- 1 Group Medical Cover (GMC)
- 2 Star Health’s Group Health Insurance Benefits
- 3 Which waiting periods are waived off?
- 4 Star Group Health Insurance Features
- 5 What is not paid?
- 5.1 Corporate Buffer
- 5.2 In-house claim settlement
- 5.3 Documents to be submitted for Reimbursement claims:
- 5.4 Who to recommend to buy Star Group Health Insurance?
- 5.5 Waiting Periods
- 5.6 Maternity Coverage
- 5.7 Family Coverage
- 5.8 Benefits for employees from Star Group Health Insurance
- 5.9 FAQs
- 5.9.1 1. Can I get a group scheme for my employees of any size in the Star Group Health Insurance Plan?
- 5.9.2 2. Is Maternity Benefit covered under Star Group Health Insurance?
- 5.9.3 3. Are health check-ups included in Star Group Health Insurance?
- 5.9.4 4. What is the premium of Star Group Health Insurance?
- 5.9.5 5. What factors can affect my Star Group Health Insurance premium?
- 5.9.6 6. Who is not eligible for Star Group Health Insurance?
- 5.9.7 7. Will I be able to customize the coverage and benefits of the plan that I want to offer my employees in Star Group Health Insurance?
- 5.9.8 8. What are the policy norms on enrolment of dependents in the middle of the policy year in Star Group Health Insurance?
Star group Health insurance is offered by Star Health and Allied Insurance Co Ltd, which is an Indian multinational health insurance company head quartered in Tamil Nadu, Chennai. The company provides services in health, personal accident, and foreign travel insurance directly as well as through various channels such as agents, brokers, and online. Star Health is also a leader in bancassurance with long-standing relationships with different banks.
Group Medical Cover (GMC)
Group medical cover is a policy that covers a defined group of people, usually members of a professional association or society or employees of a company. A group medical insurance policy will cover health and medical expenditures.
According to IRDAI, a group means a group of members who assemble together with the purpose of engaging in a common economic activity and are not formed with the main purpose of availing of insurance coverage.
The group can be broadly divided into two:
1. Non-employer-employee groups
It may include members of registered welfare associations, holders of credit cards issued by certain companies/banks, and customers of certain businesses where insurance is provided as an add-on benefit.
2. Employer-employee groups
They may include employees of any specific registered organization. Star Health and Allied Insurance Company Limited is the health insurance expert in issuing group mediclaim policies for existing groups. i.e., Employers- employees
Star Health’s Group Health Insurance Benefits
Star Group Health Insurance is offered after customizing the product to the requirement of the proposer. The following advantages are covered under this policy subject to the sub-limits prescribed in the policy schedule.
- In-patient hospitalization expenses: All expenses pertaining to in-patient hospitalization such as Room/boarding expenses inclusive of Medical Practitioners fees, Nursing Expenses, Surgical fees, ICU charges, Anesthetist, Anesthesia, Blood, Oxygen, operation theater charges, etc. incurred during hospitalization for a minimum period of 24 consecutive hours.
- Pre and Post hospitalization Expenses: Pre and post-hospitalization medical expenses up to the limits mentioned in the schedule.
- Daycare treatments/procedures: All daycare treatments pertaining to medical treatment and/or surgical procedures which are undertaken in less than 24 hours because of technological advancement are covered. Outpatient treatment under the cover of daycare treatments/procedures will be excluded.
- Maternity Benefits: This optional cover provides coverage for medical expenses incurred for C-section or normal delivery (including antenatal and post-natal expenses), and delivery as legitimate medical termination of pregnancy during the policy period. This cover also extends to cover childbirth-related expenses from 1 day up to a certain limit as specifically mentioned in the policy schedule. This coverage can be provided with or without any waiting period. The provision to waive off 9 months waiting period can also be opted for under the policy.
- Newborn cover: The newborn baby can get the cover for medical expenses incurred as an in-patient in the hospital up to the floater sum insured or a certain percentage of the mother’s sum insured as stated in the policy schedule. The newborn cover is also an optional cover.
