Star Health and Allied Insurance Co. Ltd. are specialists in the health insurance sector. They deal with basic health insurance plans, overseas mediclaim policies and personal accident plans. Since they focus on only one insurance type, they have various plans that are specific to major health conditions that people might need financial protection from. This includes plans for cancer, diabetes, cardiac care, etc. Star Net Plus is a special policy that has been designed for HIV patients.
Eligibility for Net Plus Policy
The eligibility criteria laid out for this particular plan is quite broad and does not specify any age restrictions for entry into the policy or renewal of the policy.
- A person who is infected with HIV but hasn’t reached the stage of AIDS.
- The CD4 count should be above 350.
- The proposer can be an NGO, government, or agency that is active in serving people who are affected by HIV.
Features of Net Plus Policy
This unique plan has features that help HIV-infected patients manage their medical expenses.
- The policy has two sections – Section-I (HIV Section) that provides a lump sum if the policyholder reaches the stage of AIDS, and Section-II (Medical Section) that covers the hospitalisation expenses of the policyholder.
- The minimum sum insured for Section-I is Rs.5,000 and maximum is Rs.50,000 whereas the minimum sum insured for Section-II is Rs.10,000 and maximum is Rs.50,000. The policy offers 6 plans of varying sum insured amounts from each section. The policyholder may choose what best suits his/her needs.
- The minimum premium is Rs.735 and the maximum is Rs.4,650. The premium is calculated based on the sum insured.
- A pre-acceptance medical screening is conducted to confirm that the individual is infected with HIV and to ensure that he/she has not reached the stage of AIDS already.
On change of system of medicine, up to 25% of the sum insured will be provided to the insured person.
- There is no TPA, direct in-house settlement is made.
- Cashless hospitalisation services can be availed from over 6,000 hospitals that form a network with the insurance company.
Benefits of Net Plus Policy
The plan offers certain benefits for individuals who possess this particular policy.
|Room rent and boarding expenses
||2% of sum insured
||Up to Rs.750 per hospitalisation and overall limit of Rs.1,500 per policy period
||Medical expenses up to 30 days prior to the date of admission to the hospital will be covered
||7% of the expenses incurred up to a maximum of Rs.5,000 will be provided
Exclusions of Net Plus Policy
Certain medical conditions and expenses are not covered by this plan.
- Expenses incurred on the treatment of HIV.
- Pre-existing medical conditions.
- AIDS if confirmed during the first 90 days of the policy.
- Pre-existing diseases until completion of 48 months of continuous coverage of the policy.
- Any disease contracted during the first 30 days of the policy unless covered by a scheme for a continuous period of 12 months.
- Expenses incurred on treatment of Tuberculosis and Gastroenteritis.
- Expenses incurred on treatment of certain conditions specified in the policy.
- Injury/disease caused by wars, war-like situations, or nuclear material.
- Circumcision unless necessary for the treatment of a disease not excluded in the policy.
- Vaccination or inoculation.
- Change of life or cosmic/aesthetic treatment.
- Plastic surgery unless necessitated by an accident or illness.
- Cost of spectacles, contact lenses, crutches, walkers, hearing aids, wheelchairs, etc.
- Dental surgery/treatment unless necessitated by an accident.
- Convalescence, rest cure or general debility.
- Congenital external diseases or defects, sterility, or venereal disease.
- Intentional self-injury or injury caused by intoxication.
- Diagnostic or laboratory examinations, or X-ray unrelated to the reason of hospitalisation.
- Expenses on vitamins and tonics unless required to treat the injury or disease.
- Treatments related to pregnancy, childbirth, abortion or its complications.
- Naturopathy treatment.
Requests for claims should be made within 15 days from the date of discharge from the hospital. The insured individual should furnish all bills, receipts and other documents required by the company. Any additional information or document required by the company should also be provided for the claim to be processed.
Reimbursement claims: The company should be intimated about the hospitalisation and the claims should be filed within 15 days after discharge. The documents that need to be submitted are the claim form, pre-investigation and treatment papers, original discharge summary, cash receipts from the hospital and chemist, cash receipts and reports of tests, receipts from doctors and surgeons, and diagnosis certificate from the attending doctor.
Cashless treatment: The policyholder also has the option of availing cashless hospitalisation at network hospitals across the country.