Star Comprehensive
Overview
Star Comprehensive is a fairly priced health insurance plan offered by Star Health and Allied Insurance. As the name says, it’s a really comprehensive plan that covers maternity and newborn baby expenses, apart from covering all bases. It also offers coverage for OPD expenses and dental and ophthalmic OPD expenses, subject to some limits.
It’s a good choice for those looking for maternity and OPD coverage. However, the insurer faces operational challenges that are indicated by its low claim settlement ratio and high volume of claim complaints. This is a cause of concern.
Pros and Cons
- Maternity and newborn expenses covered – Offers coverage for maternity expenses and newborn baby expenses after a 2 year waiting period, subject to limits.
- OPD expenses covered – Provides coverage for OPD consultations, including dental & ophthalmic OPD expenses.
- Bariatric surgery cover – Covers the cost of weight-loss treatments if certain conditions are met.
- Monthly premium payment mode is available.
- Room rent limit – Covers up to Single Standard AC Room. Picking a higher room category during hospitalisation leads to proportionate deductions in the claim.
- Copayment clause – Includes a mandatory 10% copay for all lives buying the cover after 60 years.
- Disease-specific limits – Includes sub-limits on modern treatments.
- Insurer metrics – The insurer faces operational challenges that are indicated by its low claim settlement ratio and high volume of claim complaints.
Plan Benefits
In-patient hospitalisation expenses covered
The plan covers in-patient hospitalisation and related expenses up to the sum insured. However, the coverage is limited to a single standard AC room. If you choose anything more fancy, you bear the cost of proportionate deductions on all charges, including surgery costs, doctors’ fee, nursing charges, etc.
Mandatory 10% copayment clause
The plan imposes a mandatory 10% copay on every claim in case your age at the time of purchase is 61 or more. This is far from desirable for the elderly looking for health insurance coverage.
Sub-limits on modern treatments
The plan includes sub-limits on modern treatments, which are mentioned in the policy terms. It’s wise to read the fine print to understand them.
Pre and post-hospitalisation expenses are covered
The insurer covers treatment-related medical expenses 60 days before and 90 days after hospitalisation. This includes diagnostic tests, follow-up consultations, medication and more.
Get cover even if you are hospitalised for less than 24 hours
Many treatments and surgeries done under anesthesia now require less than 24 hour hospitalisation. They are called daycare treatments. The insurer covers the cost of such treatments.
Alternative medicine covered
Want to take alternative treatment like Ayurveda or Homeopathy? Don’t worry. Your insurer fully covers your hospitalisation and related expenses.
Get cover even if you are forced to be hospitalised at home
Are you forced to be hospitalised at home? Imagine this. No beds are available in the hospital or the patient’s medical condition does not allow him to be moved to a hospital. This is called domiciliary hospitalisation. Your insurance policy covers the cost of hospitalisation if it happens for at least 3 consecutive days under the supervision of a medical practitioner.
Covers organ harvesting cost in case of an organ transplant
If you are an organ recipient, your insurer will cover the hospitalisation expenses of the organ donor for harvesting the donated organ. However, the maximum limit is 10% of the sum insured or Rs. 1 Lakh, whichever is less.
Get maternity and newborn care coverage
The plan covers expenses related to maternity and treatment & vaccination of the newborn, subject to limits. A 2 year waiting period applies.
Get cover for weight loss treatment
Want to undergo weight loss treatment? The plan covers hospitalisation expenses for weight loss treatment up to the sum insured if certain conditions are met.
Get coverage for OPD expenses
The plan covers OPD expenses for medical consultation at network hospitals, subject to limits. It also extends cover to dental and ophthalmic OPD expenses for acute treatment. This benefit has a separate limit over and above the sum insured.
Get daily cash benefit for each day of hospitalisation
The insurer gives you a daily fixed cash benefit for each day of hospitalisation, subject to limits, for hospitalisation-related incidental expenses.
Get free health check-up every claim-free year
Get a pre-defined free health check-up every claim-free year, subject to limits. You can avail of this benefit only at a network provider centre on a cashless basis. This benefit has a separate limit over and above the base coverage.
Automatic restoration of sum insured upon exhaustion of base sum insured
The insurer restores 100% of your base sum insured once in a policy year upon the exhaustion of the base sum insured. Restored sum insured is available for related or unrelated illnesses only for subsequent claims.
Guaranteed cumulative bonus available
You get a guaranteed cumulative bonus for every claim-free year up to a maximum of 100% of the sum insured. If you make a claim, the bonus reduces in the subsequent year.
Ambulance charges covered
The plan covers road and air ambulance charges subject to limits.
Wellness benefits for staying healthy
Stay healthy and earn reward points from your insurer. You can use these reward points to get up to a 10% discount on subsequent premiums if certain conditions are met.
