure sports: Treatments for accidents that occurred while participating as a professional in any adventurous sports like rafting, scuba diving, horse racing, etc.
7. Breach of law: Expenses for the treatment of a person who has caused a breach of law with criminal intent.
8. Excluded providers: Treatments from a medical practitioner or hospital that is not included by the insurance company.
9. Narcotics: Treatments of individuals addicted to alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic purposes.
11. Dietary supplements, substances purchased without prescription: Supplements such vitamins, minerals, etc. bought without prescription by a medical practitioner.
12. Refractive error: Treatments related to correcting refractive errors of up to 7.5 diopters to enhance your eyesight.
13. Unproven treatments: Treatments, surgeries or medical procedures that do not prove to be effective. 
14. Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, the use of a surrogate mother for gestational purposes, etc.
15. Maternity Expenses: Expenses related to childbirth, pre/post-natal costs, etc.

• Additional Permanent Exclusions: Along with these standard permanent exclusions, insurance companies may have their own additional exclusions for particular situations or medical conditions. If you have certain diseases or severe medical conditions that insurance companies consider too risky to cover, they may exclude those diseases permanently from your policy. However, it is important to understand that insurance companies are restricted to a list of diseases mentioned by IRDAI for which they can apply a permanent exclusion. They cannot permanently exclude any illness or disease that is not mentioned in the list.
• Non-standard exclusions (Specific exclusions): These are the specific exclusions that go beyond the standard permanent exclusions listed by IRDAI. These exclusions may vary between the insurance companies and may also depend on the policy’s terms and conditions. Here are some of the specific exclusions outlined under the Star Health Diabetes Safe (Plan A) plan–

1. Circumcision, unless it's needed to treat a disease or injury.
2. Treatment for external birth defects.
3. Treatment for general weakness, recovery, feeling run-down, or nutritional deficiencies.
4. Treatments related to intentional self inflicted injury or attempted suicide by any means. 
5. Injuries or diseases from war, foreign invasion, warlike actions, etc.
6. Injuries or illnesses from nuclear weapons, materials, etc.
7. Specific therapies like hyperbaric oxygen therapy, low-level laser therapy, photodynamic therapy, etc.
8. Therapies that are untested, unconventional, or experimental.
9. Biologicals, except when given during in-patient hospitalisation.
10. Costs for vaccinations and inoculations (except for post-animal bite treatment and medical therapy for therapeutic reasons).
11. Cost of glasses, contact lenses (beyond what's provided), hearing aids, walkers, crutches, wheelchairs, and other similar equipments.
12. Treatment by 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 within just 30 days. This means you're more likely to experience a smooth and seamless claim settlement process.
• Claim-Related Complaints: Our research reveals that Star Health and Allied Insurance Company Limited has received a higher number of complaints related to overall claims, as compared to other insurers, accounting to 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. Star Health and Allied Insurance Company Limited has a claims incurred ratio of 66.47%.
• Claim Settlement Ratio: It is the percentage of claims settled by the insurer compared to the total claims received in a financial year. Star Health and Allied Insurance Company Limited maintains a claim settlement ratio of 85.32%.
• Network Hospitals: Star Health and Allied Insurance Company Limited has a vast network of over 14,000+ hospitals. So, you can enjoy the convenience of cashless treatments across a wide array of healthcare facilities at various locations.

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

• Policy Purchase-Related Complaints: Our research shows that Star Health and Allied Insurance Company Limited has received a higher number of complaints for their post-sales service, as compared to other insurers, accounting for 0.06%. 
• Response via Toll-Free Number: According to our research, Star Health and Allied Insurance Company Limited's toll-free number provides a quick response, as compared to other insurers.
• Response on Twitter: The Star Health and Allied Insurance Company Limited has a slower response time on Twitter, compared to other insurers.

About Star Health and Allied Insurance Company Limited 

Star Health and Allied Insurance Company Limited is India's first Standalone Health Insurance provider. Established in 2006, the company is committed to serving a wide range of clients, from individuals to families and corporations. Based in Chennai, Tamil Nadu, Mr. V. Jagannathan serves as both the chairman and CEO of the company.