Star Medi Classic Gold
Overview
Star Medi Classic Gold is a decent and low-cost health insurance plan offered by Star Health and Allied Insurance. The policy is not very expensive. However, it offers wider benefits than the base Star Medi Classic variant. The plan still includes some disease-specific limits.
It is a decent choice if you want basic health insurance coverage at affordable prices. We recommend you read the terms and conditions before you purchase this one. Moreover, the insurer faces operational challenges that are indicated by its low claim settlement ratio and high volume of claim complaints. This can raise some concerns.
Pros and Cons
- Covers base benefits – Covers hospitalisation and related expenses, though with some limits.
- Day care procedures – Covers all day care procedures.
- Modern treatment coverage – Covers expenses related to modern treatments, subject to some limits.
- Health check-ups included – Covers the cost of health check-ups for every claim-free year.
- Monthly premium option – Monthly premium payment option is available.
- Relatively inexpensive – The plan is relatively inexpensive.
- Room rent restriction – Room rent coverage is limited to a single private AC room for a sum insured of Rs. 5 Lakh or above.
- Disease-specific limits – Includes sub-limits on modern treatments and common surgery like cataract.
- Copayment clause – A 10% copay applies to each claim if the entry age is 61 years or above.
- Insurer metrics – The insurer faces operational challenges that are indicated by its low claim settlement ratio and high volume of claim complaints.
Plan Benefits
Get coverage for hospitalisation expenses
The plan covers inpatient hospitalisation expenses including room charges, ICU charges, nursing costs, surgery costs, doctor’s fees and cost of medication, among others.
Room rent limitations
Daily room rent coverage is limited to Rs. 5000/day for base sum insured of Rs. 3 Lakh or 4 Lakh. If you choose a sum insured of Rs. 5 Lakh or above, you are eligible for a single private AC room. If you stay in a higher category room, your insurer covers all hospitalisation expenses in proportion to the eligible room category. It results in significant out-of-pocket expenses.
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.
Pre and post-hospitalisation expenses covered
The plan covers hospitalisation related expenses up to 30 days before admission and 60 days after the discharge. These include nursing expenses, doctors’ consultation fees, diagnostic charges and cost of medication.
Road ambulance charges covered
You get coverage for road ambulance charges up to Rs. 2000/- per hospitalisation.
Day care procedures covered
Some procedures or minor surgeries now require less than 24 hour hospitalisation due to advancements in medical technology. These are called day care procedures. Your insurer covers the cost of all such procedures under this plan. However, common treatments, such as cataract surgery, include sub-limits.
Get coverage for modern treatments
The plan also provides coverage for some modern treatments subject to certain limits.
Free health check-ups available
You get a free health check-up for every claim-free year, subject to certain limits.
Get cumulative bonus for every claim-free year
The plan provides a cumulative bonus of 25% of the base sum insured for the 1st claim-free year and 20% for each subsequent claim-free year, subject to a maximum of 100%.
Alternative treatments covered
Would you consider an alternative treatment, such as Homeopathy or Ayurveda, for any illness? Even if you do, your insurer covers your hospitalisation expenses up to 25% of the base sum insured, subject to a maximum of Rs. 25,000/- per policy year.
Get automatic restoration of sum insured if you run out of coverage
If you run out of cover in any policy year, your insurer restores your cover by 200% upon the full exhaustion of base cover. The restored sum insured only covers unrelated illnesses in subsequent claims during the same policy year.
Super restoration available for the same illness
If you run out of cover and need hospitalisation for the same illness again, the insurer provides a super restoration equal to 100% of the base sum insured.
Get cover even if you are forced to be hospitalised at home
Are you forced to be hospitalised at home? If hospital beds are not available or you are not in a condition to be moved to a nearby hospital, you can get hospitalised at home under the supervision of a medical practitioner. This is called domiciliary hospitalisation. Your insurer covers the expenses if such hospitalisation happens for more than 3 consecutive days.
Organ donor cover available
In case you need an organ transplant, your insurer covers the cost of harvesting the organ from the donor.
Get daily cash benefit for choosing shared accommodation
If you choose to stay in a shared accommodation during your hospital stay, you get a daily hospital cash benefit of Rs. 500/- or Rs. 1000/-, subject to certain conditions.
