Star Health Assure Insurance Policy

The policy covers eligible medical expenses incurred during hospitalization for an illness or accident. Coverage includes expenses such as room, boarding, nursing, surgeon and medical practitioner fees, anesthesia, blood, oxygen, ICU, operation theatre, medicines, diagnostics, chemotherapy, radiotherapy, pacemakers, stents and similar admissible expenses, subject to the applicable limits.

Room-rent eligibility depends on the Sum Insured. For lower Sum Insured options, a room-rent limit applies, while higher Sum Insured options provide Any Room eligibility, subject to the stated exclusion of suite or above for certain Sum Insured levels. Proportionate deductions may apply where differential billing is followed.

All eligible day-care treatments requiring less than 24 hours of hospitalization are covered up to the applicable Sum Insured, subject to the policy terms.

Eligible inpatient treatment under Ayurveda, Unani, Siddha and Homeopathy is covered up to the Sum Insured when taken at an eligible AYUSH hospital. Claims under Yoga and Naturopathy require prior approval from Star Health.

Eligible modern treatments are covered up to the applicable Sum Insured, subject to the treatment being covered under the policy and the applicable terms.

The plan covers eligible medical expenses for up to 60 days before hospitalization and 180 days after discharge, when related to an admissible hospitalization claim.

Eligible road ambulance expenses are covered when there is an admissible hospitalization claim. The benefit can apply for transportation to a hospital, transfer between hospitals for better treatment or transportation home in the same city when certified as medically necessary.

Air ambulance expenses are covered up to 10% of the Sum Insured per Policy Year, subject to an admissible hospitalization claim and applicable conditions.

Eligible inpatient expenses related to organ transplantation from a donor to the insured person are covered when the transplant claim itself is admissible. Certain donor complications requiring redo surgery or ICU admission are also covered, subject to the policy provisions.

Home care treatment is covered for specified medical conditions where treatment that would normally require hospitalization is instead taken at home. The benefit is available up to 10% of the Sum Insured, subject to a maximum of ?5 lakh per Policy Year.

Eligible domiciliary treatment, including AYUSH treatment, is covered when the treatment continues for more than three days and the insured person's condition requires hospital-level care but treatment is taken at home because the person cannot be shifted to a hospital or a hospital bed is unavailable. Certain listed conditions are specifically excluded from this benefit.

The policy provides a Cumulative Bonus of 25% of the Sum Insured for every claim-free year, up to a maximum of 100% of the Sum Insured. The bonus is subject to the conditions regarding use and renewal.

The Sum Insured can be restored an unlimited number of times, up to 100% each time, for subsequent hospitalization. On partial utilization, the restoration is to the extent used, while full utilization restores the Sum Insured to 100%. The restored Sum Insured can be used for subsequent eligible hospitalization claims.

Treatment for Chronic Severe Refractory Asthma using advanced medicines can be covered through inpatient, day-care, home-care or outpatient treatment, when recommended by the treating pulmonologist. The benefit is limited to 10% of the Sum Insured, subject to a maximum of ?5 lakh per Policy Year.

Eligible delivery expenses, including Caesarean delivery and related pre-natal and post-natal expenses, are covered up to 10% of the Sum Insured. The benefit is available for a maximum of two deliveries during the lifetime of the policy and requires both self and spouse to have been continuously covered for 24 months.

Listed in-utero fetal surgeries and procedures are covered after completion of the applicable waiting period. The waiting period does not apply to treatment related to congenital internal disease or defects of the unborn child, subject to the policy conditions.

Star Health Assure provides reimbursement for eligible medical expenses incurred for Assisted Reproduction Treatment for sub-fertility, subject to a 24-month waiting period from the first inception of the policy with the Company. The policy covers one Assisted Reproduction Treatment cycle in a Policy Year, and in-patient hospitalization is not mandatory to claim this benefit. The applicable annual limit depends on the selected Sum Insured: ?1 lakh for a Sum Insured of ?5 lakh or ?7.5 lakh, ?2 lakh for ?10 lakh to ?25 lakh, and ?4 lakh for ?50 lakh to ?2 crore, subject to the policy terms and conditions.

Star Health Assure covers eligible hospitalization expenses for the treatment of a newborn baby from Day 1 of birth until the policy expiry date. The benefit applies to treatment for any disease, illness, including congenital disorders, or accidental injury. This cover is available only when the Delivery Expenses claim is paid under the policy or when the mother has been continuously covered under the policy for 12 months without a break. The applicable limit is ?2 lakh per Policy Period for a Sum Insured of ?5 lakh, ?7.5 lakh, ?15 lakh, ?20 lakh or ?25 lakh, and ?4 lakh per Policy Period for a Sum Insured of ?50 lakh, ?75 lakh, ?1 crore or ?2 crore. These sub-limits do not apply to treatment related to congenital internal diseases or defects of the newborn, subject to the applicable policy terms and conditions.

When the insured person occupies shared accommodation during inpatient hospitalization, the policy provides ?1,000 per completed 24-hour period of stay, subject to the policy terms.

Star Health Assure arranges a preventive health check-up through its network providers, with the applicable limit depending on the selected Sum Insured and whether the policy is on an Individual or Floater basis. For an Individual policy, the limit is ?1,500 for a Sum Insured of ?5 lakh or ?7.5 lakh, ?2,000 for ?10 lakh, ?4,000 for ?15 lakh, ?5,000 for ?20 lakh to ?50 lakh, and ?8,000 for ?75 lakh to ?2 crore. For a Floater policy, the corresponding limits are ?2,500, ?5,000, ?8,000, ?10,000, and ?15,000, respectively, subject to the applicable policy conditions. 

The insured person can obtain a second medical opinion from a doctor in Star Health's network through the Star Health mobile application and digital services.

The plan provides unlimited tele-consultation through Star Health's mobile application and digital platforms, subject to the service conditions.

The insured person can use the Star Health mobile application for an AI-driven face scan to check selected vital parameters such as heart rate, oxygen saturation and respiration rate, up to two times per month per insured person.

If the insured person is hospitalized for a life-threatening emergency away from their usual place of residence, transportation expenses by air for one immediate family member can be reimbursed up to ?10,000, subject to the claim being admissible.

Following an admissible hospitalization claim, the policy provides up to ?15,000 per Policy Year towards repatriation of the insured person's mortal remains to the recorded residence, including embalming and coffin charges.

Eligible rehabilitation and pain-management expenses are covered up to the applicable sub-limit or 20% of the Sum Insured, whichever is lower, subject to treatment being taken at authorized centers and the specified medical conditions.

Eligible non-medical hospitalization expenses and consumables are covered, subject to the admissible claim and applicable policy conditions.

If hospitalization is taken at an eligible Valuable Service Provider Network hospital, the policy provides a lump-sum benefit equal to 1% of the Sum Insured, subject to a maximum of ?5,000 per Policy Period.

The Star Wellness Program rewards eligible healthy activities through wellness points. Depending on the points earned, policyholders can receive a premium discount of up to 20%, subject to the program rules.