The Family Health Optima Insurance Plan by Star Health is a comprehensive health insurance solution designed to protect your entire family under a single sum insured. This family health optima plan offers extensive coverage, including hospitalisation, pre- and post-hospitalisation expenses, and daycare procedures. The Family Health Optima Policy benefits also include coverage for newborns, emergency ambulance services, and health checkups. With its wide-ranging benefits and affordable premiums, this plan is ideal for families seeking robust health protection. Choose the Family Health Optima to secure your family's health and well-being with confidence and peace of mind.
Policy TypeThis policy provides benefits only on a Floater basis. |
Entry AgeAny person aged between 18 and 65 years can avail this policy. Dependent children are covered from the 16th day onwards up to 25 years. |
Family SizeThis policy provides wide coverage to family members including self, spouse, dependent children (maximum 3), parents and parents-in-law. |
In-Patient HospitalisationHospitalisation expenses incurred for a period of more than 24 hours on account of illness, injury or accidents are covered. |
Pre-HospitalisationIn addition to in-patient hospitalisation, the medical expenses incurred up to 60 days before the date of admission to the hospital are also covered. |
Post-HospitalisationPost-hospitalisation medical expenses up to 90 days from the date of discharge from the hospital are covered. |
Shared AccommodationExpenses incurred on occupying a shared accommodation by the insured person are covered up to the limits mentioned in the policy clause. |
Road AmbulanceAmbulance charges for the transportation of insured person by private ambulance are covered up to Rs. 750/- per hospitalisation and Rs. 1500/- per policy period. |
Air AmbulanceAir ambulance expenses are covered up to 10% of the Sum Insured for the entire policy period. |
Automatic Restoration of Sum InsuredUpon exhaustion of the limit of coverage during the policy period, 100% of the Sum Insured will be restored 3 times in the same policy year. |
Loyalty BonusFor the Sum Insured options Rs.3,00,000/- and above, the insured would be entitled to benefit of Loyalty Bonus of 10% of the expiring Sum Insured subject to a maximum Loyalty Bonus of 100% of the sum insured.
The Loyalty Bonus will be calculated on the expiring sum insured or on the renewed sum insured whichever is less. If the insured opts to reduce the sum insured at the subsequent renewal, the limit of indemnity by way of such Loyalty Bonus shall not exceed such reduced sum insured.
Loyalty Bonus shall be available irrespective of a claim and only upon timely renewal without break or upon renewal within the grace period allowed. |
Additional Sum Insured for Road Traffic Accident (RTA)If the insured person meets with a Road Traffic Accident resulting in an in-patient hospitalisation, then the Sum Insured shall be increased by 25% subject to a maximum of Rs.5,00,000/-. |
Assisted Reproduction TreatmentThe Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility 1. Waiting period of 36 months from the date of first inception of this policy is applicable. 2. Maximum liability of the Company for such treatment shall be limited to Rs.1 lakh for sum insured of Rs.5 lakh and Rs.2 lakhs for sum insured of Rs.10 lakhs and above for every block of 36 months. |
Hospitalisation Expenses for Treatment of New Born BabyCover starts from 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less, provided the mother is insured under the policy for a continuous period of 12 months without break. Note : Exclusions No.1(Code Excl 01), Exclusion No.2(Code Excl 02), Exclusion No.3(Code Excl 03) and the above sublimit will not apply for treatment related to Congenital Internal disease/defects for the new born. |
AYUSH TreatmentExpenses incurred for the treatment under Ayurveda, Unani, Siddha and Homeopathy systems of medicines in AYUSH hospitals are covered upto the Sum Insured. |
Emergency Domestic Medical EvacuationExpenses incurred towards the transportation of the insured person from the treating hospital to another hospital for treatment are covered as per the limits mentioned in the policy clause. |
