
Floater only, built around one cover the family shares - with automatic restoration of the Sum Insured and a newborn covered from its 16th day.
Two hospital bills in year one, on ₹10 Lakh of cover.
| Bill | Family Health Optima |
|---|---|
| 1st bill₹7,00,000 | CoveredPaid from Sum Insured ₹7,00,000 |
| 2nd bill₹12,00,000 | ₹7,50,000not coveredPaid from |
Tell us about your family and health - this list reorders around what matters to you.
Start the 90-second checkYour room is covered at a Private Single A/C Room, which the policy defines as the most economical single-occupancy room the hospital has - not a deluxe room or a suite.
Take a room above that category and the insurer cuts the same proportion from your nursing, operation theatre and doctor's fees too.
This policy does not pay for hospital non-payable items. Registration, admission, record and telephone charges are excluded by name, and a further list of excluded expenses is held on the insurer's website rather than in the policy. There is no add-on that buys this cover back.
Follow-up costs for 90 days after discharge are paid with no separate rupee cap, but only under three heads: consultant fees, diagnostic charges, and medicines and drugs recommended by the hospital or your doctor. The expenses must relate to the illness you were hospitalised for.
Physiotherapy, home nursing and appliances are not among the three heads, so those recovery bills are not paid here. The claim is filed after the 90 days finish, and you then have 15 days to send it in.
If a claim uses up your whole cover, the policy puts back 100% of the Sum Insured - up to three times in a policy period. The restored amount pays only for an illness unrelated to the one already claimed, and it cannot pay the bill that used the cover up. Modern Treatment claims are left out.
Each restoration starts only after the previous one is spent, and anything left over does not carry into the next year. A repeat of the same illness within 45 days of your last consultation counts as the same hospitalisation, so the restored cover will not pay for it.
A Recharge Benefit of ₹1,50,000 sits on top of your Sum Insured and Loyalty Bonus, and it can pay the very hospital bill that used up your cover. You get it once in the policy period, anything unused does not carry forward, and Modern Treatment claims cannot draw on it.
The Recharge is a flat ₹1,50,000 whatever your Sum Insured, so it goes much further on a ₹5,00,000 cover than on a ₹25,00,000 one. A road traffic accident adds a separate 25% of the Sum Insured, capped at ₹5,00,000, but only if police and hospital records show you were wearing a helmet on a two-wheeler.
Twelve modern procedures are covered, each with its own rupee cap per policy year that rises with your Sum Insured. Three of them - bronchial thermoplasty, green or holmium laser vaporisation of the prostate, and intra-operative neuro monitoring - run up to the full Sum Insured. Every cap sits inside the Sum Insured, not on top of it.
Neither the automatic restoration nor the recharge benefit applies to modern treatments. Once a procedure's cap is used for the year there is no second pool for it - at ₹10 lakh Sum Insured robotic surgery stops at ₹3,00,000 and you pay the rest from your own pocket.
This plan does not pay a lump sum on the diagnosis of a critical illness.
This policy pays nothing for pre-existing condition, or for what it directly causes, until you complete 36 months of continuous cover. There is no rider that shortens the wait, and after 36 months the condition is paid only if you declared it when you applied.
The 36 months run from the date your first policy started, not from each renewal, so keep the cover running without a break. If you ported in from another insurer, the months you already served there are deducted from these 36.
Fourteen groups of common conditions - cataract, hernia, kidney and gall bladder stones, joint and spine surgery, piles, thyroid, prostate and more - are not paid for the first 24 months of continuous cover.
Cataract is on the list, so a lens replacement planned for next year is a bill you pay yourself. Even after the 24 months are served, cataract is paid only up to a per-eye limit and a per-policy-period limit set by your Sum Insured.
This plan does not pay for childbirth. Only two things stay covered: an ectopic pregnancy, and a miscarriage caused by an accident. There is no maternity add-on inside this product.
You pay the whole delivery bill yourself, normal or caesarean, and there is no add-on inside this product that buys the cover back.
Your newborn is covered from the 16th day after birth until the policy expires, up to 10% of the Sum Insured or Rs.50,000, whichever is less - so Rs.50,000 at every Sum Insured this plan sells. The mother must have held the cover for 12 unbroken months, and the payout comes out of the family's Sum Insured.
The first 15 days of your baby's life carry no cover, and after that Rs.50,000 is the ceiling for anything that is not an internal congenital condition. You pay the rest of a newborn hospital bill from your own pocket.
This plan pays only when you are admitted to hospital. Doctor visits, tests and medicines you buy without being admitted are not covered.
The policy has no separate mental health section and excludes no mental illness.
Your cover grows by 10% of the expiring Sum Insured at every renewal, up to a maximum of 100%. The bonus is added even in a year you claimed. At that rate it takes ten unbroken renewals to double the cover, and if a claim uses part of the bonus, only the balance carries forward.
