Star Health Smart Health Pro

Star Health Smart Health Pro is designed to ease the financial strain of medical emergencies, ensuring individuals and families can enjoy quality care without fear of exorbitant expenses. Provided by Star Health and Allied Insurance Company Limited, this plan offers a comprehensive safety net against growing medical expenses, going beyond basic coverage. With its comprehensive benefits, adaptable choices, and wellness programs, the plan meets varied healthcare needs. Further add-ons increase its reach, and it becomes a good option for overall protection.

For individuals who look for a blend of affordability with extensive health insurance coverage, this plan stands out as a viable option. It provides coverage for the cost of hospitalisation, related medical costs, and even consumable items, securing extensive financial safeguarding.

However, one drawback is the lack of a monthly premium payment option. Our analysis also indicates a significant number of complaints regarding claims settlements and purchasing policies, which suggests the insurer's customer service experience might not always be up to expectations.

What are the benefits offered by Star Health Smart Health Pro?

• Inpatient hospitalisation coverage: Inpatient coverage applies when a patient is hospitalised for more than 24 hours. It takes care of essential medical expenses, including room charges, nursing care, doctor consultations, prescription medicines, ICU fees, and other necessary healthcare costs. This plan is designed to cover essential medical costs, allowing you to focus on recovery without the stress of mounting bills. The Star Health Smart Health Pro plan takes care of expenses related to inpatient hospitalisation, offering coverage without any limits on ICU or room rent charges. However, no room rent cover is available as an add-on, helping you to opt for any care and comfort you want without any limits.
• Pre-hospitalisation coverage: Before hospital admission, there are often a bunch of medical costs to take care of, known as pre-hospitalisation expenses. Think of doctor visits, lab tests, regular checkups, and all those necessary medical reports. Once the hospital stay is over, any post-hospitalisation expenses need to be directly linked to the treated condition. But here’s the catch. They are only covered if the inpatient hospitalisation claim gets approved. You can be assured of getting cover for your pre-hospitalisation expenses for 60 days up to the sum insured with the Star Health Smart Health Pro Plan.
• Post-hospitalisation coverage: Leaving the hospital is just one part of recovery, but the medical expenses don’t always end there. Follow-up doctor visits, continued care, and prescribed medications can add up quickly. That’s where post-hospitalisation coverage comes in, helping to manage these costs. However, for the coverage to apply, these expenses must be directly connected to the hospital treatment and fall within the limits of the inpatient hospitalisation plan. With the Star Health Smart Health Pro Plan, you get comprehensive coverage for post-hospitalisation expenses up to the sum insured for 180 days after your hospitalisation.
• Daycare treatment coverage: Daycare treatments cover medical procedures or surgeries that once required long hospital stays but can now be completed within 24 hours, made possible by advancements in medical technology. The Star Health Smart Health Pro Plan covers all daycare treatment procedures with no financial limit. 
• Domiciliary treatment coverage: Domiciliary treatments involve critical medical care given at home instead of in a hospital. This usually becomes necessary when a patient’s condition makes it unsafe to move them as per a Registered Doctor's prescription or when hospital beds aren’t available nearby. The Star Health Smart Health Pro Plan covers all expenses for domiciliary treatments up to the sum insured. However, the plan does come with a list of 12 illnesses that are not included in this coverage.
• Organ donor coverage: The Star Health Smart Health Pro Plan does not include expenses related to organ donation, meaning the inpatient costs incurred by the organ donor during the transplantation procedure are not covered. 
• Modern treatment coverage: Modern treatments have transformed healthcare, making it possible to treat conditions that once had no solutions. Innovations like stem cell therapy, radiosurgery, and robotic-assisted procedures are changing the game, offering highly advanced and personalized care for patients. The Star Health Smart Health Pro Plan is designed to stay up to date with these advancements and covers the expenses associated with these modern treatments with no financial limit.
• Non-medical expenses coverage: Non-medical expenses coverage takes care of essential items like vaccinations, gloves, nebulization kits, oxygen masks, medical footwear, urine bags, hospital gowns, and more. This ensures that during treatment, you are not left worrying about these additional costs. The Star Health Smart Health Pro Plan helps ease the burden by covering non-medical expenses up to the sum insured. However, it’s worth noting that this benefit is available only as an optional add-on.
• No Claim Bonus: The No Claim Bonus is a benefit offered by the insurance company as a reward for going an entire policy period without filing any claims. The No Claim Bonus under the Star Health Smart Health Pro Plan can grow up to a maximum of 600%, but this benefit is available only as an add-on. If a claim is made in the previous year, the accumulated bonus will be reduced. On the other hand, if no claims are filed, a 50% bonus is added each year. The bonus remains intact unless utilized during a claim. Upon renewal, only the portion used is deducted, while the unused bonus seamlessly carries forward to the next policy year.
• Super No Claim Bonus: The Super No Claim Bonus is an enhanced version of the standard No Claim Bonus, providing the same benefits but with a greater reward. However, the Star Health Smart Health Pro Plan does not provide provisions for the super no-claim bonus.
• Restoration benefit: The restoration benefit is a valuable feature that replenishes your sum insured if it gets completely exhausted during the policy year due to unexpected medical expenses. The Restoration Benefit in the Star Health Smart Health Pro Plan allows the sum insured to be replenished an unlimited number of times within a policy year but only as an add-on. This benefit applies to subsequent claims and is triggered when the sum insured is partially exhausted. It covers both related and unrelated illnesses, ensuring continued financial support. When the sum insured runs out, the reinstatement benefit kicks in, making additional coverage available. 

