Overview
The Star Family Health Optima plan is a comprehensive family floater health insurance policy designed to cover the entire family—including spouse, dependent children (up to 25 years), parents, and parents-in-law—under a single sum insured. It includes features such as automatic restoration of sum insured up to three times per policy year, loyalty bonuses, and coverage for assisted reproduction treatments, making it a robust option for families seeking affordable yet extensive health protection.
Experts Review
Written by Nikhil Nair
Senior Writer
The Star Family Health Optima plan is a fairly priced family floater policy providing wide-ranging coverage for multiple family members under one sum insured. Its key features include automatic restoration of the sum insured three times during the policy year on different ailments, a no-claim bonus of 10% of the cover amount, a loyalty bonus that can increase the sum insured by up to 100% (regardless of claims), and coverage for assisted reproduction treatments with defined limits.
The plan also offers coverage for newborns (provided if the mother is insured for 12 months without a break), including up to 10% sum insured or maximum of ₹50,000 as well as coverage up to sum insured for internal congenital diseases.
However, the policy imposes a three-year waiting period for pre-existing diseases, which may delay coverage for chronic conditions like diabetes. There is a mandatory co-payment of 20% for insured members aged 61 and above, increasing out-of-pocket expenses for senior family members. While premiums are generally competitive—often 10-15% lower than comparable family floater plans—the policy includes several sub-limits and conditions that require careful review before purchase.
Operationally, Star Health has an average claim settlement ratio of 83% for 2021-24, with a relatively high complaint volume and claim rejection rate, which could impact customer experience and claim processing speed.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
Maternity benefits offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
Star Health
Key Insights
Founded
2006
Star Health was established 19 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
85% claims settled in 30 Days
Star Health settles only 85% of claims it receives, which is relatively low and may raise concerns about reliability during claim payouts.
Network Hospitals
14,000+
Star Health has a strong network with over 14,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
52 complaints per 10,000 claims registered
Star Health has a relatively high volume of complaints, which may point to ongoing issues in customer service or claim handling.
Features
All
Great
Good
Bad
Co-payment
If you bought this policy after you turned 61, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for cataracts, modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
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 & other similar therapies
Autologous derived Stromal vascular fraction, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
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
Subcutaneous benign lumps (sebaceous cyst, dermoid cyst, mucous cyst lip/cheek, carpal tunnel syndrome, trigger finger, lipoma, neurofibroma, fibroadenoma, ganglion, and similar pathology)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
Maternity benefits offered.
Doctor consultations are not covered.
Customer Reviews
A
Akshay K (new)
Comprehensive family floater plan, covers all of us under one umbrella. Good for families.
T
Twinkle Khanna
Automatic restoration of sum insured by 100% is a great benefit for multiple claims in a year.
S
Shilpa Shetty
Assisted reproductive treatment covered after a waiting period, which is a rare and good feature.
A
Aishwarya Rai Bachchan (new)
The plan has many features, but the insurer's service reputation can be a concern.
J
Juhi C (new person)
Co-payment of 20% for insured persons above 60 years at entry is a significant drawback.
S
Sonali Bendre
Good network of hospitals for cashless treatment. Star Health is widely accepted.
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Frequently Asked Questions
Does Family Health Optima have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Family Health Optima have room rent restrictions?
Does Family Health Optima offer a restoration benefit?
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