Star Health Special Care Gold Policy: From eligibility to benefits; all you need to know

Special Care Gold Policy by Star Health Insurance is a unique product designed specifically for individuals with disabilities and those who are HIV/AIDS positive. This policy aligns with Star Health’s mission to provide quality healthcare for all, including those affected by some of the most neglected illnesses and disabilities.

In accordance with the 2016 Rights of Persons with Disabilities Act, the policy is tailored to cater to the needs of individuals with disabilities. Additionally, the company is launching a recruitment initiative to train and hire visually impaired individuals as insurance agents.

Entry age and sum assured – The policy term is 1 year, and it is available as an individual policy. The entry age for adults ranges from 18 to 65 years, while dependent children can be covered from newborns up to 17 years of age. The sum insured options available under this plan are ₹4 lakhs and ₹5 lacs.

Eligibility – The plan is designed for individuals with disabilities and those diagnosed with HIV/AIDS. Here is more information about the same.

Pre-policy medical check-up – No medical tests are required, regardless of age. However, previous medical records including treatment details must be submitted along with the proposal.

Pre and post hospitalisation cover – The policy covers medical expenses incurred up to 30 days before hospital admission (pre-hospitalization) and up to 60 days after discharge (post-hospitalization), including consultation fees, diagnostic charges, and prescribed medicines.

Pre-policy medical check-up – No medical tests are required, regardless of age. However, previous medical records including treatment details must be submitted along with the proposal.

Pre and post hospitalisation cover – The policy covers medical expenses incurred up to 30 days before hospital admission (pre-hospitalization) and up to 60 days after discharge (post-hospitalization), including consultation fees, diagnostic charges, and prescribed medicines.

Co-payment – A 20% co-payment applies to each claim under this policy. However, this co-payment can be waived by paying an additional premium, subject to the policy’s terms and conditions. However, room rent, boarding, nursing expenses, and ICU/ICCU charges are covered up to 1% and 2% of the sum insured per day, respectively, as per the hospital’s provisions.

Treatments – Modern treatments are covered up to 50% of the sum insured, while cataract treatment is capped at ₹40,000 per eye per policy year. However, AYUSH treatments are also covered up to 50% of the sum insured each policy year.

Lumpsum coverage for HIV/AIDS – If the policyholder CD4 count drops below 150, the company will pay a lump sum amount equal to 100% of the Sum Insured or the remaining Sum Insured, whichever is lower. This payment will be made after a 90-day waiting period from the policy’s start date and is limited to one claim per lifetime, independent of any inpatient hospitalisation claims under the policy.

Waiting period – Star Health Special Care Gold policy includes four types of waiting periods:

Pre-existing diseases:

• For conditions other than disability/HIV/AIDS – Pre-existing conditions and their direct complications are covered after a continuous 48-month waiting period from the policy start date.
• For HIV/AIDS – Treatment for HIV/AIDS and its direct complications is covered after a 90-day waiting period from the policy start date.
• For disabilities – Pre-existing disabilities and their direct complications are covered after a 24-month waiting period from the policy start date.

Specific diseases – After a 24-month waiting period from the policy’s start date, treatment costs for certain specified conditions, surgeries, and procedures are covered.

Initial waiting period – Treatment costs for any illness during the first 30 days from the policy commencement date are excluded, except for claims resulting from accidents.

Instalment payment options – Premiums can be paid on a Quarterly, Half-Yearly, or Annual basis. Please note that for instalment payments, the following additional charges apply: Quarterly Payment: 3% loading and Half-Yearly Payment: 2% loading.

Day care treatments – Day care treatments are also covered, meaning if you’re hospitalised for less than 24 hours for a minor procedure or surgical procedures, the insurer will still cover the associated costs.

Emergency road ambulance – Ambulance expenses are covered up to a maximum of ₹2,000 per hospitalisation.

What does plan doesn’t offer – This policy does not offer any type of bonuses, maternity benefits, out-patient consultations, any kind of special discounts and international coverage, as per now.

Revision of sum insured – Adjustments to the sum insured, whether an increase or decrease, are allowed only during policy renewal. Approval for any enhancement, including the amount, is at the discretion of the company and subject to some exclusions.

Tax benefit under Section 80-D – The insured person is eligible for tax relief under Section 80-D of the Income Tax Act for premiums paid through any mode other than cash.

In conclusion, the Star Health Special Care Gold Policy is a commendable initiative that prioritises the healthcare needs of individuals with disabilities and those affected by HIV/AIDS.

By aligning with the Rights of Persons with Disabilities Act, 2016, and the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, this policy not only ensures comprehensive coverage.

Through this tailored approach, Special Care Gold empowers these marginalised groups, providing them with the support and resources necessary to lead healthier lives.

Rohit Gyanchandani is Managing Director at Nandi Nivesh Private Limited