Compassionate TravelThe air transportation expenses incurred up to Rs. 5000/- are payable for an immediate family member to travel to the hospital in case of hospitalisation of the insured person for life-threatening emergency times, at the place away from insured’s usual place of residence. |
Second Medical OpinionThe Insured person can avail a Second Medical Opinion from a Doctor in the Company's network of medical practitioners. |
Modern TreatmentModern treatment expenses are payable up to the limits mentioned in the policy clause. |
Recharge BenefitAvailable up to the limits. |
Day Care ProceduresMedical treatments and surgical procedures that require less than 24 hours of hospitalisation due to technological advancements are covered. |
Domiciliary HospitalisationExpenses incurred for domiciliary hospitalisation, including AYUSH on the advice of a medical practitioner for a period exceeding three days are covered. |
Organ Donor ExpensesExpenses incurred for organ transplantation are covered up to a limit of 10% of the Sum Insured subject to the maximum of Rs. 1,00,000/- whichever is less. |
Repatriation of Mortal RemainsThe expenses incurred for the repatriation of mortal remains of the insured person are covered up to Rs. 5,000/- per policy period. |
Cataract TreatmentExpenses incurred for Cataract treatment are covered up to the limits mentioned in the policy clause. |
Treatment in Valuable Service ProvidersIf the treatment is undergone in a hospital suggested by the Company, then a lump-sum of 1% of the Sum Insured subject to a maximum of Rs. 5,000/- per policy period is payable. |
Preventive Health Check-upWe will arrange for a Preventive Health Check-up at Our Network Providers for the applicable package as per opted Sum Insured. For the updated and applicable list of tests available under such package,Insured Persons are required to check our website www.starhealth.in. |
Mandatory Co-paymentThis policy is subjected to co-payment of 20% of each and every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is 61 year and above. |
Instalment OptionsPremium can be paid Monthly, Quarterly and Half Yearly. Note: If Instalment Facility is opted for 2 year term policies, the full premium applicable for 2 year terms should be paid in monthly, quarterly or half yearly within the expiry of the first year. |
Option to choose Voluntary Co-paymentIf the insured person chooses voluntary co-payment, the Company will provide a discount on premium as specified in the Policy Clause |
Unlimited Tele-ConsultationInsured can avail unlimited number of Tele-consultations on Star Health mobile application or digital platforms. |
AI driven Face ScanThe Insured Person can avail, AI-driven face scan facility by using STAR Health mobile app to know the vital parameters such as heart rate, oxygen saturation, respiration rate
up to two times per month per Insured Person in a Policy Year. |
E-Domestic Second Medical OpinionThe Insured person can avail a Second Medical Opinion from a Doctor in the Company's network of medical practitioners. |
Star Wellness Program
This program intends to promote, incentivize and to reward the Insured Persons' healthy life style through various wellness activities. The wellness activities as mentioned below are designed to help the Insured Person to earn wellness reward points which will be tracked and monitored by the Company. The wellness points earned by the Insured Person(s) under the wellness program, can be utilized to get discount in premium during the renewal.
This Wellness Program is enabled and administered online through “Star Health” Mobile App.
Note: The Wellness Activities mentioned in the table below (from Serial Number 1 to 6) are applicable for the Insured Person(s) aged 18 years and above only. The following table shows the discount on premium available under the Wellness Program;
Wellness Points Earned | Discount in Premium |
200 to 350 | 4% |
351 to 600 | 10% |
601 to 750 | 14% |
751 and above | 20% |
The weightage is given as per the following table;
Family Size | Weightage |
| Self, Spouse** | 1:1 |
| Self, Spouse** and Dependent Children (up to 17 years) | 1:1:0:0:0 |
Self, Spouse** and Dependent Children (18 years and above) | 2:2:1:1:1 |
| **Spouse / Live-in Partner / Same Sex Partner | |
Note: In case of two-year policy, total number of wellness points earned in two-year period will be divided by two.
Please refer the Illustrations to understand the calculation of discount in premium, weightage and the calculation.