The bonus is added only if you renew on time or within the grace period - a break in cover loses what you have built up. This is a family floater, so the bonus sits in one pot for everyone named in the policy.
This policy has no aggregate deductible option. There is no version where you pay the first fixed amount of a year's medical bills yourself in return for a lower premium. The only cost-sharing you can choose is a voluntary co-payment of 10% or 20% on every claim, which earns a matching premium discount.
52 named illnesses wait 24 months accidents from day 1 read by 10 body regions about 5 min
How long you wait, for what
Covered from the first day, with no waiting at all.
After the first month, ordinary illness is covered.
Each one is then covered, like any other illness.
Conditions you declared when you bought the plan.
After this, only proven fraud can be held against a claim.
Already diagnosed with one of these? A different rule applies - conditions you already have follow the pre-existing waiting period.
Eye lens clouding (Cataract)
Head & Face
A clouding of the eye lens that makes vision blurry.
“Treatment of Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast.”
Section III – Exclusions · Standard Exclusions · 2. Specified disease / procedure waiting period - Code Excl 02 · f. List of specific diseases/procedures · pages 28–29
High eye pressure (Glaucoma)
Head & Face
Increased pressure inside the eye that can harm vision.
“Treatment of Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast.”
Section III – Exclusions · Standard Exclusions · 2. Specified disease / procedure waiting period - Code Excl 02 · f. List of specific diseases/procedures · pages 28–29
Retina tearing
Head & Face
A serious eye problem where the back layer of the eye pulls away.
“Treatment of Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast.”
Section III – Exclusions · Standard Exclusions · 2. Specified disease / procedure waiting period - Code Excl 02 · f. List of specific diseases/procedures · pages 28–29
Retina problems
Head & Face
Diseases affecting the back screen of the eye which is crucial for seeing.
“Treatment of Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast.”
Section III – Exclusions · Standard Exclusions · 2. Specified disease / procedure waiting period - Code Excl 02 · f. List of specific diseases/procedures · pages 28–29
Sinus and nasal allergy
Head & Face
Swelling inside the nose and face bones causing blockage or pain.
“Treatment of Cataract and diseases of the anterior and posterior chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast.”
Section III – Exclusions · Standard Exclusions · 2. Specified disease / procedure waiting period - Code Excl 02 · f. List of specific diseases/procedures · pages 28–29
12 never paid 9 paid only if a condition is met 15 in every policy read from all 36 under a minute
No waiting period reaches these - the plan does not cover them at all.
A disease you declared can be listed on your own policy schedule as a permanent exclusion, with your consent. No waiting period ends it and no renewal removes it. Read your schedule, because this exclusion is personal to you and appears nowhere else in the policy.
Existing disease/s, disclosed by the Insured and mentioned in the policy schedule under Permanent Exclusion (based on Insured's consent) - Code Excl 38
policy PDF p.32 item 35, Code Excl 38
If the insurer judges that the admission did not need to happen, it refuses the whole claim, not part of it. Keep the treating doctor's reasons for admitting you on the file.
Any hospitalization which are not medically necessary / does not warrant hospitalization - Code Excl 36
policy PDF p.32 item 33, Code Excl 36
An admission for recovery, weakness or a nutritional deficiency is not paid, and this plan has no convalescence lump sum either. If an elderly patient is kept in hospital after the acute treatment has finished, you pay for those days from your own pocket.
Convalescence, general debility, run-down condition, Nutritional deficiency states - Code Excl 21
policy PDF p.32 item 21, Code Excl 21
If the treatment could have been given without admitting you, this plan treats the admission as unwarranted and does not pay the hospital bill. You pay for it yourself.
Any hospitalization which are not medically necessary / does not warrant hospitalization - Code Excl 36
policy PDF p.32 item 33, Code Excl 36
Seven therapies are excluded by name, including hyperbaric oxygen therapy, which hospitals routinely offer for a diabetic foot ulcer that will not heal, and chelation therapy. The clause also excludes "such other therapies similar to those mentioned herein", so the insurer can refuse a therapy that is not on the list if it judges that therapy similar.
Expenses incurred on Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low level laser therapy, Photodynamic therapy and such other therapies similar to those mentioned herein under this exclusion - Code Excl 26
policy PDF p.32 item 25, Code Excl 26
Insurance may not pay for general caretaking. Staying at a facility just to rest is not covered. Hiring helpers for daily tasks like walking or dressing may also be paid from your own pocket.
Rest Cure, rehabilitation and respite care - Code Excl 05: Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes: 1. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons 2. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs
policy PDF p.30 item 5, Code Excl 05
The exclusion list does not end with the thirty-five clauses printed in this policy. One clause points to www.starhealth.in for "Other Excluded Expenses", and when your hospital bill is settled those items are taken off the claim as well. Ask the insurer for that list before you are admitted, so you know which costs you will pay from your own pocket.
