Health Insurance 1843 views December 11, 2020

Star Health and Allied Insurance Co Ltd has introduced a health insurance plan providing financial protection against  Accidents, Cardiac ailments, Non-cardiac ailments,  Outpatient medical expenses, and modern treatments. The flexible health cover of Star Health Cardiac Care Insurance Policy comes in two options – Silver Plan and Gold Plan. From this Star Health Insurance plan, you will get benefits like in-house claim settlement and cashless hospitalization from 9900+ network hospitals across India. Let’s read further to learn about the benefits of the Star Health Cardiac Care Insurance Policy in detail. So, read on!

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Star Health Cardiac Care Insurance Policy Options

As discussed above, this health insurance comes with two options. Check the details of these options below.

Gold Plan: This plan is applicable for an accident and non-cardiac ailment. And when cardiac ailments and complications arise, the cover for both surgical intervention and medical management will be available to you. For each Outpatient event, an INR 500 claim is admissible at the networked hospital, subject to a maximum of INR 1,500 per policy year. In the case of a personal accident, only the death of the insured will be covered and the nominee/beneficiary will get the Sum Insured you would choose when buying this plan.

Silver Plan: This plan is applicable for an accident and non-cardiac ailment. And when a cardiac ailment and complication arise, it will cover only the surgical intervention. For each Outpatient event, an INR 500 claim is admissible at the networked hospital and upto a maximum of INR 1,500 per policy year. In the case of a personal accident, only the insured person’s death will be covered where your chosen Sum Insured will be paid to the nominee/beneficiary.

Note- A 90-day waiting period will apply to the cardiac ailment cover irrespective of your chosen plan.

Star Health Cardiac Care Insurance Policy Coverage

The insurance company will pay for the following in the case of any covered risk commencement.

  1. Room, Boarding and Nursing Expenses if provided by the Hospital or the Nursing Home (Maximum INR.5,000/- per day).
  2. The hospitalization expenses are considered in proportion to the eligible room rent as per the above limit or the actual room rent expenses, whichever is less.
  3. Ambulance charges covered upto a maximum of INR.750/- per emergency hospitalization and INR.1500/- per policy year.
  4. Pre hospitalization expenses (Not more than 30 days before hospitalization)
  5. Post hospitalization expenses (up to 60 days after discharge). And for this, the payable amount should not exceed 7% of the hospitalization expenses. The calculation of the 7% consists of nursing expenses, surgeon’s or consultant’s fees, diagnostic charges, cost of drugs and medicines.
  6. All Day Care Procedures
  7. Cataract treatment is covered with sub-limits, where up to INR 20,000 per hospitalization and INR 30,000 for the entire policy period coverage is provided.
  8. 10% of each accident and non-cardiac ailment claim is borne by the insured if his/her entry age is 61 years and above. If your age is less than 61 years, the co-payment conditions shall not apply.

Waiting Period For Star Health Cardiac Care Insurance Policy (Accident & Non-Cardiac Ailments

  1. Expenses related to the treatment of pre-existing diseases and their direct complications (until 48 months of continuous coverage, starting from the inception date).
  2. Specified disease/procedure has a waiting period of 24 months for a continuous policy cover. And this includes diseases like Cataract and Anterior and Posterior Chamber disease (of the Eye), ENT diseases, Thyroid diseases, Prolapsed intervertebral disc (unless caused by accident), Varicose veins and ulcers. All Prostate, Stricture Urethra, Obstructive Uropathies diseases, different types of Hernia, Epididymal Cyst, Benign Tumours of Epididymis, Spermatocele, Varicocele, Hydrocele, Fistula or Fissure, Hemorrhoids, Pilonidal Sinus and Fistula, Rectal Prolapse, Stress Incontinence and Congenital Internal disease/defect, desmoid tumor (of anterior abdominal wall or Gallbladder) and Pancreatic diseases.

All conservative, interventional, laparoscopic and open treatments such as Hepato-pancreato-biliary (including Gallbladder and Pancreatic calculi),  types of management for Kidney calculi and Genitourinary tract calculi, diseases of Uterus, Fallopian tubes, Cervix and Ovaries, Uterine bleeding, Pelvic, Inflammatory diseases, Benign breast diseases, Umbilical sinus, Umbilical fistula, Conservative, operative treatment and types of intervention diseases related to Tendon, Ligament, Fascia, Bones and Joint Including Arthroscopy and Arthroplasty (unless caused by accident). Degenerative disc and diseases of the Musculoskeletal system, Vertebral diseases with the replacement of bones and joints, Subcutaneous Benign lumps, Sebaceous cyst, Dermoid cyst, Mucous cyst lip/cheek, Carpal tunnel syndrome, Trigger finger, Lipoma, Neurofibroma, Fibroadenoma, Ganglion and some of its similar pathology and transplant surgery.

