Special Care Gold, Star Health And Allied Insurance Company Limited

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IRDAI UIN: SHAHLIP23182V012223

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HIGHLIGHTS

Plan Essentials

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Entry Age

Any person aged between 18 and 65 years can avail this policy. Dependent children are covered from newborn to 17 years of age.
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Pre-Policy Medical check-up

No Pre-Policy Medical check-up is required to avail this policy. However, previous medical records including the details of treatment should be submitted along with the proposal.
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AYUSH Treatment

Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines are covered up to 100% of the Sum Insured.
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Modern Treatment

Expenses incurred for modern treatments either as inpatient hospitalisation or day care procedures such as Deep Brain stimulation, Intra Vitreal injections, Robotic Surgeries, etc., are covered up to 50% of the Sum Insured.
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Instalment Options

The policy premium can be paid on a quarterly or half-yearly basis with a loading of 3% and 2%, respectively. It can also be paid on an annual basis.
DETAILED LIST

Understand what’s included

IMPORTANT HIGHLIGHTS

Unique Plan

Specially designed policy for the persons with a disabilities as per The Rights of Persons with Disabilities Act, 2016 Or / and for individuals with HIV/AIDS as defined under the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017.

Policy Type

This policy provides benefits only on an individual basis.

Policy Term

The policy can be taken for a term of 1 year.

Sum Insured

The Sum Insured options under this policy are Rs.4,00,000/- and Rs. 5,00,000/-.

ELIGIBILITY

Disability Cover

The coverage under this policy is available for persons with the following disability/disabilities as defined under the Act and any subsequent additions/modifications to the list in the Act. Disability for the purpose of this policy means a person with 40% or more of a specified disability as Certified by the Certifying authority as per the Disability Act 2016. 1. Blindness 2. Muscular Dystrophy 3. Low vision 4. Chronic Neurological conditions 5. Leprosy Cured persons 6. Specific Learning Disabilities 7. Hearing Impairment (deaf and hard of hearing) 8. Multiple Sclerosis 9. Locomotor Disability 10. Speech and Language disability 11. Dwarfism 12. Thalassemia 13. Intellectual Disability 14. Haemophilia 15. Mental Illness 16. Sickle Cell Disease 17. Autism spectrum disorder 18. Multiple Disabilities including deaf/ blindness 19. Cerebral Palsy 20. Acid Attack victim 21. Parkinson's disease

HIV Cover

This policy is available for individuals with HIV/AIDS as defined under the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017. Individuals diagnosed as HIV/AIDS by a duly qualified Medical Practitioner with a CD4 count above 350 will only be eligible for cover under this policy.

HOSPITALISATION CARE (INCLUDING DISABILITY AND HIV/AIDS COVER)

In-Patient Hospitalisation

Hospitalisation expenses incurred for more than 24 hours of hospitalisation are covered.

Room Rent

Room, boarding and nursing expenses all inclusive as provided by the Hospital/Nursing Home are covered up to 1% of the Sum Insured per day.

ICU Charges

Intensive Care Unit (ICU) charges/Intensive Cardiac Care Unit (ICCU) charges all inclusive as provided by the Hospital/Nursing home are covered up to a maximum of 2% of the Sum Insured per day.

Pre-Hospitalisation

In addition to in-patient hospitalisation, the medical expenses incurred up to 30 days before the date of admission to the hospital are also covered.

Post-Hospitalisation

Post-hospitalisation medical expenses including consultation fees, diagnostic charges, medicines and drugs as recommended by the Hospital / Medical Practitioner are covered up to 60 days from the date of discharge from the hospital.

Emergency Road Ambulance

Ambulance charges are covered up to the maximum of Rs. 2000/- per hospitalisation.

Day Care Procedures

Medical treatments and / or surgical procedures that require less than 24 hours of hospitalisation due to technological advancements are covered.

Cataract Treatment

Expenses incurred for Cataract treatment are covered up to Rs. 40,000/- per eye in one policy year.

Co-payment

Each and every claim under this policy shall be subject to a Co-payment of 20% applicable to the claim amount admissible and payable as per the terms and conditions of the policy.

Waiver of Co-payment

Waiver of co-payment is available on payment of additional premium as per terms & conditions.

LUMPSUM COVERAGE FOR HIV/AIDS

Lumpsum Coverage for HIV/AIDS

In case the CD4 count of the insured is/goes below 150, then the Company will pay 100% of the Sum Insured or the balance Sum Insured available under the policy, whichever is lower, as a lumpsum amount to the insured. This payment will trigger after a waiting period of 90 days from the commencement date of the policy. Note: The claim mentioned above shall be payable once in the lifetime of the insured person and shall not be necessarily linked to an in-patient hospitalisation claim made under the policy.

WAITING PERIOD

Pre-existing Diseases

I) Applicable for Diseases other than Disability/HIV/AIDS: The expenses related to the treatment of pre-existing diseases and their direct complications are covered after a waiting period of 36 months of continuous coverage after the date of inception of the first policy with the insurer. II) Applicable for HIV/AIDS: The expenses related to the treatment of HIV/AIDS and its direct complications are covered after 90 days of continuous coverage from the date of inception of the first policy with the insurer. III) Applicable for Disability: The expenses related to the treatment of pre-existing disability and its direct complications are covered after 24 months of continuous coverage after the date of inception of the first policy with the insurer.

