Overview
The Star Health Gain plan is a health insurance policy offering flexible sum insured options from ₹1 lakh to ₹5 lakhs, available on an individual or family floater basis. The plan features a 30-day waiting period for general illnesses and a 36-month waiting period for pre-existing diseases. Designed for those seeking basic health coverage with some outpatient benefits, it provides moderate protection at a relatively affordable premium.
Experts Review
Written by Nikhil Nair
Senior Writer
Star Health Gain is a plain vanilla health insurance plan that offers basic coverage with a sum insured capped at ₹5 lakhs, which may be insufficient for many urban medical expenses. Its USP includes limited outpatient consultation coverage at network hospitals, a feature not always available in entry-level plans. The policy allows flexibility in choosing the sum insured and family size, making it adaptable for small families or individuals.
However, the plan imposes a 36-month waiting period for pre-existing diseases like diabetes, which restricts early claim access for chronic conditions. The coverage ceiling is low compared to many competitors, and the plan lacks comprehensive add-ons, has room rent restrictions, lacks restoration benefits, or offers no-claim bonuses that enhance value. Premiums are not significantly lower than similar plans, reducing cost-effectiveness.
Operationally, Star Health’s average claim settlement ratio is 83%, with a high complaint volume and claim rejection rate, reflecting ongoing challenges in claims processing and customer service. Potential buyers should be cautious and consider the insurer's reputation alongside policy features.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
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
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. But in the event, you breach this limit, get ready to pay a lot more.
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 - 30 days before you are hospitalized and 60 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 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.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs 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.
Benign ENT disorders
Tonsillectomy
Adenoidectomy
Mastoidectomy
Tympanoplasty
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
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
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Frequently Asked Questions
Does Health Gain 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 Health Gain have room rent restrictions?
Does Health Gain offer a restoration benefit?
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