When you look for a family health insurance policy, you seek affordable options to ensure your financial security during a health scare for anyone in your family. Now, affordability isn’t the only feature you factor in while choosing a family floater policy. You want a plan that poses minimum restrictions on pre-existing conditions (since senior citizens might be in your plans), minimum waiting period, nominal clauses and terms and conditions involved. Star Family Health Optima Plan is one such policy that has grown popular over the years.
However, Star’s recent hit on its credibility owing to delisted network hospitals, rejection of valid claims, withdrawal of essential plans, and high complaint volume over its claim settlement process is a significant concern. But is it still worth purchasing the plan despite the issues with the insurer?
Let’s find out!
Quick Verdict on Star Family Health Optima Plan
The Star Family Health Optima Plan is not precisely a comprehensive family floater health insurance policy, considering the multiple restrictions and sub-limits on each feature. Thus, it isn't a good pick despite being an affordable policy with a coverage of ₹3 lakhs to ₹25 lakhs. Additionally, Star as an insurer doesn’t have the best metrics.
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Star Family Health Optima Plan: Brief Overview
Star Health is one of the country's oldest standalone health insurance providers and once held a monopoly in the industry. However, as more players emerged within the industry and the online purchase of health insurance plans became popular, Star’s popularity took a hit. The company’s presence of agents in the physical market was no longer effective, and the claim reputation it built was no help either. This change is significantly noticeable in the data metrics below -
- Claim Settlement Ratio (CSR) of 82.01% (the industry average is 90.97%; the higher, the better, but not above 100%)
- Incurred Claim Ratio (ICR) of 82.17% (the industry average is 82.96%; an ideal range would be somewhere between 50-70%)
- Complaint Volume of 29.04 (the industry average is 24.029; the lower, the better)
(*Please note that we have taken the average of the last 3 years and drawn an average of the same to ensure that you gain an insight into the consistency of the provider’s performance.)
Subsequently, plans from Star Health Insurance's stable are often a bit more expensive than similar plans from other insurers and lack the comprehensiveness that we seek in the best health insurance plans. One such policy is the Star Family Health Optima Plan, available only as a family floater plan. The plan may not be a great pick because, like any other health insurance plan from this stable, this one also has multiple caveats that might pose a significant hurdle.
The policy offers coverage of ₹3 lakhs to ₹25 lakhs, along with coverage for Assisted Reproduction Treatment, domiciliary and daycare treatments, free annual health checkups, pre- and post-hospitalisation expenses, and more. However, these features are associated with a long list of caveats, including sub-limits, cappings, and exclusions.
- For example, the room rent restrictions - based on your sum insured, your room rent restrictions can range from ₹5000/day up to a single standard A/C room.
- Even in the case of disease-wise sub-limits, if you are thinking of eye surgeries like Cataracts, there is a capping of a maximum of ₹50k (per eye) or ₹75k (per policy year) based on your cover amount.
Yet, these are only two of the policy's restrictions. You will also need to consider waiting periods, co-payments, and more.
Now, suppose you compare the Star Family Health Optima Plan with other family floater health insurance policies available in the market. In that case, you can understand why we do not usually recommend the former policy.
However, if you are sure about the insurer and want to know more about the Star Family Health Optima Plan, here is a quick look at its features.
Features of Star Family Health Optima Plan
| FEATURES | DETAILS |
|---|---|
| Coverage | ₹3 lakhs to ₹25 lakhs |
| Copayment | None, unless your entry age is 61 and above (in which case the mandatory copayment would be 20%) |
| Room rent restrictions |
|
| Affordability of premiums | Affordable |
| Waiting period |
|
| Domiciliary coverage | Yes |
| Pre & Post Hospitalisation | 60 and 90 days |
Should You Buy a Star Family Health Optima Plan?
