Star Family Health Optima: what the policy wording covers
Family Health Optima (UIN SHAHLIP26046V092526) limits the room by sum insured: ₹2,000 a day at ₹1 to 2 lakh, ₹5,000 a day at ₹3 to 4 lakh, and a single standard AC room from ₹5 lakh. It restores the sum insured up to 3 times a year, but only for an unrelated illness. Anyone who joins at 61 or older pays 20% of every claim. Pre-existing diseases wait 36 months.
Room limit by sum insured
| Sum insured | Room the wording allows |
|---|
| ₹1 lakh and ₹2 lakh | Up to ₹2,000 a day |
|---|
| ₹3 lakh and ₹4 lakh | Up to ₹5,000 a day |
|---|
| ₹5 lakh to ₹25 lakh | Single standard AC room |
|---|
Restoration, bonus and other benefits
- Automatic restoration: up to 3 times a year at 100% each, for an illness unrelated to the earlier claims. Not for modern treatments. Only for sum insured of ₹3 lakh and above.
- Loyalty bonus: 10% of the sum insured a year, up to 100%, irrespective of claims (₹3 lakh and above).
- Assisted reproduction (sub-fertility) treatment after 36 months: up to ₹1 lakh at ₹5 lakh cover and ₹2 lakh from ₹10 lakh, per 36-month block.
- Road ambulance up to ₹750 per hospitalisation and ₹1,500 a year. Air ambulance up to 10% of the sum insured from ₹5 lakh.
- Cataract and modern treatments have caps that rise with the sum insured.
Waiting periods
| Waiting period | What the wording says |
|---|
| Any illness after you first buy | 30 days. Accidents are covered from day 1. |
|---|
| Pre-existing diseases | 36 months. |
|---|
| Listed illnesses and surgeries | 24 months. |
|---|
Not covered
- Maternity and childbirth.
- Items a hospital bill normally leaves out.
- Treatment outside India.
Frequently asked questions
What is the room rent limit in Star Family Health Optima?
₹2,000 a day for ₹1 to 2 lakh cover, ₹5,000 a day for ₹3 to 4 lakh, and a single standard AC room for ₹5 lakh and above.
How many times does Family Health Optima restore the sum insured?
Up to 3 times a year, at 100% each time, but only for an illness unrelated to the earlier claims, and only on covers of ₹3 lakh and above.
Is there a co-payment in Family Health Optima?
Yes, 20% of every claim for anyone who is 61 or older when they join. A voluntary co-payment for a premium discount is also available.
Compare these plans clause by clause
Where this comes from
- Star Family Health Optima Insurance Plan wording, UIN SHAHLIP26046V092526. Clauses II.1 room table, II.3 cataract, II.5 modern treatments, II.8 ambulance, II.14 loyalty bonus, II.15 restoration, ART, II.28 co-payment, Excl01, Excl02.
Checked against the wording on 2026-10-09.
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