Star Health Insurance Claims Procedure

Easy claims process and rapid reimbursement of incurred bills on treatments and medical expenses are the things that actually make a good health insurance plan even better. Along with a wide network of more than 5400 hospitals, Star Health & Allied Insurance also offers a very simple claims process that ensures that claimants and patients do not have any inconvenience when it comes to settling their bills.

Incurred Claim Ratio for Star Health Insurance:

Incurred claim ratios for health insurers are indicators of how well they are doing and if they have enough financial capability to address the valid claims that are being made. While this ratio is an indicator of the financial health of the insurer, it is also a measure of how lenient or strict an insurer is. The incurred claim ratio for Star Health Insurance is shown in the table below –

Incurred Claims Ratio of Star Health Insurance for the year 2016-17:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
1911.45 crore 1156.71 crore 60.51%

Incurred Claims Ration of Star Health Insurance for the year 2017-18:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
2739.60 crore 1692.02 crore 61.76%

Considering ICR (Incurred Claim Ratios), figures above 50% are indicators of good performance by health insurers. Claim ratios above 50% basically mean that the insurer isn’t rejecting even borderline claims and has enough funding to provide cover for all the policies that it has sold. This good ratio means that Star Health will not be in a tight fix when it comes to meeting claims.

Claim Scenarios:

Claim scenarios happen with cashless treatment as well as reimbursement cases. Both options for Star Health Insurance are mentioned in the following sections.

Cashless Treatment:

Network hospitals are the ones wherein cashless treatment can be availed under a health insurance plan. The bills generated in such cases are sent across to Star and the policyholder or the claimant doesn’t need to pay anything.

Procedure to File a Claim (Planned/Emergency Hospitalisation):

  1. Member card should be carried on person, or the policy number and member ID should be provided at the network hospital.
  2. Contact the number 1800 425 2255 / 1800 102 4477 in case of emergency or planned hospitalisation and fax the pre-authorisation form to the numbers 1800 425 5522.
  3. One would need to furnish personal details and policy ID or member ID to the hospital’s insurance desk and fill up the Pre-Authorisation form in the customer’s section.
  4. Once the balance details are filled up by the hospital, the Pre-Authorisation form will be faxed to Star.
  5. In case of planned hospitalization, the insurer should be informed 24 hours before being admitted to the hospital.
  6. In case of emergency hospitalization, the insurer should be informed within 24 hours of being hospitalized.
  7. The Star in-house medical team will review the case and documents received and intimate the guardian and hospital in case of approval, pending approval or rejection.
  8. In case of pending approval cases, Star will contact the hospital to furnish more details and in cases of rejection, a claim reimbursement process needs to be followed.

Claims Process for Cashless Treatment:

  1. Post the filling up of the pre-authorisation form, the requisite details will be verified by the hospital and the TPA
  2. A field doctor will be assigned to the policyholder to aid in the hospitalisation procedure
  3. Upon submission of the pre-authorisation form, all communications will be taken care of by Star pertaining to the settlement of the bill
  4. If in case some expenses are not covered or are beyond the scope of the policy, the same will be intimated to the patient before or post release from hospitalisation

Reimbursement of Treatment Expenses:

Treatments done at hospitals not within the network of Star Health Insurance and treatments which have not been approved for cashless mode can opt for reimbursements. The following process will need to be followed in such cases.

Procedure to File a Claim:

  1. The details required during this procedure will be the following –
    • Policyholder’s name
    • Claimant’s name and customer ID
    • Details of the hospital
    • Details of diagnosis and treatment
    • An approximation of the claim amount
    • Date of admission
  2. Collection of all related documents from the hospital to be done

Documents Required:

The claim form can be downloaded from Star’s website and along with the filled up form, the following documents need to be provided –

  1. The original copy of the claim form, fully filled and duly signed
  2. Government approved valid photo ID proof
  3. Referral letter from medical practitioner advising hospitalisation
  4. Letter from medical practitioner detailing the list of tests, medications and consultations if any
  5. Original copies of bills, receipts and discharge card from the hospital or the medical practitioner
  6. Original copies of bills or receipts from pharmacies or druggists involved
  7. Original copies of tests and reports done along with payment receipts
  8. Indoor case papers
  9. If applicable, the First Information Report and the Final Police Report
  10. Original copy of the post mortem report, if conducted

The above list of documents are the bare minimum necessities. Star Health might require additional documentation as and when needed.

The above mentioned list of documents and to be sent via post to the address at the office of Star General Insurance.

Claims Process for Reimbursement Cases:

Once the filled claim form along with the relevant documents is received by Star, the claims process is initiated and the following happens –

  1. The in-house medical team of Star reviews the case and documents received at the nearest Star Health office
  2. The case if approved, will cause the reimbursement of funds to be processed and the procedure will be completed within a week and a fortnight. Intimation of the same will be sent to the claimant
  3. In case the request has incomplete information, the same will be intimated to the claimant and requisite details will be requested to ensure claim resolution at the earliest

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GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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