What is restoration benefit in health insurance?
Restoration benefit in health insurance - Importance, types and points to note before claim.
By Pazcare
July 11, 2022
Claim settlement ratio (2019-20)
78.62%
Network hospitals
12,000+
TPA
In-house TPA
Total GHI lives insured (2020-21)
30.9 lakhs
Total GHI claims incurred (2020-21)
₹717 crores
Star group health insurance is a corporate health insurance product of Star Health and Allied Insurance Company Limited. The insurer provides insurance products for health, personal accidents and overseas travel insurance. Star Health insurance is also into bancassurance with various banks.
With Pazcare, your Star group health insurance policy gets better. We will get you the best-in-class group health insurance quotes for your employees at the best prices. Moreover, the HR/Admin can administer the Star group health insurance in one place using our tech-enabled Pazcare dashboard. This Pazcare dashboard can also be integrated with the HRMS tools.
These simple steps allow you to purchase Star group health insurance online at Pazcare.
For further information and queries, write to us at support@getpaz.com or call our customer care at +91 78291 11300.
The Star group health insurance has 2 plan types. They are
It is a comprehensive corporate medical insurance plan. The sum insured starts from rs. 1 lakh and goes upto Rs 10 lakhs. Pre-hospitalisation expenses of upto 30 days prior to the date of hospitalisation and post-hospitalisation expenses upto 60 days after hospitalisation is covered in this policy. However, this plan has certain limitations on covering the room rent and other expenses. Further, this policy has a waiting period to cover pre-existing diseases.
Star group health insurance plan is a fully customisable corporate medical insurance policy. The employer can customise the limits of cover like the room rent limits, pre-hospitalisation cover, post-hospitalisation cover, etc. Additionally, the sum insured can be decided according to the needs of the employees and the prescribed limit is upto Rs 1 crore. This plan can be purchased with or without the waiting period according to the needs of the organisation.
With more than 25 health insurance players in the insurance market, here is why you have to choose the Star group health insurance from Pazcare.
Easy claim settlement with In-house TPA
With a Star group health insurance policy, you do not have to depend on the external TPA. The claim settlement is done quickly with their in-house claim settlement team.
12,000+ cashless hospitals
With 12,000+ cashless network hospitals, Star group health insurance company has a large network of cashless network hospitals in India. This means a cashless treatment facility is available to you near your geographical location.
Higher claim settlement ratio
The claim settlement ratio of Star group health insurance is 78.62% for the year 2019-2020. A higher claim settlement ratio indicates that Star group's health insurance policy is more reliable and more credible.
No medical screening
Unlike your retail health insurance policy, the Star group health insurance policy does not require a medical check-up before the policy purchase.
Star health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled by the insurer to the number of claims requested by the policyholders in a financial year by the health insurance company. Hence, a CSR ratio can be calculated as
All health insurance companies have a huge list of cashless network hospitals, where the policyholders can claim cashless treatment. Star group health insurance has around 12,000+ network hospitals located in pan India. Hence, higher the chances of finding a cashless network hospital near your geographical location.
Star group health insurance cashless claim
With Star group health insurance you can make a cashless claim using the following steps.
The TStar group health insurance cashless claim facilities are available at a network hospital only. Hence, get to the nearest network hospital for treatment.
Confirm your identity using the Star group health insurance ID card or policy number, a valid photo ID like an Aadhar card, voter ID, driving license, etc and the company ID at the hospital’s TPA desk.
Submit the pre-authorization form to Star group health insurance. For emergency hospitalization, the form is submitted within 48 hours of hospitalisation. In the case of planned hospitalisation, it is submitted 3 days before the hospitalisation. The TPA desk will help you with the process
After the form submission, Star group health insurance will review the cashless claim request and the network hospital will be notified about the claim.
Once verified and the Star group health insurance company accepts your claim request. The claim is settled directly at the network hospital according to the terms and conditions of your policy.
Star group health insurance reimbursement claim
In case you get hospitalised at a non-network hospital, the reimbursement claim from Star group health insurance can be carried out by the following steps.
The first step is to inform Star group health insurance company about the hospitalisation. In case of emergency hospitalisation, intimate within 48 hours and in case of a planned hospitalisation inform at least 3 days before the hospitalisation.
After you get treated at a non-network hospital, settle all the hospital bills and pharmacy bills out of your pockets at the non-network hospital.
After you settle all the bills, make sure you have all the original copies of all the required documents to file for the Star group health insurance reimbursement claim.
The documents required to file Star group health insurance reimbursement claim are
After collecting all the relevant documents, submit them to the Star group health insurance company.
Once the documents are submitted, the Star group health insurance company will review your documents and reject or approve the reimbursement claim request.
