Star Family Health Optima Insurance Plan
Objective
This is a family floater health insurance policy that aims to provide adequate cover even after one of the insured members has used the initial sum.
Our View
Automatic restoration benefit is a great feature for family floater policies where single sum insured is shared among many members. It ensures that other members are not deprived of insurance cover if a member has exhausted the initial cover. We recommend this policy.
Suited for
Any two or more family members up to 65 years of age can take this policy on a floating sum basis.
What does it do?
This policy requires at least two family members to initiate the cover. The policy is different from others due to its automatic restoration facility wherein, the insurance company reinstates entire sum insured if it is exhausted by any of the members during a policy year. This restoration benefit is not available only on covers of value higher than Rs 2 lakh. Also, the restored benefit cannot be used for treatment of illness for which the claim was made.
Pros
A sufficient sum is available for other family members even after a member has used the amount. Policy pays a no-claim bonus up to 35 per cent.
One can avail 5 per cent discount on premium if the policy is bought online.
Premium paid under this policy qualifies for deduction under section 80D of Income Tax Act.
Cons
Restored benefit amount cannot be used for same illness by same member again.
There is a co-payment clause for each admissible claim for members between 61 years and 65 years, which is a drawback.
Eligibility
Entry Age (years)
Minimum
5 months
Maximum
65
Maximum Policy Renewal Age (years)
65
Coverage Type
Family floater
Sum Insured (Rs)
Maximum
15 lakh
Minimum
1 lakh
Policy Term (years)
1
Tax Benefit
Premium paid is eligible for tax benefit under section 80D of the Income Tax Act
No Claim Bonus
5% to 35% in event of a claim free year
Pre Policy Medical Check Up
Required for person above 45 years of age at company's cost
Grace Period for Policy Renewal
15 days
Policy Termination
Insurer may cancel the policy by giving a 30 days notice. The policyholder is allowed to cancel the policy too by giving a 30 day notice. The company shall refund a part of premium on basis of elapsed policy period provided no claim has been made during such period
Customer Service
Address
Star Health and Allied Insurance Company Limited
Corporate Office: No.1, New Tank Street,
Valluvar Kottam High Road, Nungambakkam,
Chennai - 600034.
Mail to
[email protected], [email protected]
Call to
1800 425 2255/ / 044 2826 3300
SMS
STAR to 56677
Additions to the Plan
| No Claim Bonus | |||
| Basic Sum Insured (R) | First Renewal | Second Renewal | Maximum Bonus Allowable |
| 100000 | 0.1 | 0.05 | 0.15 |
| 200000 | 0.1 | 0.05 | 0.15 |
| 300000 | 0.25 | 0.1 | 0.35 |
| 400000 | 0.25 | 0.1 | 0.35 |
| 500000 | 0.25 | 0.1 | 0.35 |
| 1000000 | 0.25 | 0.1 | 0.35 |
| 1500000 | 0.25 | 0.1 | 0.35 |
| The Bonus will be reduced by 50% in the event of a claim. If there is a claim in the successive year also the bonus will become zero. The basic sum insured shall however not be reduced. | |||
| Exclusions and Waiting Period | |
| Automatic Restoration of Sum Insured | Restored Sum Insured can be utilized for illness/disease unrelated to the illness/diseases for which claim's was/were made. |
| Pre existing diseases | covered after 48 months |
| No claim period | Any disease contracted during the first 30 days of commencement of the policy |
| Waiting Period | Certain diseases such as cataract, Varicose veins and Varicose ulcers etc shall be covered after a waiting period of 2 year.Certain diseases such as hernia, piles, sinusitis and related disorders etc. will be covered after a period of 1 year. |
