Health Insurance 126 views March 9, 2021

Star Health Net Plus Plan is one of the very few health insurance plans that offer coverage for AIDS. It offers you the sum insured in a lump sum in case you become an AIDS patient during the policy term. The policy covers other illnesses or injuries too. This star health insurance plan will cost you only INR 797. Check out the key features of the Star Health Net Plus Plan below.

  1. HIV
  2. In-patient Treatment
  3. Pre-and Post-hospitalization Medical Expenses
  4. Emergency Ambulance Expenses

Let’s know about the coverage of the Star Health Net Plus Plan in detail below.

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Star Health Net Plus Plan HIV Coverage

If you are diagnosed with AIDS during the policy term and the same is being confirmed by Star Health’s team of doctors, one lump sum payment shall be provided to you. The HIV cover benefit shall be provided to you if the stage of AIDS is the first incidence for you, and the signs or symptoms commences 90 days following the policy commencement date.

Note: The HIV cover for the insured individual will be automatically terminated after the lump sum payment and the same can’t be renewed.

List of In-patient Treatment Expenses Covered Under Star Health Net Plus Plan

Expenses on hospitalization shall be admissible for the claim if the minimum period of admission is 24 hours. The company shall pay for the following expenses under in-patient treatment –

  1. Room rent, boarding expenses at 2% of the sum insured
  2. Nursing expenses
  3. Surgeon, Anaesthetist, Medical Practitioner, Consultants and Specialist fees
  4. Cost of Anaesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis Chemotherapy, Radiotherapy, Cost of Pacemaker and other such similar expenses.

Pre-and Post-hospitalization Medical Expenses Coverage Under Star Health Net Plus Plan

Besides the in-patient treatment, Star Health Net Plus Plan also covers your pre-and post-hospitalization financial needs, know about them in detail below.

Pre-hospitalization – Any relevant medical expenses incurred 30 days before the date of hospitalization, for such illness, disease or sustained injury, the company will pay the compensation amount.

Post-hospitalization – An amount equivalent to 7% of the hospitalization expenses (Nursing charges, surgeon/consultant fees, diagnostic charges, medicines and drugs, each subject to a maximum of INR. 5,000 per occurrence). The post-hospitalization coverage benefits shall be provided to you if it is recommended by the attending medical practitioner.

Note: On package rates by the hospitals, the post-hospitalization benefit shall be determined after taking into account the room and boarding charges at 2% of the Sum Insured per day.

Emergency Ambulance Cover in Star Health Net Plus Plan

If you need an emergency ambulance service, the company will pay the ambulance charges up to INR 750 per hospitalization. And the maximum limit of this coverage is INR 1,500 per policy period.

Note: Only the transportation of the insured person by private ambulance service is admissible for the claim.

More About Star Health Net Plus Plan

Expenses on hospitalization will get covered only when the admission lasts for a minimum of 24 hours. However, this might not apply in the case of Dialysis, Chemotherapy, Radiotherapy, Cataract surgery, Dental Surgery, Lithotripsy (Kidney stone removal) Tonsillectomy, Cutting and Draining of Abscess, Liver Aspiration, Pleural Effusion Aspiration, Colonoscopy, Sclerotherapy. The coverage amount for these treatments are as follows:

  1. Cataract surgery – INR 20,000 for one eye and the total coverage amount is INR 30,000 during the policy period
  2. Lithotripsy (Kidney stone removal) – INR 20,000
  3. Tonsillectomy – INR 7,500
  4. Cutting and Draining of Abscess – INR 1,500
  5. Liver Aspiration – INR 2,000
  6. Pleural Effusion Aspiration – INR 2,000
  7. Sclerotherapy – INR 5,000

Note: The waiver of the minimum 24 hours of hospitalization is limited to the above-mentioned treatments only.