The wellness services and activities are categorized as below:
Sr. No. | Activity | Maximum number of Wellness Points that can be earned under each activity in a Policy Year |
1. | Sign up points for Enrolling to Wellness Program | 100 |
2. | Manage and Track Health |
|
| a. Online Health Risk Assessment (HRA) | 150 | |
| b. Preventive Risk Assessment | 200 | |
3. | Affinity to Wellness |
|
| a. Participating in Walkathon, Marathon, Cyclothon and similar activities | 200 | |
b. Membership in a health club | 200 | |
4. | Stay Active – If the Insured member achieves the step count target on “Star Health” Mobile App | 250 |
5. | Sharing ‘Active Life Success Story’ through adoption of Star Wellness Program | 50 |
6. | Condition Management Program (CMP): Weight Management, Diabetes Management, Hypertension, De-Stress & Mind Body Healing Program. | 150 |
7. | For Submission of Vaccination Certificate Eg: Vaccine for Covid, HPV, Pneumoccocal, Swine Flu (H1N1), Hepatitis etc.. | 20 |
8. | For Submission of Preventive Eye Check-up report | 20 |
9. | For Submission of Preventive Dental Check-up report | 20 |
10. | For Submission of Mammography & PAP Test (for Women) report | 20 |
11. | For Submission of Prostate specific antigen (PSA) test report (for Male persons aged > 50 years) | 20 |
12. | Glaucoma Screening (for persons aged > 50 years) | 20 |
Value Added Services |
| Medical Concierge Services |
| Digital Health Vault |
| Wellness Content |
| Post-Operative Care |
| Discounts from Network Providers |
The Health Risk Assessment (HRA) questionnaire is an online tool for evaluation of health and quality of life of the Insured. It helps the Insured to introspect his/ her personal lifestyle. The Insured can log into his/her account on the website www.starhealth.in and complete the HRA questionnaire. The Insured can undertake this once per Policy Year.
On Completion of online HRA questionnaire, the Insured earns 150 wellness points.
Note: To get the wellness points mentioned under HRA, the Insured has to complete the entire HRA within one month from the time he/she started HRA Activity.
b. Preventive Risk Assessment:
The Insured can also earn wellness points by undergoing diagnostic / preventive tests during the Policy Year. These tests should include the four mandatory tests mentioned below. Insured can take these tests at any diagnostic centre at Insured’s own expenses.
- On submission of the test reports, Insured earns 200 reward points.
Note: These tests reports should be submitted together and within 30 days from the date of undergoing such Health Check-Up.
List of mandatory tests under Preventive Risk Assessment |
|
3. Affinity towards wellness: Insured earns wellness reward points for undertaking any of the fitness and health related activities as given below. List of Fitness Initiatives and Wellness points:
| Initiative | Wellness Points |
a. | Participating in Walkathon, Marathon, Cyclothon and similar activities | 200 |
| ||
b. | Membership in a health club (50 points for each quarter) - In a Gym / Yoga Centre / Zumba Classes / Aerobic Exercise/ Sports Club/ Pilates Classes/ Swimming / Tai Chi/ Martial Arts / Gymnastics/ Dance Classes | 200 |
Note: In case if Insured is not a member of any health club, he/she should join into club within 3 months from the date of the policy risk commencement date. Insured Person should submit the health club membership. | ||
4. Stay Active: Insured earns wellness reward points on achieving the step count target on “Star Health” Mobile App as mentioned below:
Criteria to get reward points |
If the number of steps per day are minimum 8,000 or above for 16 days in a month, it will be considered as one active month and insured will get 20 reward points. |
Note:
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5. Condition Management Program:
i.Weight Management Program:
a. This Program will help the Insured Persons with Over Weight and Obesity to manage their Body Mass Index (BMI) through the empanelled wellness experts who will guide the Insured in losing excess weight and maintain their BMI.
- 150 wellness points will be awarded in case if the results are achieved and maintained as mentioned below.
Sr. No. | Name of the Ailment | Values to be submitted | Criteria to get the Wellness points |
1. | Obesity (If BMI is above 29) | Height & Weight (to calculate BMI) | Achieving and maintaining the BMI between 18 and 29 |
2. | Overweight (If BMI is between 25 and 29) | Height & Weight (to calculate BMI) | Reducing BMI by two points and maintaining the same BMI in the Policy Year |
| |||
b. Incase if the Insured is not Overweight / Obese, the Insured can submit his/her ‘Active Life Success Story’ through adoption of Star Wellness Activities with us. On submission of Active Life Success Story through adoption of Star Wellness Activities, Insured earns 50 wellness points.
ii. Chronic Condition Management Program:
a. This Program will help the Insured suffering from Diabetes, Hypertension, Cardiovascular Disease or Asthma to track their health through the empanelled wellness experts who will guide the insured in maintaining/ improving the health condition.
