Overview
Star Special Care Gold is a specialized health insurance policy tailored for individuals with disabilities (as per The Rights of Persons with Disabilities Act, 2016) and those with HIV/AIDS. It offers coverage up to ₹5 lakhs, with no pre-policy medical check-up required. It covers room, boarding, and nursing expenses, ICU charges, surgeon fees, anesthesia, and modern and AYUSH treatments.
Experts Review
Written by Nikhil Nair
Senior Writer
The Star Special Care Gold policy is designed to provide health coverage for individuals with disabilities (40% or more) and those with HIV/AIDS. It covers a wide range of medical needs, including inpatient care, surgeon fees, and even modern treatments like robotic surgeries up to 50% of the sum insured.
The plan’s key inclusions span AYUSH treatments and coverage for cataract treatments (up to ₹40,000 for each eye in one policy year). From a HIV/AIDs coverage standpoint, the Star Special Care Gold pays out 100% of the sum insured as a lump sum amount if the CD4 count of the insured falls below 150. That said, the plan comes with several restrictions on coverage, such as a 20% copayment and room rent limits.
Pros
Insurer has a solid track record with great claim and service metrics.
Offers HIV/AIDS & Disability Support, which makes this policy stand out.
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
Pre existing diseases waiting
STANDOUT
If you are already dealing with HIV/AIDS, then the insurer will cover you after 90 days. For Pre-Existing Disability, you will be covered after 2 years. However, if you are dealing with other pre-existing diseases including thyroid and cardiovascular problems, then you’ll have to wait 3 years before they start covering these complications.
HIV/AIDS & Disability Support
STANDOUT
This is a specially designed policy for individuals diagnosed HIV/AIDS or having disabilities (40% or more).
Co-payment
The policy will only cover 80% of the final bill. The rest is on you. They call this a co-payment.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have 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.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Convalescence, general debility, run-down condition, Nutritional deficiency states
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 therapies similar to those mentioned herein under this exclusion
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.
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.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
Y
Yash Varma
No pre-policy medical check-up is a huge relief for people with disabilities or HIV/AIDS.
Z
Zara Ahluwalia
Coverage up to ₹5 lakhs is good for a specialized plan like this. Provides decent financial backing.
K
Kabir Bedi
ICU charges, surgeon fees, and anesthesia all covered. Makes a big difference in hospital bills.
J
Juhi Kadam
Added benefits are mentioned as restricted, which makes me cautious about the actual out-of-pocket.
G
Gauri Handa
Several restrictions on coverage and added benefits. One has to read the fine print very carefully.
O
Ojaswini Eapen
Cataract treatment coverage up to ₹40,000 per eye is a practical benefit for many.
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Frequently Asked Questions
Does Special Care Gold 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.
- HIV & Disability Waiting Period: There's a 90-day waiting period for HIV/AIDS and 2-year for Pre-Existing Disability.
Does Special Care Gold have room rent restrictions?
Does Special Care Gold offer a restoration benefit?
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