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Welcome to the India's Insurance community.
What is Health Insurance?
Health insurance policy is a reimbursement policy, it is designed to cover medical treatment and surgicial expenses. Some of the companies also provide hospital daily allowance as an add on cover.
Individual health insurance
Covers OPD & hospitalization expenses.
Floater health insurance
Covers your entire family’s health need using this single premium policy.
Group health insurance
This policy is meant for ages between 60 - 70 years. No pre insurance medical test required.
If you are hospitalised and the board rate is higher than your
eligibility, you will bear the difference in the room charges as well
as some portion (usually between 10% - 20%) of the other eligible
benefits described in the policy contract.
Cumulative Bonus: The compensation payable for the death, loss of limb's or sight or permanent total disablement is normally increased by 5% of the Capital Sum Insured for every completed year of insurance. However, Cumulative bonus can never exceed 50% of the capital sum assured.
Domiciliary hospitalisation: Insured is treated for an injury, illness or any disease in his own home in India due to
The condition of patient is such that he cannot be taken to the hospital.
Lack of bed available in hospital.
Cverseas mediclaim policy Anyone traveling abroad for business purposes or pleasure or as student going for higher studies can qualify for an Overseas Mediclaim. Premium amount increases for the number of days he is outside India.
Any one illness:
If the patient is readmitted within 45 days then it is considered as same illness.If readmitted after 45 days then it is treated as fresh illness. Please Note- That he should be admitted in the same hospital where the treatment was taken before.
Free-look period
Its a time period in which you can cancel the policy by returning the documents to the insurance company. You will be refunded ( premium - administrative expenses ) by the insurance company.
Pre and Post hospitalization
Expenses incurred before and after the hospitalization are covered by the insurance company.
Minimum 24 hours hospitalisation is necessary to file a claim. But there are some disease which donot require 24 hours hospitalisation and are covered by the policy.
Out patient department (OPD) expense
It cover room charges, doctor/surgeon fees, medical tests, anesthesia, blood, oxygen, operation theatre, surgical appliances, medicines and drugs, diagnostic materials and X-rays, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of organs, and other similar expenses.and related expenses.
Diabetes and Hypertension
Medical policies are available that cover the cost of hospitalization due to diabetes and hypertension.
Pre-existing illness
Any illness or disease experienced by you before applying for insurance health policy. These disease or illness are not covered under the policy for first two years and in some companies it varies for first four years.
30 days exclusion
All illness or disease, arises within the first 30 days of cover except accidental and emergency cases are not eligible for claim.
1st year/2nd year exclusion
There are some 14 disease and their related conditions. You should check the details of disease with your insurance company as it varies from company to company. You will not be covered for these specified disease during the first two years of the policy.
Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy unless because of malignancy
Hernia, Hydrocele
Fistula in Anus, Piles
Arthritis, Gout, Rheumatism
Joint replacement, unless due to accident
Sinusitis and related disorders
Stone in the urinary and biliary systems
Dilatation & Curettage
Skin and all internal tumors
Dialysis required for chronic renal failure
Surgery on tonsils and sinuses
Gastric and duodenal ulcers
Permanent Exclusions
There are some disease and their related condition which are not covered under the policy. These again varies from company to company
HIV, AIDS, drugs or misuse of liquor.
Cost of spectacles, laser surgery, contact lenses, or routine check-up.
Dental treatment or vaccinations unless due to accident.
Non-allopathic treatment, pregnancy or child birth related complications, treatment due to fatness.
War,Accidents arising out of terrorist activities, strike etc.
Planned hospitalisation : Inform TPA about the hospital where you are planning to get treated. Verify wether it comes under insurance company network or not. The difference in both is, in network hospital TPA can authorize cashless facility. While the hospital not covered under the insurance company network, there you have to settle the bills from your own pocket.
Unplannned Hospitalisation : Inform TPA about your hospitalisation as soon as possible to understand the procedure of how to file a claim and to get claim form.
Once the treatment get over : Complete the Claim form, attach all supporting documentation and mail/fax to the TPA and stay in touch with them to ensure proper processing of your claim.
Documents required to reimburse the claim:
Claim form filled and signed by claimant.
Discharge certificate from hospital.
Original bills, receipts, cash memo from hospital and all documents related to illness.
Certificate from the attending medical practitioner / surgeon that the patient is fully cured.
Reimburse your claim : By submitting all necessary documents, bills etc you can reimburse your claim. If the claim is rejected make it sure to lodge a complaint within 15 days to the insurance company.
A mediclaim policy is a reimbursement of actual medical expense whereas critical illness insurance is a benefit policy i.e Insurance company pays certain portion of expense remaining claimant has to bear from his own pocket.
What are the important features you should notice before purchasing health insurance?
The plan which provide you the maximum benifits at low cost. Before purchashing any plan you must notice:
The product feature, key benefits and exclusions
Make it sure that you can afford the premium.
Only buy from registered insurance agent or directly from insurance company
Does the plan cover the health services that you need?
Does the plan cover the cost of delivering a baby?
Does the plan cover the private hospitals you're currently using?
Does the plan offer family,as well as individual coverage?
Does the plan provide for pre-existing conditions?
Does the plan cover doctor's fees and medical prescription?
Is it compulsory to renew the health mediclaim policy? It is always better to renew the policy well in time (at least 15 days before the due date) so that you don’t lose the added benefits which come from continuity of the policy. Benefits of continued coverage
Cummulative Bonus
Cost of Health Check-ups
Ailment suffered during the previous coverags
Ailment suffered during waiting Period:(30days,1st year,2nd year)
