Overview
The Star Health Premier plan is a health insurance policy specifically designed for individuals aged 50 years and above, with coverage of up to ₹1 crore. It provides extensive benefits, including inpatient hospitalization, pre- and post-hospitalization expenses for 60 & 90 days respectively, AYUSH treatments up to the cover amount, home care treatment (10% of the base cover amount up to ₹5 lakhs), and coverage for modern procedures like robotic surgeries and oral chemotherapy (up to 50% of the sum insured). The plan also includes outpatient medical expenses (payable from day 1 up to ₹10K, depending on Base SI)and hospice care (up to 10% of the sum insured, subject to a maximum of Rs. 5 lakhs payable once in the lifetime for each Insured person), making it one of the few options catering to senior citizens with OPD benefits. In case you’re interested, here’s a complete list of the modern treatments that are covered under this policy: Uterine artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy - Monoclonal Antibody to be given as injection, Intra Vitreal injections, Robotic surgeries, Stereotactic radio surgeries, Bronchial Thermoplasty, Vaporisation of the prostate (Green laser treatment or holmium laser treatment), IONM (Intra Operative Neuro Monitoring), Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions.
Experts Review
Written by Nikhil Nair
Senior Writer
The Star Health Premier plan is a thoughtful offering for senior citizens, providing a wide array of benefits tailored to meet their healthcare needs. One of its standout features is the inclusion of outpatient medical expenses, which is rare in senior citizen plans. Additionally, the plan covers modern treatments (up to 50% of the base cover amount) and non-medical consumables during hospitalization, ensuring comprehensive protection. The availability of home care treatment (10% of the base cover amount up to ₹5 lakhs) and hospice care adds value for individuals requiring extended or palliative care.
Despite these advantages, the plan has notable limitations. Room rent restrictions (1% of the cover amount or ₹20,000 per day, whichever is less) may limit flexibility during hospitalization, especially for higher sum insured options. Sub-limits on cataract surgeries (₹50,000–₹1 lakh depending on the sum insured) could lead to out-of-pocket expenses for policyholders requiring such procedures.
Furthermore, the mandatory co-payment of 20% for individuals aged 66 years and above can be financially burdensome during claims. While the plan does not require pre-medical screenings for enrollment, its claim settlement ratio (83% average from 2021-24) raises concerns about operational efficiency compared to competitors.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
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
Out Patient Department
STANDOUT
In the event, you are feeling sick and you want to visit your family physician for a general checkup, the insurer will cover the costs, up to a certain limit.
Co-payment
If you bought this policy after you turned 66, 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 maximum up to ₹20,000 per day. 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 just 2 years. It’s probably the best deal you can get to be honest.
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.
Cataract and other disorders of lens and retina
Hysterectomy for menorrhagia, fibromyoma, prolapse of uterus, or myomectomy for fibroids (unless necessitated by malignancy)
Surgery of hernia
Surgery of hydrocele
Benign ear, nose, and throat (ENT) disorders and surgeries (including tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
Maternity benefits not offered.
Customer Reviews
M
Malti Devi
OPD expenses coverage is a lifesaver for seniors! Finally, a plan that covers doctor visits.
S
Suresh Kumar
Home care treatment up to 5 lakhs is a great benefit for recovery at home. Very practical.
U
Usha Rani
Hospice care inclusion is very thoughtful for end-of-life care. Shows compassion.
M
Mohan Lal
Sub-limits on cataract surgery are a bit low. Had to pay extra.
V
Vinod Sharma
Room rent limit of ₹20,000 per day can be restrictive in major city hospitals for higher SI.
R
Rajendra Prasad
AYUSH treatments are covered, which is good for those who prefer alternative therapies.
A
Anil Kapoor
Specifically designed for individuals aged 50+, which is great as it caters to our needs.
D
Dimple Kapadia
Coverage up to ₹1 crore is very comprehensive for this age group.
J
Jackie S (new)
Outpatient medical expenses covered is a huge benefit, not many plans offer this.
S
Shakti Kapoor
Need to check co-payment clauses, as they are common in senior citizen plans.
M
Mithun C (new)
Star Health's claim settlement ratio and customer service can be a concern.
S
Sanjay Dutt
Star Health is a known name, and this Premier plan seems to offer good value for seniors.
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Frequently Asked Questions
Does Health Premier 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
Does Health Premier have room rent restrictions?
Does Health Premier offer a restoration benefit?
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