A new and more forward-looking phase is beginning in the field of medical insurance with the offer by some companies to include ayurveda, unani, homoeopathy and naturopathy in their coverage of patients. This departure from the customary focus only on allopathy as the form of treatment for which medical cover can be given is a welcome development. This is an acknowledgement of the fact that more and more people worldwide are turning to the traditional and non-invasive forms of healthcare.
One reason why patients rely on them is to escape from the side-effects of allopathy as a result of powerful drugs, which can have a debilitating impact, as well as surgical procedures, which are dicey in the case of the elderly. Yet, such patients were denied the facility of insurance protection apparently because of an ingrained bias against traditional medicine, which were not considered ‘advanced’ or scientific enough. Now that the coverage is being extended to policy-holders under the umbrella of complementary and alternative medicines, there will be satisfaction for those who depend on traditional treatment. Considering the name which India has earned for the so-called medical tourism, it is possible that in addition to those coming here for allopathic treatment and surgery, there will also be others who will be attracted by the availability of other, no less effective forms of treatment. Since ayurveda is the most preferred form among the alternative systems, hospitalisation will also be covered under the mediclaim projects for those opting for it. Apart from group policies, individuals will also be covered. The arrival of insurance for these systems will also mean that their medicines will become more standardised.
Five years ago, Jagdish Kumar (name changed)wanted to buy mediclaim for his family. He spoke to many agents to get information on different policies. He found it a challenge to get coverage for his parents at the budgeted premium. That is when someone suggested the family floater mediclaim as an option. The premium rates for family floater policies were a minimum Rs20,000 per year for Rs5 lakh sum insured (SI). Jagdish thought of settling for a lower sum insured, to remain within his budgeted premium.
But then he happened to visit a nationalised bank for some routine bank work and discovered something startling. The bank was offering family floater mediclaim (including coverage for parents) for an annual premium of Rs12,000 to its customers. The insurance policy was from a government insurer. There were no medical tests; premium rates were not age-specific; there was no co-pay (the part of the medical expense to be borne by the policyholder); and no loading (premium increase) in future years due to claims. The bank manager was not hard-selling the product, unlike unit-linked insurance plans (ULIPs). It seemed to be a perfect match for his requirements and he signed up to ensure that his family is protected for healthcare costs.
Soon, he realised that the insurance cards he was supposed to have received from his third party administrator (TPA) had not reached him. These cards were an important document proof for getting cashless services during hospitalisation. The policy was supported by only one TPA and, hence, there was no option of getting a TPA of his choice. It took a long time and a lot of calls and continuous follow-up with the TPA based in another city to get insurance cards. The next hurdle was at the time of policy renewal. The auto-debit feature did not work. Jagdish issued cheque payments before the expiry of the policy. The cheque had to be from the same bank as the policy was only for accountholders. In the following year, Jagdish did not receive a renewal letter. However, he remembered the expiry date and sent the premium payment well in advance. The insurer did send him an acknowledgement of the premium receipt each year and, hence, it was the proof of continuous policy coverage.
Family floater policies are an enhanced version of the mediclaim policy. The sum insured value floats among the family members. Most of the policies will cover husband, wife and a couple of children; some may cover parents too. The coverage for the entire family is limited to the sum insured.
The family floater mediclaim from banks have a maximum sum insured of Rs5 lakh. The premium for family floater plans is typically less than that for separate insurance cover for each family member. Moreover, the premium of family floater mediclaim from banks is lesser than a family floater purchased directly from an insurance company by about 50% (in many cases).
If a family of four (two children) takes a family floater of Rs5 lakh, they can claim up to Rs5 lakh of medical expenses in one policy year. If one person is hospitalised and gets a claim paid for Rs3 lakh, there will be only Rs2 lakh worth of medical expenses that can be reimbursed in that year. The next policy year will start with a fresh Rs5 lakh.
A family floater makes sense for a family because, that way, each one in a family gets a big cover and the probability of more than one family member getting hospitalised in the same year is too low unless the whole family is travelling together most of the times in a year or has a history of medical problems that can happen concurrently.
• It is less expensive than an individual mediclaim policy.