Other Excluded Expenses as detailed in the website www.starhealth.in - Code Excl 37
policy PDF p.32 item 34, Code Excl 37
One clause excludes the equipment people take home: walkers, crutches, wheelchairs, CPAP and BiPAP machines for sleep apnoea, and infusion pumps. Continuous Ambulatory Peritoneal Dialysis is named in the same list, so home dialysis equipment is not paid either. The clause ends with "and such other similar aids", so the list is not fixed and you pay for these items yourself.
Cost of spectacles and contact lens, hearing aids, Cochlear implants and procedures, walkers and crutches, wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar aids - Code Excl 35
policy PDF p.32 item 32, Code Excl 35 (second half of a compound clause; the spectacles and hearing half is captured under X-VISION-AIDS)
Spectacles, contact lenses and hearing aids are not paid for, even on a prescription. Cochlear implants and the procedures for them are named in the same clause. This plan has no vision or hearing benefit, so you pay for all of it from your own pocket.
Cost of spectacles and contact lens, hearing aids, Cochlear implants and procedures, walkers and crutches, wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis, infusion pump and such other similar aids - Code Excl 35
policy PDF p.32 item 32, Code Excl 35 (first half of a compound clause; the equipment half is captured under X-DME)
PRP and intra-articular injections are excluded outright, and this plan has no interventional pain benefit that pays for them instead. These are among the most common treatments offered for knee and joint pain from the mid-forties on, so if you need one, you pay for it from your own pocket.
Autologous derived Stromal vascular fraction, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy - Code Excl 28
policy PDF p.32 item 27, Code Excl 28
Birth defects visible on the outside of the body are never paid for anyone on the policy, and the newborn benefit does not cover them either. Internal birth defects are different: for everyone else, they are paid only after the 24-month specified-disease waiting period. For a baby born on the policy, the plan removes Excl 01, Excl 02, Excl 03 and the ₹50,000 newborn sub-limit, so an internal congenital condition is paid up to the Sum Insured from the sixteenth day of life.
Congenital External Condition / Defects / Anomalies - Code Excl 20
policy PDF p.32 item 20, Code Excl 20; New Born Baby cover at Coverage II.19, policy PDF pp.17–18
Standard health policies may not cover the costs of pregnancy or childbirth. Normal deliveries and C-sections are excluded. The usual exception is an ectopic pregnancy; where a policy pays maternity as a benefit, its own wording says so.
Maternity - Code Excl 18 i. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy Period
policy PDF p.31 item 18, Code Excl 18
Written as exclusions, but the policy states a way in. The condition is the whole point.
Paid when the same drug is given as an in-patient, where it is clinically indicated and hospitalisation is warranted.
Biologic drugs for rheumatoid arthritis, psoriasis, inflammatory bowel disease and many cancers are usually given as day-care or outpatient infusions. This plan pays for them only if you are admitted as an in-patient and the admission is clinically indicated. These are among the most expensive medicines people claim for.
Biologicals, except when administered as an in-patient, when clinically indicated and hospitalization warranted - Code Excl 29
policy PDF p.32 item 28, Code Excl 29
In a life-threatening situation or following an accident, expenses up to the stage of stabilisation are payable - that far and no further, not the complete claim.
Insurance companies have a list of banned hospitals and doctors. If you go to them, your claim may be rejected. The exceptions are a life-threatening emergency or an accident - and even then the policy pays only up to the point you are stabilised.
Excluded Providers - Code Excl 11: Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.
policy PDF p.31 item 11, Code Excl 11
Diagnostics that are related or incidental to the diagnosis and treatment you were actually admitted for stay covered.
Health insurance pays for actual medical treatments. If you stay in a hospital purely for diagnostic tests or scans, the bill may not be covered. There must be an active treatment going on.
Investigation & Evaluation - Code Excl 04 A. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded B. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded
policy PDF p.30 item 4, Code Excl 04
Paid when a medical practitioner prescribes them as part of a hospitalisation claim or a day care procedure.
General vitamins and supplements are not covered. You may have to pay for them yourself. Insurance may only pay if a doctor strictly prescribes them during a hospital stay.
Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure - Code Excl 14
policy PDF p.31 item 14, Code Excl 14
Paid for reconstruction following an accident, burns or cancer, or as part of medically necessary treatment to remove a direct and immediate health risk - with the attending Medical Practitioner's certificate.
Surgeries done just to look better are excluded. However, plastic surgery needed after a bad accident may be covered. Surgeries for burns or cancer reconstruction are also covered.
