
The family-stage plan - maternity, IVF and day-one newborn cover built in, where most policies charge extra or simply say no.
Two hospital bills in year one, on ₹10 Lakh of cover.
| Bill | Star Health Assure |
|---|---|
| 1st bill₹7,00,000 | CoveredPaid from Sum Insured ₹7,00,000 |
| 2nd bill₹12,00,000 | ₹2,00,000not coveredPaid from |
Tell us about your family and health - this list reorders around what matters to you.
Start the 90-second checkYour room entitlement rises with the Sum Insured. At Rs.5 lakh and Rs.7.5 lakh the room is capped at 1% of Sum Insured per day; from Rs.10 lakh you get any room except a Suite or above, and from Rs.50 lakh any room at all. If you take a room above your entitlement, the insurer cuts the same percentage off your room rent and associated medical expenses.
At Rs.5 lakh Sum Insured the room is capped at Rs.5,000 per day. A room above that triggers a proportionate deduction on the room and associated medical expenses, so a single upgrade can cost you tens of thousands of rupees on a large bill.
The consumables most insurers refuse - gloves, masks, syringes, nebulisation kits, ECG electrodes and the rest of the IRDAI List I - are paid whenever an in-patient or day care claim is admitted, up to the Sum Insured with no separate cap. These items often make up 10 to 20% of a hospital bill.
The cover runs off the admitted claim, so if the hospitalisation claim itself is rejected the consumables go with it.
Medical expenses for the 180 days after discharge are paid, up to the Sum Insured, with no separate rupee cap. A 180-day window is at the generous end of the Indian market and it applies at every Sum Insured.
Only expenses for the same condition that caused the admission count, and only if the in-patient claim was admitted. After a bypass or a joint replacement, that covers months of follow-up visits, physiotherapy and medicines.
Your Sum Insured refills automatically the moment you use part or all of it - up to 100% each time, an unlimited number of times in a policy year. The refilled amount pays only a later hospitalisation, not the bill that used up your cover, and a single claim under restoration is capped at your Sum Insured.
A relapse of the same illness within 45 days of your last consultation counts as the same hospitalisation, so the refill will not pay for it. Restoration also does not raise what one bill can be paid - your ceiling for a single claim stays your Sum Insured plus the bonus you have accrued.
This product has no extra cover sitting above your Sum Insured. The most one claim can be paid is your Sum Insured plus the cumulative bonus you have earned. The restoration benefit refills your cover, but only for a later hospitalisation, so it does not raise what a single bill can be paid.
One very large bill cannot be paid beyond your Sum Insured plus bonus. On ₹10,00,000 cover with no bonus earned yet, a ₹15,00,000 hospital bill leaves you paying ₹5,00,000 from your own pocket.
The twelve modern treatments in the standard IRDAI list, including robotic surgery, oral chemotherapy and stem cell therapy for bone marrow transplant, are covered up to the full Sum Insured. There is no separate rupee or percentage sub-limit, which is unusual - most Indian plans cap these procedures well below the Sum Insured.
Cover applies wherever the procedure is medically indicated, as in-patient or day care, and the pre and post hospitalisation expenses for it are included in the same Sum Insured.
This policy does not pay a lump sum on diagnosis of a critical illness. It is an indemnity plan - it pays your hospital bills as they are incurred. The prospectus names one add-on cover, Star Flexi, but its terms are not part of these documents.
Conditions you already had before buying are not paid for the first 36 months of continuous cover. On a 3-year policy term the wait is 30 months. After the wait, a pre-existing condition is paid only if you declared it in the proposal and the Company accepted it. Raising your sum insured later starts the wait again on the increase.
A pre-existing condition you did not declare is not paid even after the 36 months are over.
Fourteen groups of common conditions and procedures - cataract, ENT and thyroid disease, hernia, gallstones and kidney stones, joint replacement, piles and varicose veins among them - are not paid for the first 24 months. Accident claims are paid without this wait. If one of these conditions is also pre-existing for you, the longer pre-existing wait applies instead.