- Ayush Treatment: This cover provides coverage for medical expenditures for alternative treatment methods like Homeopathy, Ayurveda, Siddha, and Unani treatment provided such treatment is administered by a medical practitioner. (NABH)
Which waiting periods are waived off?
|Waiver of 30 days waiting period||Any illness within the first 30 days from the policy commencement date will be covered.|
|Waiver of first-year exclusion||The illness specified in the policy clause will be covered from the date of inception of the policy. E.g. Kidney stones, Gallbladder stones, pancreatic stones, hernia, prostrate, hydrocele, etc.|
|Waiver of first two-year exclusion||The illness specified in the policy clause will be covered from the date of inception of the policy. E.g. ENT diseases, cataracts, problems related to female genital organs, prolapse of the intervertebral, etc.|
|Waiver of Pre-existing disease exclusion||Expenses related to the treatment of pre-existing disease (PED) and its direct complications will be covered from the policy inception date.|
Star Group Health Insurance Features
- Star Group Health Insurance is provided by an employer to its employees.
- Employees can choose to include their family members like spouses, dependent children, parents, and parents-in-law.
- Star Group Health Insurance can be issued with or without a co-pay for covering elderly parents and in-laws.
- The policy will provide floater/personal sum insured to cover medical expenditures of 24-hour patient hospitalization due to illness or accident and daycare procedures.
- The employee can opt for an additional top-up cover to suit his requirements.
- Floater Benefit: The insured can avail of the floater cover and cover the family (spouse, dependent children, parents, and in-laws) by paying a single premium amount.
- Cashless and Reimbursement Facility: Insured can avail of the cashless facility in-network hospitals and also get reimbursement on submission of standard demanded documents.
- Cover Period: One year.
- Eligibility: Any age can avail of this policy.
- Group size: If your company provides the insurance, you will be qualified for it. Company size can be as small as 7 members including family members.
- Waiting Period: One of the biggest advantages of taking the Star Group Health Insurance coverage is the waiver of the waiting periods/time-bound exclusions. Generally, in Group Arogya Sanjeevani Policy, the waiting period is applied from 30 days to 4 years, and the delivery cost is not covered. However, Star Group Health Insurance allows employees to enjoy certain additional benefits like all waivers of time-bound exclusions and delivery charges.
- No pre-insurance Medical Screening: In a Group Arogya Sanjeevani Policy, pre-insurance screening is mandatory. It is unlike group insurance policies which can be provided without pre-insurance screening. Hence, an elderly person suffering from pre-existing diseases can also be covered under group insurance cover.
- Premium: The premium charged under the policy depends on the sum insured chosen, additional covers (if chosen by the insured), and other factors such as age, risk factor, city contingency, morbidity, etc.
- Type of Policy: The types of policies available are similar to those offered to regular customers, however, the level of coverage provided may depend on the policy chosen by your employer.
- Addition/Deletion: Mid-term inclusion is not possible in group health insurance policy whereas Star Group Health Insurance may allow new entrants and their family members during the mid-term of the policy on marriage and/or newborn.
What is not paid?
Star group health insurance doesn’t pay for permanent exclusions mentioned in the policy schedule.
- Vitamins and tonics, walkers and wheelchairs,
- Dental Implants
- Congenital External Anomaly
- Non-payables/consumables etc.
Corporate Buffer means an additional sum insured available for the whole group. This can be availed in case of any medical emergency falling under specific diseases/illnesses after the exhaustion of individual employees’ coverage. Under the family floater cover, this benefit can be extended to the employee, spouse, and children with the consent of the employer.
In-house claim settlement
1. Cashless claim procedures
Star Health Claim Services is a hassle-free and customer-friendly procedure that guarantees that all settlements are processed on time. Cashless claims are available from the Star group across all the network hospitals in India.
- The Star Health website has a list of network hospitals, including agreed network hospitals.
- Search through the network list on the website of Star Health and find the network hospital nearest to your residence.
- For planned surgery, approach the hospital prior to the date of admission and send the completed pre-authorization form.
- In the pre-authorization form, you have to provide your contact number.
- If the details are incomplete, approval of the authorization request may be delayed.