Exclusions from Star Health Net Plus Plan

The company isn’t liable to pay for the following medical expenses –

  1. All pre-existing conditions including the stage of AIDS, except for HIV, are specifically covered. The pre-existing illnesses shall not be covered until 48 consecutive months of continuous coverage. However, post expiry of the waiting period, the limit of the coverage of the pre-existing disease shall be limited to the sum insured.
  2. AIDS that is confirmed during the first 90 days from the policy commencement date
  3. Any illness/disease contracted within the first 30 days from the policy commencement. The exclusion won’t apply if the insured person has got covered under this scheme or group health insurance scheme with any Indian insurance company for a continuous period of the previous 12 months without a break.
  4. Exclusion of medical expenses for Tuberculosis and Gastro-Enteritis treatment
  5. The expenses on treatment of Cataract, Hysterectomy for Menorrhagia or Fibromyoma, Knee replacement Surgery (if not a result of an accident), Joint Replacement Surgery (other than caused by an accident), Prolapse of an intervertebral disc (not an accident cause), Varicose veins and Varicose ulcers. These expenses shall be covered post two years of continuous operation of insurance cover.
  6. The expenses on treatment of diseases such as Benign Prostate Hypertrophy, Hernia, Hydrocele, Congenital Internal disease/defect, Fistula in the anus, Piles, Sinusitis and related disorders, Gallstones and renal stone removal is not covered during the first 12 months of the policy.

Note: If these diseases are pre-existing at the time of proposal, they will be covered after the expiry of Pre-Existing Disease waiting period.

  1. Injury/Disease caused by war, invasion, the act of a foreign enemy, warlike operations, whether war is declared or not.
  2. Circumcision unless it is necessitated due to an accident
  3. Vaccination (except for post-bite treatment), inoculation, change of life, cosmetic/aesthetic treatment of any description, plastic surgery unless it is a case of an accident or a part of illness treatment.
  4. Cost of spectacles and contact lens, hearing aids, walkers, crutches wheelchairs and other such aids
  5. Dental treatment/surgery unless it is necessitated due to accidental injuries and requiring hospitalization
  6. Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and consumption of intoxicating drugs/alcohol.
  7. Charges incurred at hospital/nursing home for the diagnostic purpose only
  8. Expenses on vitamins and tonics unless it is a part of treatment for injury or disease as certified by the attending physician
  9. Injury/Disease caused by or contributed to by nuclear weapons or materials
  10. Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or any such complications, except for ectopic pregnancy
  11. Naturopathy treatment
  12. Hospital registration charges, record charges, telephone charges and other similar expenses
  13. Lasik Laser or Refractive Error Correction treatment
  14. Weight control services including surgical procedures for the treatment of obesity, medical treatment for weight control or weight loss programs
  15. Treatment of diseases, illness, accidental injuries by systems of medicines other than Allopathic shall be restricted up to 25% of the sum insured.

Conditions Under Star Health Net Plus Plan for HIV Cover

  1. Coverage is available for all persons irrespective of age. However, the insurer can decline cover to any person after the pre-insurance medical tests
  2. The renewals shall be automatic if the renewal premium is paid before the expiry of the current policy
  3. The pre-insurance medical tests is a precondition for all person
  4. You should submit all the documents required for a claim
  5. The findings of the company’s medical team shall be final and the binding decision of a claim
  6. Star Health Net Plus shall terminate upon the death of the insured
  7. If the company disclaims any liability and such claim within three years from the date of disclaimer isn’t made a subject matter of a suit in a Court of Law, claim for all purposes shall be abandoned and shall not be recoverable.
  8. Payment of claim under this policy is in INR only

Conditions Under Star Health Net Plus Plan for In-patient Cover

  1. A claim must be filed within 15 days from the date of the hospital discharge. It is a precedent condition to the admission of liability. However, the company will examine and relax the time limit as the case may be.
  2. Submit all original bills, receipts and other documents upon which a claim is based
  3. For reimbursement claims – submit a duly completed claim form, pre-admission investigations and treatment papers, original discharge summary from the hospital, cash receipts from the hospital/chemists, cash receipts and reports for tests done, receipts from doctors, surgeons, anesthetist, a certificate from the attending doctor regarding the diagnosis.
  4. For Cashless Treatment, only the prescriptions and receipts for pre-and post-hospitalization shall be required.

Note: The company reserves the right to call for additional documents

  1. This insurance shall terminate immediately upon either the death of the insured person or exhaustion of the sum insured, whichever is earlier
  2. If the company disclaims any liability and such claim within three years from the date of disclaimer isn’t made a subject matter of a suit in a Court of Law, claim for all purposes shall be abandoned and shall not be recoverable.
  3. All claims under this policy are payable in Indian currency INR
  4. All medical/surgical treatments shall be admissible for the claim if it is taken in India
  5. If the insured claims within two policy periods, the claims shall be paid taking into consideration the available sum insured in the two policy periods. This will include the deductible for each policy period. and if there are due premiums, the same shall be reduced from the claim amount.
  6. The company’s liability in case of package charges will be restricted to 80% of such amount. Package charges are charges that are not advertised in the schedule of the hospital.

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