Family Health Optima is a family health insurance policy offered by Star Health Insurance. This policy comes with a wide range of benefits as it covers a whole family under one single policy. The sum insured can be chosen according to the affordability and preference of the proposer. Star Family Health Optima is designed in such a way that it offers a comprehensive coverage for all family members. Some of the key features like coverage for organ donor expenses, automatic sum insured restoration, health checkup benefit etc. make this one of the most sought after policy covers for families.
Some of the eligibility criteria for Star Family Health Optima are as follows:
The sum insured for Star Family Health Optima is quite flexible ranging from Rs.1 lakh to Rs.25 lakh based on the requirements of the proposer. The premium charges for the policy is influenced by various factors such as age of the oldest family member, number of members in the family, sum insured chosen, etc.
Some of the key features of Star Family Health Optima cover are as follows:
There are various hospitalisation and domiciliary hospitalisation benefits available under Star Family Health Optima policy. Some of the major benefits available under this cover can be given as follows:
|Room, boarding, and nursing expenses||Sum assured Rs.1 lakh to Rs.2 lakh - Rs.2,000 per day Sum assured Rs.3 lakh to Rs.4 lakh - Rs.5,000 per day Sum assured Rs.5 lakh and above - single standard A/C room|
|Hospitalisation expenses covered||Surgeon, anaesthetist, medical practitioner, consultants, specialist fees, oxygen, blood, operation theatre charges, cost of pacemaker, cost of medicines & drugs, etc.|
|Ambulance charges||Up to Rs.750 per hospitalisation or Rs.1,500 per policy period Air ambulance charges (sum insured Rs.5 lakh and above) - 10% of the basic sum insured per policy period|
|Domiciliary hospitalisation expenses||Available for medical treatment for a period exceeding three days|
|Donor expenses for organ transplant||Up to 10% of the sum insured or Rs.1 lakh (whichever is less) provided that the insured is the recipient|
|Newborn baby cover||Up to 10% of the sum insured or Rs.50,000 (whichever is less) from the 16th day after the child’s birth|
|AYUSH treatment||For treatment under Ayurveda, unani, siddha, and homeopathy, the following benefits are available. Rs.10,000 for sum insured up to Rs.4 lakh Rs.15,000 for sum insured between Rs.5 lakh and Rs.15 lakh Rs.20,000 for sum insured Rs.20 lakh and Rs.25 lakh|
|Health checkup expenses||For every claim free year, the company reimburses the cost of health checkup based on the sum insured opted. This benefit is not available for sum insured Rs.1 lakh and Rs.2 lakh.|
|Emergency domestic medical evacuation||Expenses related to transportation from one hospital to another are covered. Up to Rs.10,000 is available based on the sum insured opted.|
|Treatment in preferred network hospitals||Lumpsum payment of 1% of the sum insured subject to a maximum of Rs.5,000 per policy period|
|Share accommodation benefit||Up to Rs.1,000 per day (based on sum insured) if the insured person shares in-patient hospitalisation with another person|
|Assisted reproductive treatment||This benefit comes with a waiting period of 36 months. Liability of Rs.1 lakh for sum insured Rs.5 lakh Liability of Rs.2 lakh for sum insured Rs.10 lakh and above|
|Road traffic accident||If the hospitalisation is related to road traffic accident, the sum insured gets increased by 25% subject to a maximum of Rs.5 lakh. In two-wheeler accidents, the insured person must be wearing a helmet (either as rider or pillion rider)|
|No-claim bonus||Following a claim-free year, an additional 25% of the sum insured is available for the second year and 10% of the sum insured is available for the subsequent years.|
In addition to this, expenses related to compassionate travel, repatriation of mortal remains, second medical opinion, etc. are also covered.
There are a few exclusions under Star Family Health Optima for which the company is not liable to provide any compensation. Some of the major exclusions are as follows:
The claim procedure for Star Family Health Optima is similar to that of most health insurance plans offered by the company. For any assistance, the insured can contact the company’s 24-hour helpline and obtain information. Cashless facility can be availed in the company’s network hospitals. There are no third-party administrators involved. Policyholders can raise a claim directly with the company by submitting the relevant documents related to hospitalisation. Once the required documents are submitted, the insurer will validate the claim and provide reimbursement.
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