Sr.No. | Name of the Ailment | Test to be submitted | Values Criteria to get the additional Wellness points |
1. | Diabetes(Insured can submit either HbA1c test value (or) Fasting Blood Sugar (FBS) Range and Postprandial test value) | HbA1c | ≤ 6.5 |
Fasting Blood Sugar (FBS) Range and Postprandial test value |
100 to 125 mg/dl
below 160 mg/dl | ||
2. | Hypertension | Measured with - BP apparatus | Systolic Range - 110 to 140 mmHg Diastolic Range - 70 to 90 mmHg |
3. | Cardiovascular Disease | LDL Cholesterol and Total Cholesterol / HDL Cholesterol Ratio | 100 to 159 mg/dl
≤ 4.0 |
4. | Asthma | PFT (Pulmonary Function Test) | FEV1 (PFC) is 75% or more FEV1/ FVC is 70% or more |
b. In case if the Insured is not suffering from Chronic Condition/s (Diabetes, Hypertension, Cardiovascular Disease or Asthma) he/she can opt for “De-Stress & Mind Body Healing Program”. This program helps the Insured to reduce stress caused due to internal (self-generated) & external factors and increases the ability to handle stress.
Note: This is a 10 weeks program which insured needs to complete without any break.
6. Reward points for Preventive Care: Insured can earn wellness reward points for submitting the following health check-up reports once in a Policy Year which he/ she had during the Policy Year.
Value Added Services
1. Medical Concierge Services: The Insured can also contact Star Health to avail services like, Emergency assistance information such as nearest ambulance / hospital / blood bank etc.
2. Digital Health Vault: A secured Personal Health records system for Insured to store/access and share health data with trusted recipients. Using this portal, Insured can store their health documents (prescriptions, lab reports, discharge summaries etc.), track health data add family members.
3. Wellness Content: The wellness portal provides rich collection of health articles, blogs, tips and other health and wellness content. The contents have been written by experts drawn from various fields. Insured will benefit from having one single and reliable source for learning about various health aspects and incorporating positive health changes.
4. Post Operative Care: It is done through follow up phone calls (primarily for surgical cases) for resolving their medical queries.
5. Discounts from Network Providers: The Insured can avail discounts on the services offered by our network providers which will be displayed in our website.
Terms and conditions under wellness activity
i. Any information provided by the Insured in this regard shall be kept confidential.
ii. There will not be any cash redemption against the wellness reward points.
iii. Insured should notify and submit relevant documents, reports, receipts etc for various wellness activities within 1 month of undertaking such activity/test.
iv. For services that are provided through empanelled service provider, Star Health is only acting as a facilitator; hence would not be liable for any incremental costs or the services.
v. All medical services are being provided by empanelled health care service provider. We ensure full due diligence before empanelment. However Insured should consult his/her doctor before availing/taking the medical advices/services. The decision to utilize these advices/services is solely at Insured Person’s discretion.
vi. We reserve the right to remove the wellness reward points if found to be achieved in unfair manner.
vii. Star Health, its group entities, or affiliates, their respective directors, officers, employees, agents, vendors, are not responsible or liable for, any actions, claims, demands, losses, damages, costs, charges and expenses which a Member claims to have suffered, sustained or incurred, by way of and / or on account of the Wellness Program.