- Star as an insurer: Star Health Insurance started its operations in 2006 and quickly grabbed the limelight with its long list of products and a queue of agents selling these policies in the physical market. However, over the years, the brand took a hit in its credibility (and hence, popularity) when it started rejecting valid claims, delisted network hospitals and withdrew crucial plans from the market only to relaunch them later. Such inconsistencies affected their overall operational proficiency, reflected well in the complaint volume.
However, as a health insurance provider, Star still offers a few popular plans that can be considered comprehensive and affordable. Additionally, they are one of the few providers in the market offering plans to cancer patients in remission and multiple other critically ill policyholders.
Unfortunately enough, none of these plans are without a solid set of caveats (think copayment, room rent restrictions, disease-wise sub-limits, and more), thus encouraging you to use free tools to compare the best health insurance plans available in the market (from other providers) and choose accordingly.
- In-Built Features: Star Family Health Optima Plan has a basic structure that attempts to cover most bases. However, most of its features come with a certain amount of restrictions and limitations. Here is a look at some of the highlighted in-built perks of this plan -
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Coverage: Under the Star Family Health Optima Plan, you can opt for coverage of ₹3 lakhs to ₹25 lakhs. While the range isn’t wide enough to cater to the financial and medical requirements of policyholders, if you have included your parents (senior citizens) and your child in the policy, the upper limit might suffice (unless there is a medical condition requiring multiple treatments/hospitalisations across a year).
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Co-Payment: Under the Star Family Health Optima Plan, no copayments are involved unless your entry age is 61 years or above. Under such circumstances, a mandatory copay of 20% for each claim raised is required.
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Room Rent Restrictions: Like any other health insurance policy from the Star Health stable, the Star Family Health Optima Plan also has certain room rent restrictions based on your chosen sum insured. Now, this is a major red flag for us because if you exceed the room rent/type limit, you won’t just be paying the additional amount for the room rent but will actually be paying a pro-rata share of the entire bill.
So, say you have a room rent restriction of ₹1000/day. During hospitalisation, you didn’t have the option to choose a room within the pre-set rent limit. Your room costs ₹1500/day. So, you surpassed the limit by 50%. After a stay of 7 days, you won’t just be paying the additional room rent (₹500 * 7 = ₹3500) but will be paying 50% of the entire hospital invoice. So, you dig into your savings for a substantial amount despite having a health insurance plan.
Keeping that in mind, here is a look at the room rent/type restrictions for the Star Family Health Optima Plan -
| Sum Insured | Room rent/type restrictions |
|---|---|
| ₹3 lakhs - ₹4 lakhs | Up to ₹5000/day |
| ₹5 lakhs to ₹25 lakhs | Up to a single standard A/C room |
In the case you opt for shared accommodation, the amount that you can get per day is -
| Sum Insured | Room rent/type restrictions |
|---|---|
| ₹3 lakhs - ₹4 lakhs | ₹800/day |
| ₹5 lakhs to ₹25 lakhs | ₹1000/day |
- Disease-Wise Sub-Limits: The Star Family Health Optima Plan has a few disease-wise sub-limits, which is again a major concern that discourages us from recommending this policy.
Here is an example of the disease-wise sub-limit feature in this policy -
Say you have cataract surgery and have availed of this plan. The policy has certain restrictions on the coverage offered based on your chosen sum insured -
| Sum Insured | Per eye coverage cap | Per policy year coverage cap |
|---|---|---|
| ₹3 lakhs | ₹25,000 | ₹35,000 |
| ₹4 lakhs | ₹30,000 | ₹45,000 |
| ₹5 lakhs | ₹40,000 | ₹60,000 |
| ₹10 lakhs - ₹25 lakhs | ₹50,000 | ₹75,000 |
Take a look at the cappings -
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the insurer’s per-eye cataract surgery may cover one treatment,
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the per-year coverage cap is 1.5 times the per-eye coverage. So, if your 2nd cataract surgery falls in the same year, you will pay significantly out of pocket.