Contact the insurance desk at a network hospital. Intimation can be given either through contacting us at 044 4674 5800 or email at email@example.com
- Inform the Operator to receive Claim Number
- Customer ID / Policy No
- Hospital Name
- Insured/Patient Name
- Cause of Hospitalization
Planned hospitalizations can be reported 7 to 10 days in advance and emergency hospitalizations are intimated within 24 hours of hospitalization.
- Register claim.
- Approach the insurance desk and submit all the required documents to the network hospital.
- Documents will be sent to the Star Claims Team.
- Documents will be verified by the Start Health Claim Processing Team.
- If approved, the claim is settled according to the terms of the policy.
- Payment will be made to the network hospital.
- Pay the difference and get leave from the hospital.
2. Reimbursement claim procedures
In the case of planned treatments, the insured gives prior intimation about the treatment to the insurer and obtains the claim number. In case of an emergency admission, the insured can avail claim number within 24 hours of hospitalization. The insured can call the helpline at 1800-425-2255 to obtain his claim number providing the required information like hospital name and patient’s name etc. The insured can claim reimbursement for those expenditures within 15 days from the date of discharge after submitting the necessary documents.
Documents to be submitted for Reimbursement claims:
- Duly completed claim form
- Pre-admission investigations and treatment papers
- Cash receipts and reports for tests done
- Receipts from doctors, surgeons, and anesthetist
- Certificate from the attending doctor regarding the diagnosis
- Cash receipts from the hospital and chemists
- Canceled cheque, PAN card copy, or NEFT details
You may also reach out to the 24/7 customer care of Star Health to get your queries cleared.
Co-payment is a cost-sharing requirement under a health insurance policy where the insured should bear a specified percentage of the amount of the admissible claims. This co-payment facility will decrease the cost of group insurance.
Who to recommend to buy Star Group Health Insurance?
Employees are the most valuable asset of any company, and employers are taking many initiatives to promote healthy employees to ensure their excellent mental and physical health which sets them up to perform well. In the current scenario, there is a growing trend among organizations to consider Health insurance as an employee benefit.
Health Insurance is the key factor in recognizing and rewarding employees. Health insurance can also be used as a retention tool where the employees are obliged to work with the company for a longer period. When the needs of the employee are taken care of like the hospitalization for his aged parents, therefore it brings satisfaction to give his best to the employer.
SMEs and start-ups: Group health insurance for startups with a small team size consisting of a minimum of 7 members can be provided with a group medical policy. For instance, if you are a new company with a count of 7 members, you could still sign up for a group health insurance plan. Employers can take advantage of investing in group health insurance policies on two fronts. Not only can they provide benefits to your employees but can also help in your tax exemption under Section 37(1) of the Income Tax Act.
Large organizations: Corporate social responsibility is an ongoing commitment by businesses to behave ethically and contribute to the welfare of employees and their families and to the welfare of the local community and society.
Time-bound exclusions/waiting periods are generally of 4 types. Time-bound exclusions under Star Group Health Insurance are as follows:
- Pre-existing diseases- 4 years.
- Some specific diseases related to – eye, ENT, female genital diseases, etc. are 2 years.
- Some specific diseases related to – Hernia, Piles, stone formation, etc. are one year.
- Any disease developed or contracted during the first 30 days of the policy.
The above time-bound exclusions can be waived under Star Group Health Insurance.
The Star Group Health Insurance provides for the delivery and newborn baby cover as add-on benefits. It is a good option to provide these benefits and show your support to your employees during the birth of a child.
Employees will admire it a lot when you cover their family with comprehensive health insurance. It is the best perk you can offer to show them how much you value them. Of course, this gesture does come at a cost but you can always choose to customize an insurance plan to suit your employee’s needs. As with maternity add-ons, it makes sense to evaluate your team by their age group and make a well-calculated decision. For example, a group in their 20s may not require family coverage as much as a team in their mid- 30s with aging parents and kids. If your employees can’t use their health insurance properly in an emergency, your efforts will be wasted.