The 24-month wait applies even to a listed condition you develop after buying the policy, and even if you declared it and the Company accepted it without a specific exclusion.
Delivery is covered up to 10% of your sum insured, and pre-natal and post-natal expenses sit inside that same 10%. You wait 24 months from the first policy, and both you and your spouse must have been covered for those 24 months. Only 2 deliveries are payable in a lifetime; later deliveries carry no fresh waiting period.
Pre-hospitalisation and post-hospitalisation expenses are not paid under this section, so tests before admission and follow-ups after discharge are paid by you. The 10% cap covers normal delivery and C-section together - on a ₹10,00,000 sum insured that is ₹1,00,000 for the whole delivery.
Your newborn is covered from Day 1 of birth, including congenital disorders, up to ₹2,00,000 on sum insured of ₹25,00,000 and below, and ₹4,00,000 above that. The pre-existing, specified-disease, 30-day and congenital-external waiting periods do not apply to the baby. Cover starts only if a delivery claim is paid or the mother has been covered for 12 continuous months.
If no delivery claim is paid and the mother has been covered for less than 12 continuous months, the newborn gets no cover at all. A NICU admission in the first weeks is then paid entirely by you.
Star Health Assure has no out-patient benefit. Doctor visits, tests and medicines taken without being admitted are not paid. Out-patient expenses appear in only two named covers - treatment of Chronic Severe Refractory Asthma by Advanced Medicine, and rehabilitation after an admissible in-patient claim - and both are scored under their own features, not as OPD cover.
If you want everyday doctor, pharmacy and diagnostic cover, this policy will not give it to you. Plan for those costs separately.
Star Health Assure carries no mental health benefit. Neither the policy nor the prospectus has a psychiatric or psychological treatment cover, and the Schedule of Benefits has no row for one. Psychiatric conditions are named once, and only to leave them out: home treatment under Domiciliary Hospitalisation does not pay for any psychiatric or psychosomatic disorder.
If someone in your family may need treatment for depression, anxiety or a similar condition, check this before you buy. The one place the policy names psychiatric disorders is a carve-out, not a benefit.
Every claim-free year adds 25% of your Sum Insured as bonus, up to a maximum of 100%. On ₹10,00,000 cover, four claim-free years take you to ₹20,00,000. A claim does not always cost you the bonus - it is cut only to the extent you actually use it.
The bonus is calculated on the expiring Sum Insured, so if you reduce your Sum Insured at renewal the bonus cannot exceed the reduced amount. Partial use of your Sum Insured leaves the bonus untouched.
You can choose an aggregate deductible of ₹50,000 or ₹1,00,000 when you buy, and pay 35% to 55% less premium depending on your Sum Insured. The company starts paying only after your claims in that policy year add up to the deductible you chose. The deductible starts again from zero every policy year.
52 named illnesses wait 24 months accidents from day 1 read by 10 body regions about 4 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.
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 C. Exclusions · 2. Specified disease/procedure waiting period – Code Excl 02 · pages 28–29
Ear skin cyst
Head & Face
A harmful, growing cyst inside the ear that needs to be removed.
“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 C. Exclusions · 2. Specified disease/procedure waiting period – Code Excl 02 · 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 C. Exclusions · 2. Specified disease/procedure waiting period – Code Excl 02 · pages 28–29
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 C. Exclusions · 2. Specified disease/procedure waiting period – Code Excl 02 · 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 C. Exclusions · 2. Specified disease/procedure waiting period – Code Excl 02 · pages 28–29
8 never paid 11 paid only if a condition is met 14 in every policy read from all 33 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 p.31 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
policy p.32 Excl 36
An admission for recovery, weakness or a nutritional deficiency is not paid. 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
policy p.31 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
policy p.32 Excl 36
Seven therapies are excluded by name, including hyperbaric oxygen therapy 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
policy p.32 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 (except to the extent covered under Coverage 26) and respite care – Code Excl 05: Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. 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
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs
policy p.30 · cl. Excl 05
Spectacles, contact lenses, hearing aids, cochlear implants, walkers, crutches, wheelchairs, CPAP and BiPAP machines are all excluded. Home peritoneal dialysis equipment is on the same list, and this plan's home-care benefit does not cover dialysis either, so you pay for home dialysis 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.