This capping and sub-limit are a major letdown if you remember that this is a family floater policy in which senior citizens may be policyholders. Since such senior citizen policyholders may almost always require this surgery, the sub-limit discourages potential policyholders. -
AYUSH Treatment coverage: If you are considering opting for alternate treatments under this Star Family Health Optima Plan, you will be covered, but partially. Depending on the sum insured that you have opted for, your AYUSH capping resembles this -
| Sum Insured | AYUSH Cappings |
|---|---|
| ₹3 lakh - ₹4 lakhs | Up to ₹10,000 |
| ₹5 lakhs - ₹15 lakhs | Up to ₹15,000 |
| ₹20 lakhs - ₹25 lakhs | Up to ₹20,000 |
- Waiting Period: Under the Star Family Health Optima Policy, there are a variety of waiting periods involved:
- Initial: 30 days
- Pre-existing ailments: 48 months
- Specific illness: 24 months
- Assisted Reproduction Treatment: 36 months
While the other waiting periods are quite similar to those of top-notch health insurance policies in the industry, the one for pre-existing medical conditions is redundantly extensive. A four-year waiting period for pre-existing conditions in a family floater health insurance plan is uncalled for.
- Assisted Reproduction Treatment: While the presence and inclusion of Assisted Reproduction Treatment coverage is an encouraging feature in a family floater health insurance policy, the feature isn’t without a sub-limit -
Additionally, this feature has a 36-month waiting period.
- Automatic Restoration of Sum Insured: In case of the complete exhaustion of the base cover amount, an automatic restoration of 100% of the sum insured kicks in. However, this perk can only be availed 3 times across a year, and in each case, the restored sum kicks in only upon the complete utilisation of the last sum insured.
This automatic restoration is only available for different ailments (not the same diseases) and for policyholders who have chosen a cover amount of ₹3 lakhs and above.
- Recharge Benefit: A Recharge amount kicks in if the base cover amount is utilised in a policy year. This additional amount can cover treatment of the same and different ailments. However, there is a sub-limit on this recharge amount that is based on the chosen sum insured -
| Sum Insured | Recharge Benefit Cap |
|---|---|
| ₹3 lakhs | ₹75,000 |
| ₹4 lakhs | ₹1 lakh |
| ₹5 lakhs - ₹25 lakhs | ₹1.5 lakhs |
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Additional Sum Insured for Road Traffic Accident (RTA): If the policyholder is hospitalised following a road accident, Star Health will offer you an extra 25% of the base cover amount up to a maximum of ₹5 lakhs. However, there are a few clauses involved -
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This additional amount only kicks in when the base cover is exhausted
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The perk kicks in only once during a policy year
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The buffer amount can only be used for this hospitalisation (which was a result of the accident).
The insurer also offers a cumulative bonus (25% for the first year and 10% for the subsequent claim-free years until the total reaches 100% of the base cover), compassionate travel coverage, cover for Repatriation of Mortal Remains (up to a specific limit), and more.
What’s Unique about the Star Family Health Optima Plan?
The Star Family Health Optima Plan offers many in-built features, including automatic restoration, recharge benefits, assisted reproductive treatment cover, additional Sum Insured for Road Traffic accidents, and more. The only caveat? All these features have a long list of clauses, terms and conditions, and sub-limits.
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Conclusion
While recommending any of the best health insurance policies, we prioritise 3 major checkpoints - co-payment, disease-wise sub-limit and room rent restrictions. While the presence/inclusion of other features and perks are a deciding factor too, these 3 are the most important. In the case of Star Family Health Optima Plan, a co-payment exists if your entry age is 61 or above, there are room rent/type restrictions, and there are disease-wise sub-limits. Additionally, each feature offered by this plan comes with limitations and clauses.
Subsequently, such limitations make us overtly cautious about recommending such plans to our clients unless they specifically ask for the insurer and/or the plan. You can always find better family floater health insurance policies in the market offered by much more credible health insurance providers.
