Star Medi Classic
Overview
Star Medi Classic is a decent health insurance plan offered by Star Health and Allied Insurance. The policy is not very expensive. However, it offers limited benefits with room rent restrictions and 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 once in a block of 4 continuous claim-free years.
- 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 2% of the sum insured, up to a maximum of Rs. 5000/day.
- 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.
- Underwhelming cumulative bonus – A mere 5% cumulative bonus for every claim-free year up to a maximum of 25%.
- No domiciliary hospitalisation cover – The plan does not cover expenses if you are forced to be hospitalised at home.
- 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 2% of the base sum insured, subject to a maximum of Rs. 5000/day. 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. This benefit is capped at 7% of hospitalisation expenses or Rs. 5000/hospitalisation, whichever is lower.
Road ambulance charges covered
You get coverage for road ambulance charges up to Rs. 750/- per hospitalisation and up to Rs. 1500 per policy year.
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 free health check-ups once in a block of 4 continuous claim-free years. This benefit is limited to 1% of the base sum insured or Rs. 5000, whichever is lower
Get cumulative bonus for every claim-free year
The plan provides a cumulative bonus of 5% of the base sum insured for every claim-free year, subject to a maximum of 25%. This stands nowhere in comparison to cumulative bonuses offered by other standard plans. However, it’s still a bonus.
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.
Policy Conditions
| Sum Insured Range | Rs. 1.5 Lakh – Rs. 15 Lakh |
| Entry Age | 5 Months – 65 Years |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual |
| Family Coverage | Not available |
| 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
- Weight-loss treatments
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 Star Medi Classic policy?
Star Medi Classic is an individual health insurance plan offering coverage for hospitalisation expenses due to illness, disease, or accidents, with lifetime renewability.
What age groups can purchase it?
Individuals aged 5 months to 65 years can purchase this plan, with lifelong renewal after that.
What Sum Insured options are available under Star Medi Classic?
Sum insured options range from Rs. 1.5 Lakh to Rs. 15 Lakh in base variant.
What hospitalisation expenses are covered under Star Medi Classic?
Coverage Includes room rent (up to Rs. 5,000/day), pre and post-hospitalisation expenses, daycare procedures, ambulance charges, and AYUSH treatments.
Does it include AYUSH treatments?
Yes, AYUSH treatments such as Ayurveda, Unani, Siddha, and Homeopathy are covered.
Are pre-existing diseases covered under Star Medi Classic?
Yes, the plan covers pre-existing conditions after a waiting period of 3 years.
Does Star Medi Classic cover maternity benefits?
No, this plan does not offer maternity benefits.
Does it cover day care procedures?
Yes, all day care procedures are covered under the plan.
Does Star Medi Classic offer outpatient (OPD) care?
No, OPD coverage isn’t included in the plan.
Is there a 30-day waiting period?
Yes, a 30-day initial waiting period applies to non-accident illnesses after policy inception.
What’s the waiting period for specific diseases?
Specific conditions have a 2 year waiting period.
Is there automatic restoration of the sum insured under Star Medi Classic?
Yes, 200% restoration of the sum insured is available once per policy year after the exhaustion of the base sum insured.
Does Star Medi Classic include a no-claim bonus?
Yes, the plan includes a 5% cumulative bonus per claim-free year up to a maximum of 25% of the base sum insured.
Are pre-medical tests required?
Yes, applicants over 50 years must undergo medical screening at approved centers.
Can premiums be paid in installments?
Yes, monthly, quarterly, half-yearly, as well as annual premium payment options are available.
Are there multi-year premium discounts?
Yes, a 10% discount on the 2nd year for two-year policies and 11.25% discount on 2nd and 3rd years for three-year policies are available.
How do cashless claims work?
Intimate the insurer 24 hours before hospitalisation (or within 24 hours of emergency). The treating hospital’s insurance desk helps in claim-related documentation and intimation, and the insurer responds within 2 hours.
What about reimbursement claims?
Pay the hospital bill upfront, then submit claim documents within 15 days of discharge. The insurer processes the claim post document verification.
How many network hospitals are available?
Cashless facility is available at over 14,0000 hospitals across India.
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