policy p.32 Excl 35
PRP and intra-articular injections are excluded outright. 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
policy p.32 Excl 28
Written as exclusions, but the policy states a way in. The condition is the whole point.
Paid when given as an in-patient, where clinically indicated. Coverage 14 separately pays for monoclonal-antibody therapy in severe refractory asthma including as an outpatient, and being the specific provision it should prevail.
Biologic drugs are paid only if you are admitted as an in-patient and the admission is clinically indicated. If the same drug is given to you in an outpatient chair, the insurer refuses it. These are among the most expensive medicines people claim for.
Biologicals, except when administered as an in-patient, when clinically indicated and hospitalization warranted.
policy p.32 Excl 29; tension with Coverage 14 p.14
In a life-threatening situation or after an accident, expenses up to the stage of stabilisation are payable.
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 p.31 · cl. Excl 11
Diagnostics related or incidental to the treatment you were 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.
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 p.30 · cl. Excl 04
Paid when prescribed by a doctor as part of a hospitalisation claim or 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 p.31 · cl. Excl 14
Paid for reconstruction following an accident, burns or cancer, certified as medically necessary.
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 p.30 · cl. Excl 08
Paid only when BOTH are true: an accident caused it, AND it needs hospital admission.
Dental treatment is paid only when both are true: an accident caused it, and it needs hospital admission. If an accident is treated as an out-patient, 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 p.32 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 eye sight due to refractive error less than 7.5 dioptres.
policy p.31 · cl. Excl 15
Paid on your doctor's advice, at 18 or older, with BMI 40 or more - or 35 or more with obesity-related cardiomyopathy, coronary heart disease, severe sleep apnoea or uncontrolled Type 2 diabetes, after less invasive weight-loss methods have failed.
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 p.30 · cl. Excl 06
Covered to the extent of this plan's New Born Baby cover (Coverage 18).
Birth defects visible on the outside of the body are not paid, except to the extent that this plan's New Born Baby cover pays for them. That exception is unusual, so check the limits of the newborn benefit itself.
Congenital External Condition / Defects / Anomalies (except to the extent covered under Coverage 18) - Code - Excl 20
policy p.31 Excl 20
ART IS covered under this plan's Coverage 17 - IUI, ICSI, IVF and TESA/TESE, capped at ₹1L / ₹2L / ₹4L by Sum Insured, one cycle per policy year, after a 24-month wait. Contraception, sterilisation, surrogacy and reversal of sterilisation stay out.
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 (Except to the extent covered under Coverage 17)
policy p.31; Coverage 17 pp.15–16 · cl. Excl 17
Delivery IS covered under Coverage 15, up to 10% of the Sum Insured, after a 24-month wait - normal or caesarean, plus pre-natal and post-natal care. Ectopic pregnancy sits outside the exclusion entirely and is paid as ordinary hospitalisation up to the full Sum Insured.
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 (Except to the extent covered under Coverage 15)
policy p.31; Coverage 15 · cl. Excl 18
5 just for qualifying 1 cost you a deductible about 2 min
On the 2nd (and 3rd) year premium only - year 1 is always full rate
One-time - not for renewal, migration or portability
Kept at renewal only if first bought online AND renewed online
Each policy year you pay the first ₹50,000 or ₹1,00,000 of claims yourself before the policy pays anything.
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: SHAHLIP26048V032526
3 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