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Plan Overview

Star Special Care is a specialized health insurance plan designed for children aged 3 to 25 years diagnosed with Autism Spectrum Disorder. It aims to provide comprehensive coverage tailored to the unique healthcare needs of these children.

Policy Details

  • Policy Term: 1 year
  • Sum Insured: Rs. 3,00,000/-
  • No pre-acceptance medical check-up required, though prior treatment records need to be submitted.

Coverage Highlights

  • Room, boarding, nursing expenses up to Rs. 5,000/- per day
  • Shared accommodation benefits with specified limits
  • Surgeon, anesthetist, medical practitioner, consultancy fees
  • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines
  • Emergency ambulance charges up to Rs. 750/- per hospitalization
  • Post-hospitalization expenses up to 7% of hospitalization costs or actuals incurred up to 60 days after discharge
  • Coverage for all day-care treatments
  •  

Specific Treatment Sublimits

  • Adeno Tonsillectomy: Rs. 25,000/-
  • Hospitalization for treatment of seizures: Rs. 30,000/-
  • Hospitalization for fracture surgery: up to 20% of sum insured
  • Botox injections (inpatient only): Rs. 5,000/- per sitting, max Rs. 20,000/-
  • Behavioral, Physiotherapy, Occupational, and Speech Therapy (including outpatient): Up to Rs. 1,500/-

Co-payment & Waiting Periods

  • 20% co-payment on each claim
  • Waiting periods:
  • 30 days standard waiting period
  • 24 months for specified illnesses/diseases/treatments
  • 48 months for pre-existing diseases (autism not considered pre-existing)

Exclusions

  • Circumcision, vaccinations (except post-bite treatment)
  • Congenital defects, cerebral palsy, genetic abnormalities
  • Dental treatments except due to accidents requiring hospitalization
  • Cosmetic surgery, weight control treatments, Lasik surgery
  • Psychological/psychiatric treatments without indication
  • Non-allopathic treatments
  • Expenses for non-medically necessary hospitalizations
  • And several others as specified in the policy document

Renewal & Portability

  • Renewable up to 25 years of age
  • Portability available with prior application before renewal

Claims Process

  • 24-hour helpline for assistance
  • Cashless hospitalization at network hospitals
  • Reimbursement with supporting documents at non-network hospitals

Additional Benefits

  • Direct in-house quick claim settlement with no TPA involvement
  • Tax benefits under Section 80D of the Income Tax Act

Important Notes

  • Free look period of 15 days available for policy review after receipt
  • Grace period of 30 days for renewal to maintain benefits continuity
  • Cancellation and refund rules detailed in the policy
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