viii. Services offered are subject to guidelines issued by IRDAI from time to time
Illustration of Benefit
A 51 year old Individual Gopal and his wife Ramya along with their two dependent children (aged below 18 years) buy a Family Health Optima Insurance Plan with Sum Insured 10 Lacs, let’s understand how they can earn Wellness Points. Gopal has declared that he is suffering from Diabetes. Ramya has declared her BMI as 27. Gopal and Ramya enrolled under the Star wellness program and completed the following wellness activities. | |||
Sr. No. | Activity | Wellness Points Earned by Gopal | Wellness Points Earned by Ramya |
1. | Sign up points for Enrolling to Wellness Program | 100 | 100 |
2. | Manage and Track Health |
|
|
| a. Online Health Risk Assessment (HRA) | 150 | 150 | |
| b. Preventive Risk Assessment | 200 | 200 | |
3. | Affinity to Wellness |
|
|
| a. Participating in Walkathon, Marathon, Cyclothon and similar activities | 200 | 0 | |
b. Membership in a health club | 100 | 150 | |
4. | Stay Active (Wellness points based on Step Count) | 250 | 120 |
5. | For Sharing ‘Active Life Success Story’ | 50 | 0 |
6. | Condition Management Program (CMP) | 150 | 150 |
7. | Submission of Vaccination Certificate | 20 | 20 |
8. | For Submission of Preventive Eye Check-up report | 20 | 0 |
9. | For Submission of Preventive Dental Check-up report | 0 | 20 |
10. | For Submission of Mammography & PAP Test (for Women) report | 0 | 20 |
11. | For Submission of Prostate specific antigen (PSA) test report (for Male persons aged > 50 years) | 20 | 0 |
12. | Glaucoma Screening (for persons aged > 50 years) | 20 | 0 |
| Total Number of Wellness Points earned | 1280 | 930 |
| No of wellness points based upon weightage - 1:1:0:0 | 640 (1280X1/2) | 465 (930X1/2) |
Total Number of Wellness Points earned by Gopal and Ramya = 1105 (640+465) Based on the no of Wellness Points earned, Gopal & Ramya are eligible to get 20% discount on renewal premium | |||
As a Health Insurance specialist, we extend our services from offering tailor-made products to fast in-house claim settlements. With our growing network of hospitals, we ensure easy access to fulfill your medical needs.
Get your future secured with us.
What can be more important than ensuring the health and well-being of your loved ones in this active world? The Star Family Health Optima Insurance Plan is crafted to provide extensive health coverage for your entire family under a single policy. Above all, you and your family can get pre-eminent medical care without worrying about financial stress.
With this health insurance policy, your family is secured against unforeseen medical emergencies and can receive the best care. Family Health Optima Insurance Plan provides extensive coverage, which includes hospitalisation expenses, pre- and post-hospitalisation costs, and an array of other medical expenses.
The Family Health Optima Insurance Plan offers cashless hospitalisation across a network of more than 14000+ hospitals. Thus, in the event of a medical emergency, you can fully attend to the necessary treatment without worrying about upfront payments. The insurance company settles the bills directly with the hospital, guaranteeing a smooth experience for you and your family.
For the Sum Insured options of Rs . 3,00,000/- and above, the insured would be entitled to the benefit of Loyalty Bonus of 10% of the expiring Sum Insured, subject to a maximum Loyalty Bonus of 100% of the sum insured.
The Loyalty Bonus will be calculated on the expiring sum insured or on the renewed sum insured, whichever is less. If the insured opts to reduce the sum insured at the subsequent renewal, the limit of indemnity by way of such Loyalty Bonus shall not exceed such reduced sum insured.
Loyalty Bonus shall be available irrespective of a claim and only upon timely renewal without a break or upon renewal within the grace period allowed.
You can enjoy lifelong renewability, ensuring continuous coverage for your family with the Star Family Health Optima Insurance Plan. Therefore, as long as you renew your policy promptly, your family will always have access to health insurance, providing tranquillity in the years ahead.
This Plan covers pre-hospitalisation expenses for up to 60 days before admission and post-hospitalisation expenses for up to 90 days after discharge.
The plan benefits include extensive coverage for hospitalisation, maternity care, and emergency services, ensuring complete and comprehensive protection for your entire family. This plan is a perfect choice for families looking for comprehensive health coverage at an economical price. Invest in your family’s health and well-being with the Family Health Optima Insurance Policy today!
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