Cosmetic or plastic Surgery - Code Excl 08: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
policy PDF p.30 item 8, Code Excl 08
Paid only when BOTH are true - an accidental injury caused it AND it needs hospitalisation. There is then no sub-limit; the claim runs to the Sum Insured.
Dental treatment is paid only when both are true: an accidental injury caused it, and it needs hospitalisation. If an illness makes a filling, a root canal, a crown or an extraction necessary, you pay for it yourself. Dental implants are never paid, even after an accident.
Dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization (Dental implants are not payable) - Code Excl 32
policy PDF p.32 item 30, Code Excl 32
At 7.5 dioptres or worse, the correction is paid.
Surgeries to remove your glasses are usually not covered. They are seen as a cosmetic choice. The policy pays only when your eyesight is very weak - 7.5 dioptres or worse.
Refractive Error - Code Excl 15: Expenses related to the treatment for correction of eyesight due to refractive error less than 7. 5 dioptres.
policy PDF p.31 item 15, Code Excl 15
Paid when all four conditions hold together: the surgery is on the doctor's advice, it is supported by clinical protocols, the member is 18 or older, and Body Mass Index is 40 or more - or 35 or more alongside obesity-related cardiomyopathy, coronary heart disease, severe sleep apnoea or uncontrolled Type 2 diabetes, after less invasive weight-loss methods have failed. There is no separate bariatric benefit in this plan; a qualifying surgery is paid as ordinary hospitalisation.
The policy pays for weight-loss surgery only when your doctor advises it, you are 18 or older, and your BMI is 40 or more - or 35 or more together with a condition like heart disease, severe sleep apnoea or uncontrolled diabetes. Surgery to change how you look is not covered.
Obesity / Weight Control - Code Excl 06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions; A. Surgery to be conducted is upon the advice of the Doctor B. The surgery/Procedure conducted should be supported by clinical protocols C. The member has to be 18 years of age or older and D. Body Mass Index (BMI); 1. greater than or equal to 40 or 2. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss: a. Obesity-related cardiomyopathy b. Coronary heart disease c. Severe Sleep Apnea d. Uncontrolled Type2 Diabetes
policy PDF p.30 item 6, Code Excl 06
Fertility treatment IS paid, under Coverage II.18 - intra-uterine insemination, ICSI, IVF and TESA/TESE for sub-fertility, and an admission is not required. The gates: Sum Insured of ₹5,00,000 and above only; a 36-month wait from first inception; both spouses insured continuously without break; and a cap of ₹1,00,000 at ₹5,00,000 Sum Insured or ₹2,00,000 from ₹10,00,000 upward, for each block of 36 months rather than each year. Left outside: surrogacy, cryopreservation and storage, selective termination of an embryo, reversal of voluntary sterilisation, fertility-enhancing surgery, and treatment for a second or later pregnancy where a child from an earlier delivery is alive.
Medical costs for family planning are not covered. This means the policy may not pay for treatments to prevent pregnancy. It also may not pay for treatments to get pregnant.
Sterility and Infertility - Code Excl 17: Expenses related to sterility and infertility. This includes; a. Any type of contraception, sterilization b. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI c. Gestational Surrogacy d. Reversal of sterilization Note: Except to the extent covered under Coverage II. 18
policy PDF p.31 item 17, Code Excl 17; positive cover at Coverage II.18, policy PDF pp.16–17
7 just for qualifying 1 cost you a co-pay about 4 min
Only on a 2-year policy term - there is no 3-year option
At renewal only if the policy was first bought online and is renewed online
You pay 10% or 20% of every claim amount yourself, on each and every claim across eleven of the policy's coverages.
99.06% claims settled 14,000 cashless hospitals 2.21 solvency under a minute

10 comparisons, every clause that differs under a minute
Sources
Everything on this page is read from the insurer’s own filings. It is an educational summary - not advice, not a recommendation to buy, and we sell nothing.
Plan facts last updated 9 Sept 2026.
IRDAI UIN: SHAHLIP26046V092526
2 documents we read this from under a minute
Sum Insured, bonus and extra pools only. Room rent, co-pay and other limits are separate rules, not in these figures.
Star Health and Allied Insurance began operations in 2006 as India's first standalone health insurance company (SAHI). Headquartered in Chennai, it runs an in-house claims settlement model rather than relying on third-party administrators, and is the market leader in retail health insurance in India. It has been listed on the NSE and BSE since 2021.
99.06%
of claims settled, counted by number of claims
66.47%
share of premium paid back out as claims
2.21
capital cushion held - IRDAI floor is 1.5
14,000+
where claims can be settled without you paying first
Every insurer sits inside the same regulated safety net. You are never left with only the insurer's answer.
Raise it with Star Health
Escalate to IRDAI - Bima Bharosa
Insurance Ombudsman