Specific Disease

The expenses related to the treatment of listed conditions, surgeries and treatments are covered after a waiting period of 24 months of continuous coverage after the date of inception of the first policy with the insurer.

Initial Waiting Period

The expenses related to the treatment of any illness within 30 days from the first policy commencement date are excluded except for claims arising due to an accident.
Please refer to the Policy Documents to know the policy details and Terms & Conditions.
STAR HEALTH

Why Choose Star Health Insurance?

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.

OUR CUSTOMERS

‘Happily Insured!’ with Star Health

We are committed to saving you time, saving you money, and getting rid of the hassles that make health insurance so hard to navigate.

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My friend told me to buy health insurance from Star Health Insurance. That helped me during my son’s illness. Their cashless treatment facility was very helpful at the time. I truly appreciate their service and support.

Tiji K Oommen

Thiruvananthapuram

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I have been with Star Health Insurance for the past 8 years, and have applied for two claims in that time. Both claims got settled, and I received good support from the company during my hospitalisation.

Vanishree

Bengaluru

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My family has been with Star Health Insurance since 2006. Our claim, which we applied during last month, was handled without any hassle. We are happy that we are part of such service providers.

Ramachandran

Chennai

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Star Health Insurance helped me a lot when I was in need. I was covered under Star’s Comprehensive policy, which provided me cashless treatment at their network hospital during my Angioplasty surgery.

Shaila Ganachari

Mumbai

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I have been using Mediclaim services for the last 7-8 years. I had tried other companies. But, I satisfied with the service Star Health Insurance has provided me, they also have friendly support personnel.

Sudhir Bhaiji

Indore

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user
Tiji K Oommen
Thiruvananthapuram

My friend told me to buy health insurance from Star Health Insurance. That helped me during my son’s illness. Their cashless treatment facility was very helpful at the time. I truly appreciate their service and support.

user
Vanishree
Bengaluru

I have been with Star Health Insurance for the past 8 years, and have applied for two claims in that time. Both claims got settled, and I received good support from the company during my hospitalisation.

user
Ramachandran
Chennai

My family has been with Star Health Insurance since 2006. Our claim, which we applied during last month, was handled without any hassle. We are happy that we are part of such service providers.

user
Shaila Ganachari
Mumbai

Star Health Insurance helped me a lot when I was in need. I was covered under Star’s Comprehensive policy, which provided me cashless treatment at their network hospital during my Angioplasty surgery.

user
Sudhir Bhaiji
Indore

I have been using Mediclaim services for the last 7-8 years. I had tried other companies. But, I satisfied with the service Star Health Insurance has provided me, they also have friendly support personnel.

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Special Care Gold 

 

In India, both HIV prevalence and disability rates are critical public health concerns, each requiring customized responses. Health Insurance can play a crucial role in a context where both HIV and disabilities often lead to social stigma and economic hardship.

 

Special Care Gold is an unique offering particularly designed for individuals with disabilities and those living with HIV/AIDS. This initiative aligns with Star Health’s core mission to ensure that first-class health care is accessible to everyone, specifically for those affected by diseases and disabilities.

 

The policy is crafted in accordance with the Rights of Persons with Disabilities Act, 2016, , as amended from time to time, and extends coverage to individuals with HIV/AIDS as highlighted under the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, as amended from time to time.

 

Eligibility for a Disability cover:


It covers a person with 40% or more of a specified disability and the disabilities covered under this plan are:

 

  • Blindness 
  • Muscular Dystrophy 
  • Low vision 
  • Chronic Neurological conditions 
  • Leprosy Cured persons 
  • Specific Learning Disabilities 
  • Hearing Impairment (deaf and hard of hearing) 
  • Multiple Sclerosis 
  • Loco-motor Disability 
  • Speech and Language disability 
  • Dwarfism 
  • Thalassemia 
  • Intellectual Disability 
  • Haemophilia 
  • Mental Illness 
  • Sickle Cell disease
  • Autism spectrum disorder 
  • Multiple Disabilities including deaf/ blindness 
  • Cerebral Palsy 
  • Acid Attack victim 
  • Parkinson's disease

 

Eligibility for HIV cover:

 

Individuals diagnosed as HIV/AIDS by a duly qualified Medical Practitioner with CD4 count above 350 will only be eligible for cover under this policy.

 

  • Sum Insured options available under this plan are Rs. 4 Lakhs and Rs. 5 lakhs
  • The Room Rent and ICU/ICCU expenses can be covered up to 1% and 2% respectively of the Sum Insured chosen 
  • This plan covers all day care procedures with Cataract expenses covered up to Rs. 40,000 per each eye in a policy year
  • Special Care Gold’s additional coverages include emergency road ambulance expenses, modern treatments, AYUSH and pre & post hospitalization expenses
  • A Co-payment of 20% is applicable for all admissible claims
  • There is an option for the customers to waive off the Co-payment on payment of additional premium 
  • This plan also provides a lump-sum coverage for HIV / AIDS if the CD4 count of the Insured is/goes below 150 with a waiting period of 90 days.

 

Thus, Special Care Gold has been brought out in line with Star Health’s founding value of making quality health care accessible to specially-abled individuals by empowering them to manage their health with confidence and ease. 

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