• Star Health Gain Insurance Policy

    Health Insurance
    • Enjoy options to cover yourself, your spouse, kids and even your parents
    • Enjoy access to 10,000+ hospitals for cashless treatment
    • Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

    Star Health Gain is an insurance policy that offers comprehensive health insurance coverage for both individuals and families. This policy can be used to cover both inpatient and outpatient medical expenses. One of the unique features of this health insurance cover is that it has a flat premium charge irrespective of the age of the insured, sum insured opted, or the number of members covered in a family. The range of benefits offered by this cover aims to address the health insurance requirements of individuals as well as families.

    Eligibility For Star Health Gain Insurance Policy

    The following eligibility criteria applies to Star Health Gain Insurance Policy.

    • Anyone between the ages of 5 months and 65 years can enter this policy.
    • Children below 18 years of age can be covered only if their parents are covered.
    • Lifelong renewal option is available for people entering the policy within the above mentioned age.
    • This policy can be availed on an individual basis or on a family floater basis.
    • For family floaters, the coverage is limited to self, spouse, and dependent children (below 25 years of age).

    Sum Insured & Premium Charges

    Star Health Gain Insurance Policy is available in five different sum insured options - Rs.1 lakh, Rs.2 lakh, Rs.3 lakh, Rs.4 lakh, and Rs.5 lakh. Irrespective of the sum insured opted, age of the insured person, or the number of members in a family (under family floater), the premium amount for this policy remains the same.

    Options  Premium Amount  Sum Insured  
    Option 1  Rs.15,000  Rs.1 lakh   Rs.2 lakh   Rs.3 lakh  Rs.4 lakh   Rs.5 lakh 
    Option 2  Rs.20,000 
    Option 3  Rs.25,000 
    Option 4  Rs.30,000 

    Features Of Star Health Gain Insurance Policy

    Some of the key features of Star Health Gain Insurance Policy can be listed as follows:

    • Pre-acceptance medical examination is required for persons above 50 years of age. As of now, the company bears the cost of this examination.
    • All pre-existing diseases and illnesses can be covered only after 48 months of continuous policy coverage.
    • Pre-hospitalisation medical expenses are covered for up to 30 days before the date of admission in the hospital.
    • Post-hospitalisation medical expenses are also covered and paid as a lumpsum amount.
    • Coverage is available for both inpatient and outpatient treatments.
    • Enhancement of sum insured is available during the time of renewal.
    • A grace period of 30 days is available for renewal from the date of expiry.
    • Income tax relief is available for premium payment under Section 80D of the Income Tax Act.
    • A free look period of 15 days is available for policyholders to return the policy if they are not satisfied with the terms.
    • Portability option is available under this policy. To make the transfer to another insurer, the company must be notified at least 45 days before the date of renewal.

    Benefits Of Star Health Gain Insurance Policy

    The maximum extent of hospitalisation coverage and outpatient treatment benefits under Star Health Gain Insurance Policy can be given as follows.

    Room rent and boarding expenses Class A cities - 2% of the sum insured subject to a maximum of Rs.4,000 per day Class B cities - 1% of the sum insured subject to a maximum of Rs.3,000 per day Other locations - 1% of the sum insured subject to a maximum of Rs.1,000 per day
    Medical expenses covered Surgeon’s fee, consultant’s fee, anaesthetist’s fee, medical practitioner’s fee, blood, oxygen, drugs & medicines, cost of pacemaker, diagnostic expenses, and other similar expenses
    Emergency ambulance charges Up to Rs.750 per hospitalisation subject to a maximum of Rs.1,500 per policy period
    Outpatient treatment cover Expenses are covered up to certain limits specified in the policy document. Treatment costs are covered even for pre-existing diseases, dental conditions, prenatal and postnatal care, etc. Unutilised amount can be carried forward subject to a maximum of one year.
    No claim bonus A 10% discount on premium charges is available following a claim-free year. However, this discount is not cumulative.

    Exclusions From Star Health Gain Insurance Policy

    There are certain exclusions under Star Health Gain Insurance Policy for which the company is not liable for any payment. These exclusions apply only for inpatient medical treatment.

    • Any diseases or illnesses contracted within the first 30 days of commencement of the policy
    • Conditions like benign prostatic hypertrophy, hydrocele, hernia, congenital internal diseases, sinusitis, renal stone removal, etc. for the first one year of the policy
    • Conditions like cataract, hysterectomy, knee replacement surgery, joint replacement surgery, varicose veins, etc. for the first two years of continuous policy coverage
    • Intentional self injuries or injuries caused during suicide attempt
    • Injuries caused by war or warlike activities
    • Injuries caused by nuclear weapons or radioactivity
    • All kinds of cosmetic and aesthetic treatments
    • Dental treatment or surgery of all kinds unless necessitated by an accident
    • Convalescence, general debility, or run-down conditions
    • Congenital external diseases, birth defects, and anomalies
    • Treatment for HIV, venereal diseases, or any other sexually transmitted diseases
    • Injuries caused while under the influence of alcohol or drugs
    • Expenses related to treatment for pregnancy, childbirth, abortion, miscarriage, etc.
    • Expenses incurred for weight control or weight management treatments
    • Treatment performed through systems of medicines other than allopathy
    • Cost of medical aids such as contact lens, spectacles, hearing aids, crutches, walkers, wheelchairs, artificial limbs, etc.

    Claim Procedure

    Claim procedure for Star Health Gain Insurance Policy is similar to the company’s other insurance products. Policyholders can contact the company’s helpline anytime and request information related to their policies. The insurer must be notified 24 hours before admission in case of planned hospitalisation. During emergency hospitalisation, the insurer must be notified within 24 hours after admission in a hospital.

    Cashless treatment can be availed in the company’s network hospitals. The insured must provide the policy details and identity proof to the hospital in order to avail cashless treatment. Since there are no third-party administrators involved, the claim settlement process is direct and hassle-free. For normal hospitalisation claims, the insured must provide all the documents related to the medical expenses incurred. Once these documents are validated by the company, the settlement amount will be provided to the insured.

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