The benefits mentioned above, along with their limitations and conditions, are applicable to a sum insured of Rs 10 lakhs.

Star Health Smart Health Pro: Financial Limits

• Room rent limit: The room rent limit sets the maximum amount your insurance will cover for hospital room charges. Staying within this limit means no extra costs for you. However, choosing a higher-priced room will result in a proportionate deduction from your coverage. With the Star Health Smart Health Pro Plan, you can select any room without any restrictions. However, this facility is available as an add-on. 
• ICU rent limit: The ICU rent limit defines the highest amount your plan will cover for intensive care unit expenses during hospitalisation. Because there is no cap on ICU rent under the Star Health Smart Health Pro Plan, the entire cost of your ICU stay up to the sum insured is covered. 
• Copayment: A copayment, or copay, is the share of the approved claim amount that falls on you to pay out of pocket. After covering this portion, the insurer takes care of the rest. The Star Health Smart Health Pro Plan does not include any copayment requirements. 
• Deductible: A deductible is the portion of medical expenses you need to cover on your own before your insurance kicks in to handle the remaining costs. However, deductibles are not available under the Star Health Smart Health Pro Plan.   
• Limits on surgeries/treatments: Understanding the coverage limits for surgeries and treatments in your health insurance plan is crucial. These limits define the maximum amount your insurer will pay for specific medical procedures, ensuring clarity on what expenses are covered. Certain plans set predefined limits on coverage for specific procedures, whereas others offer a more flexible approach to medical expenses. With the Star Health Smart Health Pro Plan, joint replacement surgeries and cataract treatment are covered up to the sum insured.

It’s important to note that the financial limits outlined above are based on a 30-year-old individual selecting a sum insured of Rs. 10 Lakhs.

Star Health Smart Health Pro: Waiting Periods & Exclusions

👉Waiting period

The waiting period refers to the initial phase after buying a policy when coverage for specific illnesses and medical conditions is temporarily unavailable. Claims for these conditions can only be made once this period is over. The duration of the waiting period varies depending on the insurance provider. The several kinds of waiting periods are listed below-

• Initial waiting period: For the first 30 days after getting the policy, claims for hospital stays won’t be accepted unless they’re due to an accident. Any other medical condition will need to wait until this period is over before coverage kicks in.
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any health issue or illness that was present in the 36 months leading up to the purchase of a health insurance policy. The pre-existing disease waiting period is 36 months for the Star Health Smart Health Pro Plan.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers have a separate list of medical conditions or illnesses that come with their own waiting periods. These waiting periods apply regardless of your medical history and are set by the insurer, independent of your current health status. There is also a waiting period of 24 months for specific diseases under the Star Health Smart Health Pro Plan.

👉Exclusions

Health insurance exclusions refer to specific medical conditions or situations that are not covered under the plan. Here are some common examples: 

• Standard Permanent Exclusions: Every insurance company must adhere to 'the standard permanent exclusions' established by the IRDAI. These consist of -