  1. Expenses for the treatment of any illness within 30 days from the policy commencement will not be admissible, except for the covered accident expenses. This exclusion is not valid if the Insured has continuous coverage of more than 12 months. And if you enhance the Star Health Cardiac Care Insurance Policy Sum Insured, this 30-day waiting period is applicable on your subsequent higher sum insured

Note- After the expiry of the waiting period, the same will be covered if it is declared at the time of application.

Exclusions from the Star Health Cardiac Care Insurance Policy

While buying this Star Health Insurance, do check the following list of exclusions.

  1. Diagnostics & Evaluation expenses (Not related or not incidental to the current diagnosis and treatment)
  2. Enforced bed rest (with no treatment), Custodial care (at home or nursing facility)
  3. Services for the insured person who is terminally ill and unable to address physical, social, emotional and spiritual needs.
  4. Surgical treatment of obesity if it is not recommended by the doctor, conducted without any clinical protocols, age is less than 18 years and Body Mass Index (BMI) is greater than or equal to 40 or greater than or equal to 35 in conjunction with Obesity-related cardiomyopathy, Coronary heart disease, Severe Sleep Apnea, Uncontrolled Type2 Diabetes.
  5. Any treatment with surgical management, change of the body to the opposite sex
  6. Cosmetic, Plastic surgery, or any treatment that changes appearance (unless it is needed for the treatment of an Accident, Burn(s) or Cancer).
  7. Injury or illness due to participation in hazardous or adventure sports such as para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, scuba diving, hand gliding, skydiving, deep-sea diving.
  8. Injury or illness due to committing a breach of law with criminal intent
  9. Treatment in a hospital or by a Medical Practitioner which are specifically excluded by the Insurer. However, in the case of life-threatening situations or an accident, expenses up to the stage of stabilization will be covered by the company.
  10. Alcoholism, drug or substance abuse and its consequences
  11. Expenses of health hydros, nature cure clinics, spas and any other similar establishments
  12. Vitamins, Minerals and any such Organic substances (unless prescribed by a medical practitioner)
  13. Treatment for the correction of eyesight (if the refractive error < 7. 5 dioptres)
  14. Unproven treatments or supplies that lack significant medical documentation
  15. Sterility & Infertility treatments like any type of contraception, sterilization, assisted reproduction that includes artificial insemination and advanced technologies such as IVF, ZIFT, GIFT, ICSI. Gestational Surrogacy and Reversal of sterilization.
  16. Treatment related to childbirth and its complications including cesarean sections during hospitalization. Under this, ectopic pregnancy doesn’t come. It means the same will be covered if mentioned in your policy document.
  17. Termination of pregnancy
  18. Circumcision (unless needed for the treatment of a covered disease or an accident)
  19. Preputioplasty
  20. Frenuloplasty
  21. Preputial Dilatation
  22. Removal of SMEGMA
  23. Congenital External Condition, Defects, or Anomalies
  24. Convalescence, General Debility, Run-down condition, Nutritional deficiency
  25. Intentional self-injury
  26. Venereal Disease
  27. Sexually Transmitted Diseases(Other than HIV)
  28. Injury or illness arising from or attributable to war, invasion, the act of a foreign enemy, warlike operations, nuclear weapons/material
  29. Enhanced External Counterpulsation Therapy
  30. Chelation therapy
  31. Hyperbaric Oxygen Therapy
  32. Rotational Field Quantum Magnetic Resonance Therapy
  33. VAX-D
  34. Low-level laser therapy
  35. Photodynamic therapy and other similar therapies
  36. Unconventional, Untested and Experimental therapies
  37. Chondrocyte Implantation, Procedures via Platelet Rich plasma and Intraarticular injection therapy
  38. Biologicals (unless administered as an in-patient, when clinically indicated and hospitalization warranted)
  39. Treatment for Priapism and erectile dysfunctions
  40. Inoculation or Vaccination (unless it is for post-bite treatment and medical treatment for therapeutic reasons)
  41. Dental treatment or surgery (unless caused due to accident)
  42. Dental implants
  43. Medical and/or surgical treatment of Sleep apnea (for the endocrine disorder)
  44. Hospital registration, admission, telephone and any such other charges
  45. Spectacles, Contact lens, Hearing aids, Walkers, Crutches, Wheelchairs, Cochlear implants, CPAP, BIPAP, Ambulatory Peritoneal Dialysis, infusion pump and any other similar aids.
  46. Medically Unnecessary Hospitalizations
  47. Treatment of diseases, illness, or accidental injuries by any system of medicine other than allopathy

Exclusions from the Personal Accident Cover

The Star Health Cardiac Care Insurance Policy does not cover any claim regarding the occurrence of a personal accident before the commencement of the risk or outside the insurance period. If an accidental claim arises due to intentional self-injury, suicide/attempted suicide or under the influence of liquor or drugs, the same is not claimable (unless it is for self-defense or to save human life).