Get extra cover for road accident cases
In case you are hospitalised due to a road accident, your insurer provides an extra cover equal to 50% of your base sum insured.
Get cover for new born baby expenses
You can add a new born baby under the family floater option from 16th day after birth. The plan covers the new born baby hospitalisation expenses up to a maximum of 10% of the base sum insured or Rs. 50,000/-, whichever is less.
Get cover for patient care at home after discharge with an add-on
With this add-on, you get cover for daily home care expenses for the patient after discharge. A daily benefit of Rs. 400/- for a maximum of 5 days is payable if recommended by the attending physician.
Get hospital cash benefit with an add-on
This add-on provides a daily cash benefit of Rs. 1000/- for each day of hospitalisation up to a maximum of 7 days/hospitalisation. You can include this to cover incidental expenses related to hospitalisation.
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. 3 Lakh – Rs. 25 Lakh |
| Entry Age | 16 Days – 65 Years |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage |
Up to 2 adults and 2 dependent children, sum insured is equally apportioned among all insured family members. |
| 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
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
- OPD and Dental OPD treatments
- Maternity and related expenses
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 – 66.47%
Volume of Claim Complaints – 55.79
Network Hospitals – 14,000+
Get In Touch
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Frequently Asked Questions
What is the entry age for the Star Medi Classic Gold plan?
Entry age is 16 days to 65 years for the insured, and 16 days to 25 years for dependents.
What sum insured options are available under Star Medi Classic Gold?
The Gold variant offers sum insured options ranging from Rs. 3 Lakh to Rs. 25 Lakh.
What are room rent limits under Star Medi Classic Gold?
The plan covers a single standard AC room for a sum insured of Rs. 5 Lakh and above. For Rs. 3 or 4 Lakh sum insured, room rent is limited to 2% of sum insured up to Rs. 5,000/day.
Are ICU charges sub-limited?
ICU charges are covered at actuals with no sub-limit.
Does Star Medi Classic Gold cover daycare procedures?
Yes, it includes all daycare medical/surgical procedures that require less than 24 hours.
Is there domiciliary hospitalisation cover?
Yes, domiciliary hospitalisation for more than 3 consecutive days is covered if done under the supervision of a medical practitioner.
Are AYUSH treatments covered under Star Medi Classic Gold?
Yes, alternative treatments such as Ayurveda or Homeopathy are covered up to 25% of the base sum insured, capped at Rs. 25,000 per policy year.
Are organ donor expenses covered?
Yes, organ harvesting expenses are covered up to the full sum insured in case you are the organ recipient.
Is newborn baby hospitalisation included under Star Medi Classic Gold policy?
Yes, new born baby hospitalisation expenses are covered from day 16 after birth, up to 10% of the sum insured or Rs. 50,000, whichever is lower, assuming mother is insured from 12 months prior.
Are emergency ambulance charges covered?
Yes, road ambulance charges are covered up to Rs. 2,000 per hospitalisation.
Is shared accommodation benefit available?
Yes, the plan offers a daily cash benefit when you opt for a shared accommodation. The benefit amount varies depending upon the base sum insured.
Is there an accident sum insured for road traffic accidents?
Yes, the insurer adds 50% of the basic sum insured for hospitalisation due to road traffic accidents.
Are annual health check-ups included under Star Medi Classic Gold?
Yes, you are entitled to free health check-ups each claim-free year; the amount varies by the sum insured.
What restoration benefits are included under Star Medi Classic Gold plan?
The plan includes
- Automatic Restoration: 200% of the sum insured is restored once per year and can only be used for unrelated illnesses.
- Super Restoration: Additional 100% sum insured, usable in the same year for the same illness.
Is there an initial waiting period?
Yes, the plan includes a 30 day initial waiting period for all illnesses (except accidents)
What waiting period is applicable for pre-existing and specified illnesses under Star Medi Classic Gold?
Pre‑existing illnesses are covered after a waiting period of 36 months under the plan and specified diseases get covered after 24 months.
Is copayment required under Star Medi Classic Gold plan?
Yes, a 10% copay applies to each claim if the entry age is 61 years or above.
How is the No-Claim Bonus structured under Star Medi Classic Gold?
You get 25% in 2nd year, then 20% add-on every claim-free year up to a maximum of 100% of base sum insured.
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