1. Investigation and evaluation: Hospital admissions purely for evaluation or routine monitoring without any active medical treatment.
2. Rest, rehabilitation, and respite care: Services focused on rehabilitation, rest, or long-term recovery rather than direct medical intervention or surgery.
3. Obesity/weight control: Treatments, surgeries, or programs designed for weight loss or obesity control.
4. Gender reassignment: Medical interventions, including surgeries and therapies, for transitioning or altering gender identity.
5. Plastic/Cosmetic surgery: Surgeries or treatments performed solely to enhance appearance without medical necessity.
6. Profession in adventure or hazardous sports: Medical expenses for injuries sustained while professionally engaging in extreme sports such as mountaineering, scuba diving, or river rafting.
7. Breach of law: Costs of treatment for injuries or illnesses resulting from involvement in unlawful activities or criminal acts.
8. Excluded providers: Medical expenses incurred at hospitals or with practitioners not recognized under the insurance policy.
9. Narcotics: Costs associated with rehabilitation or medical care for addiction to alcohol, drugs, or other controlled substances.
10. Treatments in establishments arranged for domestic purposes: Expenses for treatments received in nursing homes or other establishments primarily meant for personal or domestic care rather than medical treatment.
11. Dietary Supplements: Costs for vitamins, minerals, and other dietary supplements that aren’t medically prescribed by a doctor.
12. Refractive error: Expenses for procedures to correct refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Medical procedures, surgeries, or therapies that lack scientific validation or proven effectiveness.
14. Expenses related to sterility, birth control, and infertility: Expenses for contraceptive procedures, sterilization, artificial insemination, and advanced reproductive technologies like IVF, GIFT, ZIFT, ICSI, and surrogacy.
15. Maternity expenses: Hospitalisation charges for childbirth, including prenatal and postnatal care, along with delivery expenses.

• Additional permanent exclusions: Insurance companies have the right to impose extra exclusions for certain medical conditions or situations in addition to the standard permanent exclusions. If they determine that a particular illness or severe health condition carries too much risk, they may decide to exclude it from coverage permanently. 

Health insurance companies must follow the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), which specifies the medical conditions eligible for permanent exclusions. They are not allowed to impose permanent exclusions on illnesses that are not part of this approved list. 

• Non-standard exclusions (Specific exclusions): Non-standard exclusions are additional conditions that insurers may choose not to cover, beyond the permanent exclusions set by IRDAI. These exclusions vary from one insurer to another and depend on the specific terms and conditions of each policy. The most significant particular limitations of the Star Health Smart Health Pro Plan are as follows: 

1. Circumcision expenses are not covered unless the procedure is required to treat an illness or injury.
2. Costs related to screening, counselling, or treatment of external birth defects are excluded from coverage.
3. Treatments for general weakness, recovery from illness, fatigue, and nutritional deficiencies are not included.
4. Certain specialized therapies like hyperbaric oxygen therapy, low-level laser therapy, and photodynamic therapy are not covered.
5. Procedures such as Platelet-Rich Plasma (PRP) therapy, intra-articular injections, and chondrocyte implantation are excluded from insurance coverage.
6. Biological treatments are not covered unless they are administered as part of an inpatient hospitalisation.
7. Expenses for vaccinations and inoculations are not included, except in cases of post-animal bite treatment or when required for medical reasons.
8. Costs of spectacles, contact lenses beyond the specified limit, hearing aids, walkers, crutches, wheelchairs, and similar assistive devices are not covered.

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

• Speed of claims settlement: Star Health and Allied Insurance Company Limited has streamlined its claim settlement process, successfully resolving 98.86% of claims within 30 days. 
• Claim-related complaints: According to our analysis, Star Health and Allied Insurance Company Limited has a claims complaint rate of 0.56%, which is higher compared to other insurers. 
• Claims incurred ratio: The claims incurred ratio is a key measure of an insurer's financial stability, reflecting the percentage of claims paid out relative to the total premiums collected in a given year. Star Health and Allied Insurance Company Limited has a claims incurred ratio of 66.47%. 
• Claim settlement ratio: Star Health and Allied Insurance Company Limited has a claim settlement ratio of 85.32%, indicating the percentage of claims successfully processed out of the total claims received in a given financial year. 
• Network hospitals: Star Health and Allied Insurance Company Limited provides access to an extensive network of 14,000+ hospitals. This extensive network allows customers to undergo cashless care without worrying about money. 

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 0.06% of complaints regarding its after-sales service.
• Response on Toll-Free: Our study highlights that Star Health and Allied Insurance Company Limited offers a quick response time on its toll-free number compared to other insurers. 
• Response on Twitter(X): Our investigation indicates that, in comparison to other companies, Star Health and Allied Insurance Company Limited has a slow reaction time on Twitter(X). 

About Star Health and Allied Insurance Company Limited

Star Health and Allied Insurance Company Limited is India’s first standalone health insurance provider, offering a diverse range of products tailored for individuals, families, and corporations. Established in 2006, the company is headquartered in Chennai, Tamil Nadu, and is led by Chairman and CEO Mr. V. Jagannathan. With a strong presence in the industry, Star Health has issued over 83.78 lakh policies and successfully settled more than 21.22 lakh claims. The company has achieved a remarkable Gross Written Premium (GWP) of Rs 16,599.48 crores, reflecting its significant growth and commitment to customer-centric healthcare solutions.