Enhance your coverage with Star Protect Extra add-on
This is a many-in-one add-on, as you get multiple benefits. You get an upgrade to any room, coverage for non-medical items and enhanced limits for modern and advanced treatments.
Policy Conditions
| Sum Insured Range | Rs. 5 Lakh – Rs. 1 Crore |
| Entry Age | 3 Months – 25 Years for dependent children, 18 – 65 Years for adults. |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Up to 2 adults and 3 children |
| Premium Payment | Monthly, Quarterly, Half-Yearly and Annual. |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months.
- Waiting Period on Pre-Existing Diseases: 36 months.
- Maternity and Newborn Care Waiting Period: 24 months
- OPD and Dental & Ophthal OPD Waiting Period: 24 months
Medical Exclusions
- Change of gender treatment
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatments
- Refractive error correction for less than 7.5 diopters
- Sterility and Infertility
Non-Medical Exclusions
- Expenses related to any admission primarily for diagnostics and evaluation purposes
- Expenses related to any admission primarily for enforced bed rest
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Treatment necessitated by committing breach of law with criminal intent
- Treatment taken by a medical practitioner outside his discipline
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
Star Health and Allied Insurance Company is India’s largest health insurer, offering health insurance solutions for individuals and families. It specialises in health, personal accident and travel insurance solutions. The company was established in 2006 and was promoted by Safecrop Investments India LLP, Westbridge AIF I and Rakesh Jhunjhunwala.
The insurer has a business track record of almost 2 decades. However, the company is facing challenges with its claim settlement and operational processes, which reflect in its relatively low claim settlement ratio. It also has had a very high volume of claim-related complaints that indicates problems in claim handling. Let’s see how the insurer handles these issues in future and wins customers’ trust.
Performance Highlights (FY24)
Turnover – Rs. 16,113 Crore
Claim Settlement Ratio – 86.49%
Incurred Claim Ratio – 64.47%
Volume of Claim Complaints – 55.79
Network Hospitals – 14,000+
Get In Touch
Looking for some insurance related advice? You can book a call with us. It’s absolutely FREE.
Frequently Asked Questions
What is the Star Comprehensive Health Insurance Policy?
Star Comprehensive is an all-inclusive health insurance plan by Star Health Insurance that offers extensive coverage for hospitalisation, maternity, outpatient treatments, modern procedures, and more.
Who is eligible to purchase Star Comprehensive policy?
Individuals aged between 18 and 65 years can purchase the policy. Dependent children are covered from 91 days up to 25 years.
Is there any exit age for this policy?
No, the policy offers lifelong renewals with no exit age limit.
What are the sum insured options available?
Star Comprehensive offers sum insured options ranging from Rs. 5 Lakh to Rs. 1 Crore.
Does the policy cover pre and post-hospitalisation expenses?
Yes, the plan covers pre-hospitalisation expenses up to 60 days and post-hospitalisation expenses up to 90 days.
Are maternity and newborn expenses covered under Star Comprehensive?
Yes, the policy covers delivery expenses, normal as well as cesarean, and newborn baby expenses up to specified limits.
Is there coverage for outpatient (OPD) consultations?
Yes, outpatient consultations, including dental and ophthalmic treatments, are covered up to specified limits.
Does Star Comprehensive cover modern treatments?
Yes, expenses for modern treatments are covered up to the specified limits.
Are day care procedures covered under Start Comprehensive?
Yes, medical treatments and surgical procedures that require less than 24 hours of hospitalisation are covered.
Does Star Comprehensive cover domiciliary hospitalisation?
Yes, expenses incurred for domiciliary hospitalisation, including AYUSH treatments, are covered if certain conditions are met.
Does the policy provide a hospital cash benefit?
Yes, a fixed daily cash benefit is provided for each completed day in the hospital, up to specified limits.
Are ambulance charges covered?
Yes, both road and air ambulance expenses are covered up to specified limits.
Is there a copayment clause under Star Comprehensive?
A 10% mandatory copayment applies on every claim if the age at entry is 61 years or more.
Are pre-existing diseases covered?
Yes, pre-existing diseases are covered after a waiting period of 3 years. You have an option to cut this waiting period to 1 year with an additional premium.
Does the policy cover AYUSH treatments?
Yes, hospitalisation expenses for treatments under Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy are covered.
Can I include my newly married spouse or newborn baby mid-term?
Yes, a newly married spouse and newborn baby can be included in the policy by paying an additional premium.
Is there any waiting period for maternity benefits?
Yes, maternity benefits are subject to a 2 year waiting period as specified in the policy terms.
Are vaccinations for newborns covered?
Yes, vaccination expenses for the newborn baby are covered up to specified limits.
Does the policy offer cashless hospitalisation?
Yes, cashless treatment is available in over 14,000+ network hospitals.
How can I renew my policy?
You can renew your policy online through the Star Health website. You can also contact your insurance advisor for renewal support.
Get on a call
WhatsApp Us
