Health Insurance 504 views January 7, 2021

Star Health Criticare Plus Insurance Policy reimburses your hospitalization expenses incurred due to illness, injury or accident. And if the insured person is diagnosed with one of the policies listed major illnesses, Star Health will pay a lump sum amount from your sum insured. Star Health Criticare Plus Insurance Policy Sum Insured ranges from INR 2-10 lakh and will depend on your entry age. So, let’s read this page below and learn more about Star Health Criticare Plus coverage and exclusions.

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Coverage in Star Health Criticare Plus Insurance Policy

You will be covered against the following expenses under Star Health Criticare Plus Insurance Policy.

  1. In-patient hospitalization expenses at 2% of the sum insured, subject to a maximum of INR 4,000 per day.
  2. Surgeon, Consultant, Anesthetist, and Specialist fees
  3. ICU expenses
  4. Expenses of medicines and drugs prescribed by doctors
  5. Ambulance fee up to INR 750 per hospitalization and up to INR 1,500 per policy year
  6. AYUSH Treatment cover for up to 25% of the sum insured, subject to a maximum of INR 25,000
  7. Pre-hospitalization expenses up to 30 days
  8. Post-hospitalization expenses are payable in a lump sum at 7% of the in-patient hospitalization expenses, subject to a maximum of INR 5,000.
  9. Cerebrovascular Accident, Cardiovascular Disease, Cancer and Breakage of bones, Renal Complications up to INR 1.5 lakh for persons aged between 60-65 years and up to the sum insured for persons aged between 18-59 years.

Major Illness Protection Under Star Health Criticare Plus Insurance Policy

Only one lump sum payment is made during your lifetime regardless of the number of major illnesses you have suffered from. The hospitalization expenses will be payable to you till the date of diagnosis of the major illness. After that, a lump sum compensation will be paid to you. The following is the list of major illnesses for which Star Health will pay a lump sum.

  1. First-time diagnosis of Cancer, Chronic kidney Disease or Brain Tumor
  2. First-time major organ transplant surgery
  3. Cerebro CerebroVascular stroke that causes Hemiplegia
  4. Acute Myocardial Infarction that results in left Ventricular Ejection Fraction of less than 25%
  5. Established irreversible coma, paraplegia or quadriplegia

Waiting Period on Star Health Criticare Plus Insurance Policy

There is a 30-day waiting period for illness treatment from the date of policy commencement. If a major illness is diagnosed to you within 90 days from the date of policy commencement, the same will not be payable by Star Health. The treatments and complications of pre-existing disease will be covered after a waiting period of 48 months.

Whereas the expenses related to the treatment of Cataract, Hysterectomy, knee or joint, varicose veins and varicose ulcers, Congenital Internal disease/defect.is going to be excluded until the expiry of 24 months. And after 12 months from the date of policy commencement, treatment of Benign Prostate Hypertrophy, Hernia, Hydrocele, Fistula in the anus, Piles, Sinusitis and related disorders, treatment for gallstones and renal stone will be covered under Star Health Criticare Plus Insurance Policy.

Exclusions from Star Health Criticare Plus Insurance Policy

Expenses incurred on the following will not be payable under Star Health Criticare Plus Insurance Policy throughout the policy period.

  1. Investigation & Evaluation
  2. rest cure, rehabilitation and respite care
  3. Obesity and weight control programs
  4. Gender change treatments
  5. Cosmetic and Plastic Surgery
  6. Injury or Illness from participation in hazardous and adventurous sports
  7. Breach of law with a criminal intent
  8. Treatment at excluded providers
  9. Alcoholism and drug abuse treatments and rehab care expenses
  10. Treatments at health hydros, nature cure clinics, spas or similar establishments
  11. Dietary supplements and medicines which are not prescribed by your doctor
  12. Refractive error
  13. Unproven treatments
  14. Sterility and infertility
  15. Maternity expenses
  16. Circumcision
  17. congenital disease/defect whether external or internal
  18. convalescence, general debility, run-down condition
  19. Intentional self-injury
  20. Venereal disease except for HIV
  21. Injury or Illness due to War, Invasion, Act of Foreign Enemy and Warlike operations
  22. Injury or Illness due to nuclear weapons or materials
  23. Naturopathy treatment
  24. Inoculation or Vaccination (except for post-bite and therapeutic medical reasons)
  25. Dental treatment or surgery
  26. Hospital registration charges, record charges, incidental and miscellaneous charges
  27. Cost of spectacles, contact lens, hearing aids walkers, crutches, wheelchairs, etc.

Free Look Period for Star Health Criticare Plus Insurance Policy

Within fifteen days from the date of the policy document, you can read the terms and conditions and return the policy if it is not agreeable to you. And if the insured hasn’t made any claim under Star Health Criticare Plus Insurance Policy, he/she will be entitled to receive the paid premiums less the medical examination expenses and stamp duty charges.

Star Health Criticare Plus Insurance Policy Claim Procedure

To claim Star Health Criticare Plus Insurance Policy Sum Insured follow the steps below

Contact the 24X7 help-line number – 1800 425 2255 or 1800 102 4477

Tell your Policy Number to the service provider

If this is a planned hospitalization, inform Star Health 24 hours before hospitalization and receive a cashless treatment at any of the Star Health network hospitals. On the other hand, if it is an emergency hospitalization, inform Star Health within 24 hours of hospitalization and get cashless treatment in all network hospitals wherever possible. Otherwise, you can get treatment in a non-network hospital, and get the expenses reimbursed by Star Health later.

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