Health Insurance 1830 views November 10, 2020

With a faster & direct in-house claim settlement process, Star Health Gain Insurance Policy is one of the most popular policies among customers. Features like Cashless hospitalization and a wide network of over 9,900 hospitals across India make this insurance policy quite lucrative for individuals who want to take care of their health. Because of the modern lifestyle, we have become more prone to disease, and hospital bills are only increasing with time. That’s where a Star Health Gain Insurance Policy can help by providing maximum benefits at an affordable premium to both individuals and their families.

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Before providing coverage to customers, Health Insurance Companies usually request individuals to undergo a pre-policy medical checkup to minimize their risk covering them. The best thing about Star Health Gain Insurance Policy is that you don’t need to undergo any pre-acceptance medical screening till the age of 50. Apart from this, you also get coverage for pre-existing medical conditions with this insurance plan. This policy from Star Health Insurance can be a suitable option for someone taking Health Insurance for the first time. The reason: this plan covers maximum diseases at an affordable premium.

Thinking about the other features of this policy? Here, we will cover the same in detail with its eligibility, exclusion, premium options, etc. Keep reading to know more!

Star Health Gain Insurance Policy Highlights

Want to know what makes this insurance plan so popular among first-time Insurance Buyers? Well, we are showing some of them below. Please check!

  1. The best thing about Star Health Gain Insurance policy is that it can cover both individuals and their families. An individual can choose the policy premium according to individual and floater sum insured required from several options.
  2. Coming to the premium options, Star Health provides four options – INR 15,000, INR 20,000, INR 25,000, and INR 30,000 (plus applicable GST). You can choose any of them according to your needs and convenience.
  3. Similar to premium options, you will also get options in the Sum Insured for Inpatient Hospitalizations. These will be INR 1 lakh, INR 2 lakh, INR 3 lakh, INR 4 lakh, and INR 5 lakh.
  4. Another highlight of this policy is it can cover both Inpatient hospitalization and outpatient expenses of a patient. So, you don’t need to worry about the type of treatment.
  5. All Daycare Procedures ( Treatments for which you get discharged on the same day; less than 24 hours) will get coverage under the Health Gain Insurance Policy.
  6. You will also get cover for Ambulance Charges up to INR 750 per hospitalization. This amount can be a maximum of INR 1,500 in an overall policy period of 1 year.
  7. On paying the premium of your policy by any mode other than cash, you will also get tax benefits under Section 80D of the Income Tax Act.

Benefits of Star Health Gain Insurance Policy

Now that you have information about the highlights of Star Health Gain Insurance Plan and why it is so popular, you should also know the benefits of it. These are divided into two sections —  Hospitalization Cover and Outpatient expenses. We are showing them below. Do check!

Section 1: Hospitalization Cover

  1. Room, Boarding, Nursing Expenses up to 1% of the Total Sum Insured per Day of your Hospitalization
  2. Expenses on ICU, Theatre, Blood, Oxygen, Diagnostic Materials, etc.
  3. If you exceed the limit of Room Rent Expenses, the company will make a proportionate deduction in the overall Hospitalization expenses.
  4. Pre-hospitalization expenses up to 30 days before the admission to the hospital
  5. Post Hospitalization expenses after 60 days of Discharge from the hospital
  6. Ambulance charges up to INR 750 per hospitalization (up to INR 1,500 per year)
  7. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, and Cost of Medicines & Drugs.
  8. Expenses related to all Daycare procedures
  9. Expenses on Cataract Treatment up to limit mentioned in the policy
  10. Co-payment of 20% on every claim amount for fresh and Renewal Policies for individuals above 60 years of age at the time of policy inception

Section 2: Out-Patient Benefits

  1. Individuals will get Out-patient Benefits according to the Premium Option and Sum Insured Options chosen by them at the time of entry
  2. You can get reimbursement for all your medical expenses at Network Hospitals of Star Health Insurance Companies. For this, there is no waiting period or Co-payment facility available.
  3. One of the amazing benefits of Star Health Gain Insurance Policy is that you can carry forward your unutilized benefit in a policy year to the immediately succeeding Renewal Year. Apart from this, you cannot carry over any further.
  4. Coverage for Modern Treatments like Balloon Sinuplasty, Robotic Surgeries, Intravitreal Injections, Deep Brain Stimulation, etc. up to the limit mentioned in the policy

Waiting Period in a Star Health Gain Insurance Policy

There are different waiting periods decided by Star Health Insurance Policy that you should know. Within this period, you cannot enjoy the benefits of your policy. We are mentioning them below. Have a look.

SituationsWaiting Period
Expenses related to Treatments of any illness within30 days from the inception of Policy30 Days
Accidental CasesNot Applicable
Specific Illnesses/ Diseases24 Months
Treatment for Pre-existing Diseases48 Months

Eligibility Criteria for Star Health Gain Insurance Policy

To get a Star Health Gain Insurance Plan, you will need to meet a few conditions, which are mentioned below. Have a look!

  1. The minimum age at the entry time can be as low as 91 days, while the maximum can be 65 years.
  2. You can also choose the Family Floater Plan for your family that includes Self, Spouse, Dependent Children up to 25 years of age.
  3. Individuals will also get a free look period of 15 days from the starting date of your policy. Within this period, you can review the policy and return it without paying any extra charges. However, this period is not available at the time of renewal.

Exclusions from the Star Health Gain Insurance Policy

There are a few treatments for which you will not get covered under the Star Health Gain Insurance Policy. Before choosing the plan for yourself, it is important to know them. We are showing the same below. Do check!

  1. Attempted Suicide
  2. Use of Alcohol or Drugs
  3. All types of treatment related to Degenerative Disc and Vertebral Diseases
  4. AIDS
  5. Congenital Internal Disease/Defect
  6. Naturopathy Treatment
  7. All types of Hernia
  8. All Diseases of Prostate, Stricture Urethra
  9. Varicose Veins and Varicose ulcers
  10. All type of Transplant and Related Surgeries

How to Get Claims for Star Health Gain Insurance Policy?

As we told you in the introduction that one of the amazing features of Star Health Gain Insurance policy is its fast and in-house settlement. Understanding the claim settlement procedure is one of the crucial aspects. The company provides two options — Cashless and Reimbursement methods. Look at the details about both of them!

Cashless Claim Method

  1. Dial 1800 425 2255 or 1800 012 4477 to intimate the Star Health Insurance Company about your Claims.
  2. At the Hospital’s reception, you will need to show your Health ID Card for identification.
  3. Submit all the relevant papers to the Hospital. These will be the Pre-admission investigations Paper and Consultation paper. Your network hospital will verify your identity and papers and submit the pre-authorization form to the company.
  4. Before Claim processing, the team will verify all the documents. If required, an assigned doctor may visit the hospital.
  5. After discharge, the hospital will send all the claim documents to the company, and the amount will be settled directly to the hospital.

Reimbursement Claim Method

  1. At both Network and Non-network hospitals, you can get reimbursement of all the expenses within 15 days from the date of discharge. Don’t forget to intimate the insurer about the claim within 24 hours of Hospitalization.
  2. After admission to a hospital, get the treatment, settle your bills, and send your reimbursement claims regarding your plan.
  3. You will need to submit the necessary claim documents to the company within 15 days of getting discharged from the hospital..

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