Star Health Insurance’s Unique Health cover pre-existing diseases just after 11 months, after a customer buys this policy. This part of the policy keep Star Health’s Unique Health apart from the other products in the market, where the insured has to wait for about four years for the policies to begin covering diseases that existed prior to the purchase of insurance. The policy will cover all pre-existing diseases except cancer and renal disorders, but here is the catch – “The insured will be paid only 50 per cent (not 100 per cent) of the cover sum if an ailment arises out of a pre-existing disease.”
Salient features of Unique Health
1-Pre Existing Diseases (other than those for which specific time periods have been mentioned separately) covered after complete of 11 months
2- The policy provides coverage to HIV positive persons.
3- The minimum age of entry in this case is 18 years, while 65 is the upper limit.
4- It is available for Rs 1 lacs, Rs 2 lacs and Rs 3 lacs covers.
5- It will be a two-year contract, with premiums payable in annual instalments.
6- No medical tests are mandatory for individuals up to 65 years of age.
7- The policyholder can renew the policy until the age of 70. Thereafter, the insured has an option to switch over to any other equivalent insurance scheme of the company, and more importantly, with continuity of benefits.
Does all Pre-Existing Disease covered after 2 years?
Only certain Pre-Existing Disease/ Condition(PED) will be covered after 11 months of continuous coverage under the policy.
1. Room rent, Boarding and Nursing Expenses @ 1% of sum insured subject to a maximum of Rs.3000/- per day.
2. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees.
3. Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses.
4. Emergency ambulance charges for tranporting the insured person upto a sum of Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policy period.
Coverage for HIV positive persons
1. The policy extends coverage to HIV positive persons except Opportunistic infections (eg : Tuberculosis, Gastroenterology, etc).
2. The Minimum CD 4 count at entry level should be 350.
1. Any illness diagnosed within 30 days of inception of policy is not covered, however accidental injuries will be covered
2. First year exlusions : Deviated Nasal Septum, Benign Prostate Hypertrophy, Hernia, Hydrocele, Congenital Internal diseases/defects, Fistula in anus, Piles, Fissure in anus, Sinusitis, and related disorders, Nasal Polyps ,Post trauma non union / mal union, Cholecystectomy, Gall Bladder Calculi and Renal Calculi If any of these are Pre-Existing they will be covered after 24 months of continous insurance with the Company.
3. First two Years exclusions : Cataract, Hysterectomy (abdominal and Vaginal), Dysfunctional Uterine Bleeding (DUB) Fibroid Uterus, Prolapsed Uterus, Myomectomy, Cystectomy, Treatment of Internal Derangement of Knee (other than caused by an accident), Treatment for Joints (other than caused by an accident), other Arthroscopic procedures, Inter-Vertebral Disc Prolapse (other than caused by accident), Degenerative Vertebral and Disc diseases, Varicose veins and Varicose ulcers, Thyroiditis, Treatment of Goitre, Tympnoplasty, Mastoidectomy Glaucoma. These are not payable irrespective of whether they are Pre-Existing or not.
4. First Four Years Exclusions : Stapedectomy, Bone marrow transplant, Cirrhosis of liver with or without portal Hypertension, Hepatitis, Loss of vision partial / total including Retinopathy, Retinal Detachment, Macular degeneration and Papill Oedema, all types of Cancer, Nephropathy and Chronic Kidney diseases, Implant Removal. The above shall not be payable during the first four years only if these are Pre-Existing at the commencement of this insurance.
1. 30% on all claims including PED claims. This copayment would apply on the sub limit mentioned for PED claims
2. War and allied perils including nuclear risks
3. Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident,
4. Vaccination or inoculation (except as a post-bite treatment)
5. Change of life or cosmetic or aesthetic treatment of any description,
6. Plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
7. Cost of spectacles and contact lens, hearing aids, walkers, crutches wheel chairs and such other aids.
8. Dental treatment or surgery of any kind unless necessitated due to accidental injuries and requiring hospitalization.
9. Convalescence, general debility, Run-down condition or rest cure, Psychosomatic disorders, Congenital external disease or defects or anomalies, infertility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol.
10. Treatment for HIV / AIDS and opportunistic infections
11. Purely diagnostic expenses
12. Expenses on vitamins and tonics not forming part of treatment
13. Maternity expenses (other than ectopic pregnancy)
14. Naturopathy Treatment
15. Hospital registration charges, admission charges, record charges, telephone charges and such other charges
16. Lasik Laser or Refractive Error Correction treatment
17. Weight control or treatment for obesity
18. Non allopathic treatment is limited to 25% of the sum insured per occurrence subject to an overall limit of Rs. 25000/- for each year of insurance.
Advantages on Unique Health
1- Coverage available to HIV + individuals, subject to conditions.
2- Coverage to pre-existing illnesses starts after 11 months.
3- Covers Individuals up to 65 years without a Medical Check-up.
4- No Third Party Administrator, direct in-house claims settlement.
5- Network of more than 4600 hospitals across India.
Disadvantages on Unique Health
1- The co pay ratio of 30% for all claims, is too high.
2- Cover for pre-existing illnesses is capped at 50% of the sum insured.
3- Mandatory cover for 2 years. If you claim in the first year, the second year’s premium is deducted from the admissible claim amount.
4- Cover ceases at the age of 70 years, after which the insured has the option to move to any other existing product of Star.
The Bottom Line
1- The best part of this policy is pre-existing illnesses coverage, just after 11 months of buying the policy and coverage to HIV positive persons, provided their CD 4 count is not less than 350. Other insurers cover pre-existing diseases only after 4 continuous years of policy renewal.
2- But here is the end of good news – policyholders will get paid only 50% towards these pre-existing illnesses. For any other claim 70% claim will be covered (30% co pay). A co-pay ratio of 30% means that if your admissible claim stands at Rs 1 lacs, you will have to shell out Rs 30,000 from your pocket, before the company chips in with the balance of Rs 70,000.
3- Low sum insured cover option.
4- The policy also has differential premium structure for insured in different cities. Those residing in Ahmadabad, Bangalore, Delhi and Mumbai will have to pay a comparatively higher premium than their counterparts in other cities.
We recommend you to avoid this plan, buy only if you have no other option.