| Copayment | 20% of each and every admissible claim for person aged between 61 to 65 years at entry level |
| General Exclusions | Naturopathy treatment and any treatment other than allopathyCosmetic, beauty or slimming treatment |
| Scope of Cover | |
| Cashless facility | Available at empanelled hospitals in India |
| Re-imbursement | Available at non empanelled network of hospitals |
| Pre hospitalisation | Covered; upto maximum of 30 days prior to hospitalisation |
| Post Hospitalisation | lumpsum calculated at 7% of the hospitalization expenses (excluding room charges) subject to a maximum of Rs.5,000 |
| In-patient hospitalisation | Covered |
| Room rent, boarding and nursing expenses | 2% of sum insured,subject to a maximum of Rs.5000/- per day in Class A cities and 1% of Sum Insured upto a maximum of Rs 3000 per day in Class B cities and 1% of Sum Insured subject to a amximum of Rs 1000 per day in other cities |
| Surgeon's fees, Consultant's fees, Anaesthetist's and Specialist's fees, Cost of medicines and drugs | Covered |
| Emergency Ambulance | Rs 750 per hospitalisation upto maximum of Rs 1500 per policy period |
| Day Care Procedures | covers 101 procedures |
| Cataract Treatment | Rs 12000 per policy perisod for Sum Insured upto Rs 2 lakhRs 20000 in respect of one eye and Rs30000 for entire policy period for Sum Insured ranging between Rs 3 lakh to Rs 5 lakhRs 30000 in respect of one eye and Rs 40000 for the entire policy period for Sum Insured above Rs 5 lakh |
Cost Details
| Annual Premium Option for Rs 1 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 3890 | NA | NA | NA | 3250 | 4150 | NA |
| 36-45 | 3890 | NA | NA | NA | 3875 | 4700 | NA |
| 46-50 | NA | NA | NA | NA | NA | NA | NA |
| 51-55 | NA | NA | NA | NA | NA | NA | NA |
| 56-60 | NA | NA | NA | NA | NA | NA | NA |
| 61-65 | NA | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 3600 | NA | NA | NA | 3250 | 3850 | NA |
| 36-45 | 3600 | NA | NA | NA | 3700 | 4300 | NA |
| 46-50 | NA | NA | NA | NA | NA | NA | NA |
| 51-55 | NA | NA | NA | NA | NA | NA | NA |
| 56-60 | NA | NA | NA | NA | NA | NA | NA |
| 61-65 | NA | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 2 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 3950 | 4620 | 6110 | 6510 | 3500 | 4310 | 5200 |
| 36-45 | 4675 | 5170 | 6875 | 7975 | 3950 | 4905 | 5960 |
| 46-50 | 7870 | 8580 | 9425 | 10625 | 5800 | 7400 | 8975 |
| 51-55 | 8145 | 8855 | 9800 | 11200 | 6225 | 7575 | 9735 |
| 56-60 | 9400 | 9635 | 10840 | 11840 | 7225 | 8200 | 11000 |
| 61-65 | NA | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 3850 | 4255 | 5450 | 6300 | 3500 | 4100 | 5200 |
| 36-45 | 4465 | 4935 | 6565 | 7415 | 3875 | 4830 | 5410 |
| 46-50 | 7515 | 8190 | 8995 | 9845 | 5300 | 7210 | 8530 |
| 51-55 | 7775 | 8455 | 9260 | 10110 | 6000 | 7300 | 8790 |
| 56-60 | 8515 | 9195 | 9870 | 10720 | 7005 | 8200 | 9030 |
| 61-65 | NA | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 3 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 4300 | 5400 | 6875 | 7975 | 3875 | 4910 | 5940 |
| 36-45 | 5320 | 5900 | 7245 | 8195 | 4275 | 5365 | 6005 |
| 46-50 | 9515 | 11070 | 11880 | 12980 | 7010 | 7980 | 9725 |
| 51-55 | 9790 | 11350 | 12155 | 13255 | 7335 | 8910 | 10100 |
| 56-60 | 12675 | 13440 | 14030 | 15130 | 8995 | 9995 | 11445 |
| 61-65 | 20500 | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 4200 | 5300 | 6565 | 7465 | 3875 | 4910 | 5670 |
| 36-45 | 5170 | 5555 | 6775 | 7675 | 4275 | 5100 | 5670 |
| 46-50 | 9085 | 10565 | 11340 | 12240 | 7010 | 7810 | 9555 |
| 51-55 | 9345 | 10830 | 11605 | 12505 | 7335 | 8770 | 9800 |
| 56-60 | 12090 | 12830 | 13390 | 14290 | 8645 | 9510 | 11225 |