Benefits for employees from Star Group Health Insurance
Today, employees look for attractive organizations that provide more than just a salary. One such meaningful compensation is Star Group Health Insurance, which has gained precedence in the current pandemic. Considering the notification issued by the Ministry of Home Affairs to provide mandatory group health insurance plans for employees in light of Covid-19, corporate health insurance can provide various benefits to both employers and employees.
Healthy employees create a more productive workforce. Especially in situations where a family member is admitted to the hospital, employees are under a lot of stress. Let’s take a closer look at the many benefits of getting Star Group Health Insurance from your employer to cover your medical requirements.
1. With Star Group Health Insurance, you can offer your employees the benefits they need to stay productive.
- A reduction in absenteeism
- Improved employee retention
- Increased business productivity
- Boosted productivity
2. Reducing the cost of sick days: Every employer, in every company, has the challenge of reducing the number of sick leaves taken by their employees. Days of work are lost on sick leaves, which significantly affects the bottom line of businesses. You can’t control when your employees fall ill, Star Group Health Insurance can provide your employees with quick access to quality healthcare, helping them return to work sooner.
3. Helps you hire and retain staff: When hiring talent, providing company medical insurance as part of your benefits package may be the reason a candidate prefers you over other corporations. At the same time, your present employees are less probable to look elsewhere for employment because providing the company with private medical insurance makes them feel more valued and cared for.
4. Increases job satisfaction: Company medical insurance is one of the most desired employee benefits. When people know that their employer has an interest in their health and well-being by providing them with access to quality private healthcare through a corporate health insurance plan, they may experience improved motivation and productivity and be tempted to stay with your company forever.
1. Can I get a group scheme for my employees of any size in the Star Group Health Insurance Plan?
Answer: Any group with 7 members or more may purchase a group health insurance policy, based on the circular from IRDAI. Additionally, it is up to insurers to decide on the minimum size of groups to offer coverage. Star Health can tailor a Star Group Health Insurance that fits the needs of your employees with a group size of a minimum of seven members.
2. Is Maternity Benefit covered under Star Group Health Insurance?
Answer: Maternity expenses mean medical expenses traceable to childbirth (including complicated deliveries and C-sections) incurred during hospitalization and expenses related to lawful termination of pregnancy. Maternity benefits can be very beneficial for the employee with a 9 months waiting period or day-one cover. This is an optional cover.
3. Are health check-ups included in Star Group Health Insurance?
Answer: Yes. Health checkups should be opted for at the beginning of the policy purchase, by paying an additional premium. A health checkup can be one of the advantages of a group scheme. All benefits under the scheme depend on the group scheme and the type of coverage chosen by the employer.
4. What is the premium of Star Group Health Insurance?
Answer: The cost of the premium amount depends on the number of employees, their family members that you desire to cover, and the type of coverage you prefer for your employees. Please visit the official website of Star Health (starhealth.in) to obtain a free quote for group medical insurance.
5. What factors can affect my Star Group Health Insurance premium?
Answer: The size of the group you are insuring is the most obvious factor impacting your Star Group Health Insurance rates. The premium of Star Group Health Insurance is decided according to the number of employees in an organization, their age, the number of dependents, occupation, and cover opted.
6. Who is not eligible for Star Group Health Insurance?
Answer: Like all insurance plans, Star Group Health Insurance also comes with certain limitations. The following provides an understanding of who is not eligible for Star Group Health Insurance:
1. A sole proprietorship with no employees is not eligible for group cover.
2. A self-employed small business owner with zero employees is not qualified for group insurance coverage.
3. A group formed solely for the purpose of obtaining health insurance.
7. Will I be able to customize the coverage and benefits of the plan that I want to offer my employees in Star Group Health Insurance?
Answer: Yes, the Star Group Health Insurance offered by Star Health allows the proposer to customize the benefits for employees according to requirements.
8. What are the policy norms on enrolment of dependents in the middle of the policy year in Star Group Health Insurance?
Answer: Addition and deletion of Employees are possible upon joining and exiting the organization. Mid-policy year enrollment or dependent enrollment changes are not permitted except for dependents due to changes in marital status, newborns, or new hires.