Any claim due to sexually transmitted conditions, anxiety, stress, depression, venereal disease (Other than HIV) is excluded under this cover. If you engage in Air Travel and an accident happens, the claim can be made, if you are a fare-paying passenger on an aircraft that is properly licensed to carry passengers.

The exclusion on Air Travel applies when you are in or on or boarding an aircraft for flying. Accidents from war and warlike occurrence, invasion, an act of the foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion, military or usurped power, seizure, capture, arrest, restraints, detainments in any nation.

The exclusion of a personal accident applies even if you participate in riots, confiscation, nationalization, requisition of,  destruction of, damage to property by or under the order of any government /local authority.

If a claim arises due to any consequential loss directly or indirectly caused due to ionizing radiation and contamination by radioactivity from any nuclear fuel/waste or combustion of nuclear fuel/waste. This includes any self-sustaining process of nuclear fission such as Nuclear weapons material, radioactive, toxic, explosive, nuclear assembly. or nuclear component and any d. Nuclear, chemical and biological terrorism.

If an accidental claim arises due to sports, whether for the training or participation in competitions (professional or semi-professional), you won’t get any cover unless this matter is specifically agreed and endorsed in the policy. When you commit an illegal act or violate the law, such claims will be excluded. Any claim due to an accident related to pregnancy or childbirth, infirmity will be excluded whether affected directly or indirectly.

Important Details of the Star Health Cardiac Care Insurance Policy

The following terms and conditions are necessary to read before you buy this health insurance plan.

  1. The age of the insured should be between 10-65 years.
  2. You must have undergone through the following if you want to buy this policy:

Percutaneous Transluminal Coronary Angioplasty (PTCA), Coronary Artery Bypass, Graft (CABG) (within 7 years before the insurance proposal, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) (if corrected), Patent Ductus Arteriosus (PDA) (if treated), RF Ablation or RF Ablation to correct the cardiac condition, and Angiogram.

  1. Sum Insured Amount is INR 3-4 lakh
  2. Policy term 1, 2 and 3 years, if the policy term is more than 1-year, the sum insured will apply for each year and there will be no carry forward benefit on it.
  3. The premium payment frequency is Monthly, Quarterly, Half-yearly. You can also make the payment Annually, Biennial (Once in 2 years), and Triennial (Once in 3 years).
  4. The moratorium period is of 8 years that first applies to the first-year policy sum insured. And the 8-continuous moratorium years will apply when the sum insured is enhanced. And the moratorium applies to the enhanced limit only. Post moratorium, if any claim is made, it is not contestable by the insurer except for fraud and permanent exclusions.
  5. A grace period of 30 days is provided to the insured person during which he/she can renew the Star Health Cardiac Care Insurance Policy. In this grace, period coverage is not available for you.
  6. The Sum Insured can be revised at the renewal date
  7. Before the 30 days of policy renewal, you have the option to migrate to any other health insurance policy offered by Star Health. (as per the IRDAI migration guidelines)
  8. At least 45 days before, but not earlier than 60 days from the renewal date, you can port Star Health Cardiac Care Insurance Policy to other insurers.
  9. In case the policy is withdrawn in the future, the company will give you a 90-day notice, and during such a period, you can migrate to the other policy.
  10. You have a free look period of 15 days starting from the date you receive the policy document. During this period, if you return the policy, you can claim a refund of the paid premiums minus the medical examination fee and stamp duty charges (if no claim is made). If risk is commenced during the free look period, the paid premium gets refunded after the deduction of the proportion risk premium. And if only a part of the risk has commenced, such proportionate premium commensurate with the insurance coverage.
  11. You can cancel your policy by giving a 15-day notice to the company anytime during the policy term.
  12. To claim, dial 1800 425 2255 or 1800 102 4477 – the official helpline number of Star Health
  13. Planned hospitalization claim must be informed to the company within 24 hours before the hospitalization ·
  14. For an emergency, hospitalization claim, inform the company within 24 hours after hospitalization
  15. To use the cashless facility, check out the list of network hospitals on the official website of Star Health and Allied Insurance Co Ltd
  16. In the case of a non-network hospital, the payment must be made upfront, and after that, you can seek reimbursement by submitting the required documents.

Tax Benefits Under Star Health Cardiac Care Insurance

If you pay the policy premiums other than cash mode, you are eligible for an income tax benefit as per the prevailing income tax law. Under Section 80(D) of the Income Tax Act 1961, you can claim a tax exemption up to INR 1.5 lakh in a financial year.

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