• You can add your immediate family members like your spouse and kids. Oriental ‘Happy Family Floater’ will cover parents or parents-in-law too.
• It is great for younger families with members having low health risk.
• Instead of individual mediclaim of Rs3 lakh, if the family opts for a floater of Rs6 lakh, they will benefit if there is a big claim in a year of, say, Rs5 lakh.
• Some family floaters like Star Health–Family Health Optima have a maximum age limit of 60 years. They may offer portability to a senior citizen mediclaim plan after the policyholder completes 60 years, but it is better to find a family floater that has maximum age of 75 years (or more).
• Instead of an individual mediclaim of Rs3 lakh, if the family opts for a floater of Rs6 lakh, they will lose if total claims from different family members are more than Rs6 lakh, even if individual claims are less than Rs3 lakh.
• Most policies are silent about renewal in case the proposer dies. The spouse may be elderly at that age—and may not easily get an individual policy. Moreover, the PED waiting period will start afresh, unless continuous coverage is allowed for an individual plan by the insurer.
• An elderly family—with higher medical needs—will benefit from individual mediclaim.
Following the success of Preferred Provider Network (PPN) of hospitals to provide cashless transaction for health insurance policyholders in tier-I cities, the scheme will now be extended to newer tier-II cities like Pune, Surat and Vadodra.
“The PPN network would be introduced in these three cities in the next two to three months after the success of the second phase of the PPN network launch in Hyderabad in April this year,” said Segar Sampath, DGM, New India Assurance. Kolkata, where the scheme was originally scheduled to be rolled out in April this year, would also see a launch anytime now.
Once the scheme comes into force, health insurance policyholders in Pune, Surat and Vadodra will have to check if their hospital is among those identified to provide cashless treatment. Hospitals outside the list will not be able to offer cashless treatment and the policyholder will have to pay the hospital for treatment and get it reimbursed later from their health insurance company.
The concept of having a PPN list of hospitals was developed by the four public sector insurance companies — New India Assurance, United India Insurance, Oriental Insurance and National Insurance — after controversies arose about private hospitals charging more for patients covered by health insurance policies than those without it. It resulted in the four nationalised insurance companies losing over
Rs 2,000 crore last year, through higher claims.
The PPN network of hospitals was first launched in the four metros — Delhi, Mumbai, Chennai and Bangalore last year in July. In the second phase, the PPN scheme was to be rolled-out in Hyderabad, Kolkata, Chandigarh and Ahmedabad in April 2011. Kolkata missed the deadline and would see the scheme being implemented anytime now, according to Sampath.
“Today, the network covers about 860 hospitals across the country. Even large hospitals like Bombay Hospital, which did not want to be part of the network, have joined in,” Sampath said.
The list is finalised after negotiating with hospitals and arriving at standard rates applicable for different surgical procedures.
The looming fear of terror attacks has forced more than 400 govinda mandals in the city to secure insurance cover against such incidents.
And the insurance firm is more than happy to accommodate this product at the same premium.
“Organisers want govindas to build eight to nine tier human pyramids to break handis. Naturally, the risk factor increases so we got our members insured. This year, we also got terrorism insurance cover,” said Siddhesh Mangonkar, office bearer of the Gopal Krishna Krida Mandal Govinda Pathak at Bombay Central.
Earlier, govinda mandals would seek insurance cover for road mishaps and dahi handi-related injuries, even during practice sessions.
Oriental Insurance Company Limited, which is the only firm offering insurance covers to govinda mandals for the last seven years, will issue terrorism insurance this year. Gradually, other firms will also start the scheme for govindas.
“For the first time in insurance policy, we are covering terrorism insurance. Last year, a govinda had died in a road accident. Within a day, we approved Rs1.5 lakh to the mandal,” said Sachin Khanvilkar, administrative officer of Oriental Insurance Company Limited.
The insurance scheme is applicable from July 15 to August 23. To claim reimbursement, the govinda has to be admitted to a hospital and the insurance company has to be informed in writing. The firm will then send a cheque in favour of the govinda mandal, whose member is injured.
