Star Health and Allied Insurance Company

For a cashless claim at a network hospital, first confirm that the hospital appears on Star Health’s current cashless list. The hospital then needs to submit the pre-authorisation form. Star Health reviews the request and either approves it, raises a query or declines it, while communicating the approved amount. Under the IRDAI Master Circular on Health Insurance Business, insurers must provide a pre-authorisation decision within one hour and discharge approval within three hours. These are regulatory timelines applicable across the industry, not a Star Health-specific promise.

For “Cashless Anywhere” treatment at a non-network hospital, Star Health’s claims page states that intimation must reach the company 48 hours before a planned admission or within 24 hours of admission in an emergency. Acceptance remains subject to the policy terms and any arrangement the hospital may have with Star Health.

For a reimbursement claim, the policyholder pays the hospital first and then submits the required documents. These include a completed claim form, original bills, discharge summary, chemist bills along with the prescription, diagnostic reports and the surgeon’s bill where applicable. For accident claims, a self-declaration or FIR/MLC copy may also be required. Star Health’s claims page states that pre- and post-hospitalisation claims should be submitted within 15 days of the relevant period ending. Missing documentation is a common reason for reimbursement issues, alongside questions of coverage.

To escalate a complaint:

1. Raise a grievance directly with Star Health through its grievance page, by emailing support@starhealth.in, or by visiting the nearest branch or zonal office. Star Health states that each grievance receives a unique reference number for tracking.
2. If the matter remains unresolved, escalate it through Star Health’s internal grievance mechanism up to its Chief Grievance Redressal Officer.
3. If the insurer’s internal process does not resolve the issue, escalate it to IRDAI through the Bima Bharosa portal.
4. The Insurance Ombudsman can also be approached for eligible complaints where the amount in dispute does not exceed ₹50 lakh. There is no fee and a lawyer is not required. The Ombudsman must issue an award within three months of receiving all required information from the complainant. Under the Master Circular, the insurer must comply with an Ombudsman award within 30 days or face a penalty of ₹5,000 per day.