Health Insurance 603 views January 6, 2021

Star Health Special Care is a health cover for children aged between 3 and 25 years. This is a specially designed product for children who are suffering from Autism Spectrum Disorder (ASD). Usually, ASD is diagnosed in childhood from the age of 2-3 years, but sometimes ASD develops even during toddlerhood days. But a Star Health Special Care can cover your child against health risks financially with a sum insured of INR 3 lakh. Also, Star Health doesn’t require any pre-acceptance medical check-up. However, along with your signed proposal form, submit a copy of the prior treatment records of your child. Let’s read this page below and know about Star Health Special Care coverage and exclusions.

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Coverage Under Star Health Special Care

Star Health will pay the following expenses if you purchase the Star Health Special Care policy.

  1. Room Rent, Boarding and Nursing Expense from hospital/nursing home up to INR 5,000
  2. For Shared Accommodation, Hospitalization Expenses to be covered are as follows INR 500 per day, INR 2,000 for each hospitalization and INR 10,000 per policy period.
  3. Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialist fees
  4. Cost of anesthesia, blood, oxygen, surgical appliances, medicines and drugs used during your hospitalization.
  5. Operation theatre charges
  6. ICU charges 
  7. Emergency Ambulance charges up to INR 750 per hospitalization and INR 1,500/ per policy period.
  8. Post-hospitalization expenses equal to 7% of the hospitalization expenses or the actuals incurred up to 60 days after discharge from the hospital.
  9. All daycare treatments
  10. Modern Treatments

Sub-limits for Ailments/Treatments Under Star Health Special Care

Star Health put a cap for covering the following diseases under this health insurance plan.

  1. Adeno Tonsillectomy has a sub-limit of INR 25,000 per policy period
  2. Treatment of Seizures is capped at INR 30,000 per policy period
  3. Treatment of fractures is capped up to 20% of the sum insured per policy period
  4. Botox injection capped at INR 5,000 per sitting and covered up to INR 20,000 per policy period, only when it is administered during in-patient hospitalization.
  5. Behavioral Therapy, Physiotherapy, Occupational Therapy and Speech Therapy capped up to INR 15,000 per policy period.

Waiting Period on Star Health Special Care

Star Health is not liable to pay certain medical expenses related to Pre-Existing Diseases for a certain period, which is also called a waiting period in a health insurance policy. So let’s check out the waiting period for treatment/diseases under Star Health Special Care.

Pre-Existing Disease (PED)Waiting Period
Treatment & Complications of PED48 months
Anterior & Posterior Chamber Disease of the Eye24 months
ENT Diseases24 months
All types of Hernia24 months
All obstructive uropathies24 months
Hydrocele24 months
Fistula or Fissure in Ano24 months
Hemorrhoids, Pilonidal Sinus and Fistula24 months
Rectal Prolapse and Congenital Internal disease, defect or anomalies24 months
Gallbladder and Pancreatic diseases24 months
All treatments related to Hepato-pancreato-biliary diseases including Gallbladder and Pancreatic calculi24 months
Management for Kidney and Genitourinary tract calculi24 months
Subcutaneous Benign lumps, Sebaceous cyst, Dermoid cyst, Mucous cyst lip or cheek, Carpal tunnel syndrome, Trigger finger, Lipoma, Neurofibroma, Ganglion and similar pathology24 months
Conservative, operative treatment24 months
All types of intervention for diseases related to Tendon, Ligament, Fascia, Bones and Joint including Arthroscopy and Arthroplasty24 months
Treatment of any illness30 days from the date of policy commencement

Exclusions from Star Health Special Care

Star Health is not liable to pay for the following expenses under this health insurance plan.

  1. Investigation & Evaluation
  2. Rest Cure, rehabilitation and respite care
  3. Obesity/ Weight Control Programmes
  4. Change-of-Gender treatments
  5. Cosmetic or Plastic Surgery
  6. Injury from participation in Hazardous or Adventure sports
  7. Breach of law with a criminal intent
  8. Treatment at excluded providers
  9. Alcoholism and Drug Abuse treatments
  10. Treatments at health hydros, nature cure clinics, spas or similar establishments
  11. Non-prescribed dietary supplements and medicines
  12. Refractive error
  13. Unproven treatments
  14. Sterility and infertility treatments
  15. Maternity expenses
  16. Congenital Internal disease, defect or anomalies excluded till the waiting period completes
  17. Convalescence, General Debility, Run-down condition and Nutritional Deficiency states
  18. Venereal disease
  19. Sexually transmitted diseases(Other than HIV)
  20. Injury/Illness due to war, invasion, an act of foreign enemy and warlike operations
  21. Injury/Illness due to nuclear weapons/materials
  22. Cerebral palsy
  23. Mental retardation
  24. Chromosomal
  25. Genetic abnormalities
  26. Unconventional, untested, experimental therapies
  27. Chondrocyte Implantation
  28. Bone marrow transplantation
  29. Naturopathy Treatment
  30. Erectile dysfunctions treatments
  31. Inoculation or Vaccination (not for post-bite treatment and medical treatment for therapeutic reasons)
  32.  Dental treatment or surgery
  33. Expenses of diseases, illness or accidental injuries treatment from the system of medicines other than Allopathy
  34. Hospital registration charges, admission charges, record charges, telephone charges and similar other charges
  35. Expenses of spectacles, contact lens, hearing aids, walkers, crutches, wheelchairs, muscle relaxing pump, CPAP, BIPAP, etc.
  36. Continuous Ambulatory Peritoneal Dialysis, infusion pump and similar aids
  37. Cochlear implants and procedure-related expenses
  38. Hospitalizations that are not medically necessary
  39. OPD expenses, except for Behavioral Therapy, Physiotherapy, Occupational Therapy and Speech Therapy

Free Look Period on Star Health Special Care

A free look of 15 days will be provided to you under Star Health Special Care during which you can read the terms and conditions of the policy and return the same if not satisfied with it. If you haven’t made any claim at Star Health Special Care during the free look period, you will be entitled to receive your paid premiums minus the medical examination expenses and stamp duty charges.

Claim Procedure for Star Health Special Care

To claim the sum insured from Star Health Special Care, you need to follow the below instructions:-

  1. Contact the 24X7 help-line number – 1800 425 2255 or 1800 102 4477
  2. Tell your Policy Number to the service provider
  3. If this is a planned hospitalization, inform Star Health 24 hours before hospitalization
  4. Whereas in case of emergency hospitalization, inform Star Health within 24 hours of hospitalization.

Note- For cashless facilities get treatment at network hospitals. Because if you get treatment in non-network hospitals, you need to pay upfront and get the expenses reimbursed by Star Health later by submitting the necessary documents.

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