| 61-65 | 18750 | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 4 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 5300 | 6825 | 8300 | 9500 | 4640 | 5865 | 7385 |
| 36-45 | 6510 | 7730 | 8915 | 9715 | 5165 | 6235 | 7590 |
| 46-50 | 12000 | 13900 | 15270 | 16570 | 8570 | 9565 | 11960 |
| 51-55 | 13200 | 14925 | 16100 | 16890 | 9090 | 11110 | 12985 |
| 56-60 | 16000 | 18075 | 18835 | 20035 | 10135 | 12665 | 14420 |
| 61-65 | 28500 | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 5300 | 6610 | 7920 | 8820 | 4640 | 5640 | 7050 |
| 36-45 | 6350 | 7375 | 8525 | 9425 | 5005 | 6000 | 7245 |
| 46-50 | 12000 | 13200 | 14665 | 15565 | 8375 | 9345 | 11730 |
| 51-55 | 13000 | 14250 | 15185 | 15885 | 8685 | 10875 | 12650 |
| 56-60 | 15500 | 17255 | 17980 | 18880 | 9865 | 12440 | 14100 |
| 61-65 | 23200 | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 5 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 6885 | 8080 | 9655 | 10955 | 6510 | 7785 | 8800 |
| 36-45 | 8000 | 9125 | 10090 | 11390 | 7225 | 8010 | 9000 |
| 46-50 | 14970 | 16080 | 16510 | 17810 | 9995 | 14240 | 15610 |
| 51-55 | 15300 | 16400 | 16840 | 18140 | 12100 | 14700 | 15930 |
| 56-60 | 20050 | 21180 | 22075 | 23375 | 14885 | 16900 | 20590 |
| 61-65 | 30315 | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 6885 | 7710 | 9210 | 10210 | 6510 | 7435 | 8560 |
| 36-45 | 7640 | 8710 | 9635 | 10635 | 7225 | 7650 | 8630 |
| 46-50 | 14290 | 15350 | 15760 | 16760 | 9565 | 14000 | 14895 |
| 51-55 | 14600 | 15665 | 16075 | 17075 | 11850 | 14450 | 15215 |
| 56-60 | 19145 | 20225 | 21070 | 22070 | 14500 | 16335 | 19650 |
| 61-65 | 25750 | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 10 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 9110 | 11665 | 13445 | 16405 | 8700 | 10775 | 13575 |
| 36-45 | 11350 | 13450 | 16200 | 19505 | 9900 | 11995 | 15010 |
| 46-50 | 20500 | 21800 | 23555 | 26780 | 16330 | 17750 | 22100 |
| 51-55 | 22100 | 24800 | 27900 | 32665 | 17680 | 22875 | 26860 |
| 56-60 | 30300 | 32340 | 36210 | 39500 | 24000 | 26970 | 30010 |
| 61-65 | 40500 | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 8900 | 11000 | 12800 | 15900 | 8500 | 10100 | 12575 |
| 36-45 | 11000 | 12875 | 15380 | 18100 | 9700 | 11000 | 13895 |
| 46-50 | 18750 | 20990 | 22800 | 25710 | 15000 | 16900 | 20100 |
| 51-55 | 21000 | 22700 | 26440 | 28850 | 16810 | 21000 | 25660 |
| 56-60 | 28800 | 30325 | 35080 | 37500 | 23000 | 26090 | 27775 |
| 61-65 | 38500 | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
| Annual Premium Option for Rs 15 lakh Sum Insured for Mumbai, Delhi and Gujarat region | |||||||
| Age (in years) | Family Size | ||||||
| 2Adults | 2Adults + 1Child | 2Adults + 2Children | 2Adults + 3Children | 1Adult + 1Child | 1Adult + 2Children | 1Adult + 3Children | |
| 5 months-35 | 10885 | 13990 | 17780 | 20780 | 10540 | 13450 | 16770 |
| 36-45 | 13865 | 15800 | 19700 | 22700 | 11995 | 14400 | 18000 |
| 46-50 | 25650 | 29910 | 32100 | 35100 | 19875 | 21880 | 27030 |
| 51-55 | 31125 | 37750 | 41780 | 44780 | 24000 | 29020 | 33770 |
| 56-60 | 39500 | 43660 | 49205 | 52205 | 30890 | 32910 | 37990 |
| 61-65 | 50500 | NA | NA | NA | NA | NA | NA |
| for other cities | |||||||
| 5 months-35 | 10100 | 12770 | 16660 | 19310 | 10000 | 12450 | 15875 |
| 36-45 | 12500 | 14500 | 18300 | 20950 | 11240 | 13750 | 16550 |
| 46-50 | 24400 | 27500 | 31650 | 34300 | 19030 | 21000 | 25010 |
| 51-55 | 29895 | 35000 | 40700 | 43350 | 22875 | 28050 | 30080 |
| 56-60 | 36500 | 41200 | 47810 | 50460 | 28880 | 32000 | 34700 |
| 61-65 | 41135 | NA | NA | NA | NA | NA | NA |
| Figures are indicative premium for appropriate sum insured for each age band excluding service tax | |||||||
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