You can also contact us at support@pazcare.com, to guide you through the whole process of Star group health insurance reimbursement claim process. We provide 24X7 claim assistance for your employees.
The Star group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Star group health insurance plan.
Step 1: Firstly, get in touch with Pazcare. Submit a basic form containing details like your name, name of the company, the number of employees you wish to insure, work email address and phone number to renew your Star group health insurance policy.
Step 2: Once the form is submitted, our consultants will get in touch with you. Since this is not a fresh policy, you will have to submit the following documents to renew your Star group health insurance plan for employees.
Step 3: You can choose additional add-ons and riders to your existing policy like dental insurance riders, maternity insurance riders to your existing Star group health insurance policy.
Step 4: Our consultants will get back to you with the competitive quotes for your Star group health insurance.
Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Star group health insurance policy. The policy will be usually valid for a year after the renewal.
Step 6: In case, you are purchasing your Star group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this period, our associate will get in touch with you and provide you with all the essential information to get started with your group health insurance.
We make sure that your Star group health insurance experience will be seamless using our Pazcare dashboard.
The Star group health insurance premium is calculated based on certain factors. They are
Average age of the insured
The Star group health insurance premium is calculated based on the average age of the people insured. The younger the age, the lower the premium. This is because according to the insurance companies the younger generation poses lesser health risks.
Type of plan
Different types of Star group health insurance policies opted are employee only (E), employee+spouse+children (ESC) and employee+spouse+children+parents (ESCP) plans. The number of people covered under the ESCP plan is more than the ones covered in the E plan, this means that the premium will be higher.
Nature of the job
The nature of the job one performs is also a factor considered to decide the annual premium of your Star group health insurance policy. Jobs associated with high risks will have a higher premium compared to the lower-risk jobs.
Sum insured
It is the maximum amount that an insurance company will pay you in case of any hospitalisation in a particular financial year. So the higher the sum insured, the higher the premiums paid towards the Star group health insurance policy.
Riders opted
The riders opted for, say maternity insurance riders, dental insurance riders along with the existing Star group health insurance policy will increase your premium.
Your Star group health policy is tailor-made according to your preferences. Here is what it covers.
Pre-existing diseases
Your policy will cover all of your pre-existing diseases from diabetes, cancer, asthma, hypertension, etc from day 1 of your Star group health insurance policy coverage. This means there is no waiting period.
Pre and post-hospitalisation expenses
With Star group health insurance cover your pre and post-hospitalisation expenses are covered. The number of days to offer coverage can be customized in your Star group health insurance plan.
Maternity-related expenses
By opting for a maternity insurance rider with your existing Star group health insurance plan, you can cover the maternity-related expenses for a normal and c-section delivery.
Covid -19 coverage
The Star group health insurance policy covers all hospitalisation expenses related to Covid-19.
Accidental hospitalisations
In case of any hospitalisation expenses due to accidents, your Star group health insurance covers these. But these hospitalisations must be for more than 24 hours and coverage is limited to India only.
Cosmetic treatments
Cosmetic treatments like plastic surgery, liposuction, and botox are not generally covered in your Star group health insurance plan.
Gender-changing surgeries
Expenses due to gender-changing treatments or surgeries are excluded from your Star group insurance policy.
Self-harm injuries
Injuries due to self-harm, like suicide and hospitalisation expenses for the same are not covered in this Star group health insurance policy.
Treatments for substance abuse
Treatment expenses due to substance abuse like drugs or alcohol are exempted from coverage in your Star group health insurance plan.
Pre-existing diseases covered
With Star group health insurance, all your pre-existing diseases are covered from day 1 of the policy purchase. It means there is no waiting period to cover pre-existing illnesses like diabetes, asthma, hypertension, etc.
Tailor-made policy
Star group health insurance is a tailor-made group health insurance plan according to your company's needs. You can choose the type of policy, sum insured, or any other add-ons you require from the options given.
Easy and quick claims process
With an in-house claim settlement team in place for your Star group health insurance your claims can be processed at a faster pace as the external TPAs are not involved.
Sum insured up to 1 Crore
Depending on the type of policy and the coverage you require, your sum insured can be decided up to Rs 1 crore. This means there is a scope to cover your medical treatment expenses without having to worry about exhausting the sum insured limit.
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The Star health group insurance for employees premium chart is calculated based on certain factors. Some are
The premium of Star Health group insurance is determined by factors like the number of employees working in your organization, their occupation, age, number of dependents covered, age of the dependents, and the type of cover opted.
Find the Star group health insurance hospital list based on your city here under the network hospitals section.
The Star Birla group health insurance claim settlement ratio for the years 2019-20 is 78.62 %.
The Star group health insurance customer care number is 044 43664666. You can also email them at support@starhealth.in.