“As a part of premium, we charge Rs30 per person and give Rs1.5 lakh insurance cover. We pass the insurance claimed depending upon the seriousness of the injury,” Khanvilkar added.
Source : www.dnaindia.com
The Treatment Action Campaign and Section27, a public interest law centre, back the government’s efforts to restructure the health system through the national health insurance scheme, but there are some concerns regarding refugee, asylum seeker and non-citizen access, and the structure and governance of NHI, they say.
The two groups said in a joint statement on Friday that they plan to raise these in response to the publication of the green paper, a discussion document released for public comment.
What was required were measures to ensure transparency of tariff structures, reasonableness of prices, significant improvements in the quality of public health and a proposed office of health standards compliance.
“With this in mind, we commit ourselves to defending the [health] minister’s right, essentially a constitutional obligation, to take all reasonable evidence-based measures necessary to restructure the health system,” said Section27 and TAC, which lobby for comprehensive care for people with HIV-Aids.
According to some details of the NHI released on Thursday, everybody over a yet-to-be-determined income threshold would be legally required to contribute.
Money would come from four sources: the tax everybody contributes; mandatory contributions from individuals and employers; co-payments and user charges from individuals; and certain public-private partnerships.
The government did not intend abolishing private medical schemes.
A conditional grant would be allocated in the 2012 budget to fund NHI pilot projects, which would start that year at 10 selected sites. These would be selected based on the outcomes of a planned audit.
Details TAC and Section27 believed the green paper did not cover included information on the source of funds, the future role of medical scheme administrators, and what the benefit packages would be.
They also wanted to know where refugees, asylum seekers and non-citizens stood, as well as more information on the nature and governance structure of the NHI fund, which they believed did not have adequate structural and operational autonomy.
Business Unity SA supported the NHI’s “social imperative”, but warned the cost, design and institutional changes would require vigorous debate.
“If additional funds are to be allocated to public health, it is imperative that they be effectively used.”
The concepts contained in the green paper would affect household budgets, public finance and the labour market, so phasing in and consultation with the National Economic Development Labour Council was also called for.
The People’s Health Movement, an NGO that promotes “health for all”, and social justice movement the Alternative Information Development Centre stressed the importance of strengthening district health facilities.
“In line with the primary healthcare approach, this will require both active community participation and a collaborative intersectoral approach by a range of government departments and will require significant policy changes.”
They would study the green paper and decide whether it offered a comprehensive health service where nobody had to pay at the point of delivery.
Credit : www.timeslive.co.za
What is cashless hospitalization?
Cashless hospitalization is service provided by an insurer wherein you are not required to settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company. However, prior approval is required from the TPA before the patient is admitted into the hospital.
What are the types of cashless claims?
Cashless claims can be of two types:-
Planned: Where the insured is aware of the hospitalisation 2-3 days in advance.
Emergency: Where the insured or any covered family member meets with sudden accident or suffers from bout of illness that requires immediate hospitalisation.
What do I do in case of planned / emergency hospitalisation?
In case of planned hospitalisation
- Contact the toll free help-line number.
- Fax / submit the required documents. E.g. Doctor’s certificate, etc.
- Obtain approval from the TPA .
- Obtain authorisation for network / non-network hospitals.
- Avail health treatment.
In case of emergency hospitalisation
- Rush the patient to the hospital
- Patient avails treatment
- Family contacts toll free number provided by the insurer
- Family submits required documents. E.g. Doctor’s certificate, etc
- Family obtains approval from the TPA
- Family obtains authorization for network / non-network hospitals
- Hospital bills are directly settled by the TPA
What is non-cashless claim or claim reimbursement? How do I go about filing such a claim?
A non-cashless claim is when you avail treatment in hospitals that do not form part of insurer’s network. In such cases, you have to pay the hospital bills and subsequently claim reimbursement from the insurer.
The procedure to be followed in case of claim reimbursement :-
- Call toll free number and provide hospitalization details.
- Settle the hospital bills directly.
- Submit the relevant bills / documents to the TPA.
What are the documents required for filing a non-cashless claim?
The following documents are required:-
- Duly completed claim form
- Xerox copy of the policy
- Bills, receipts and discharge certificate/card from the hospital in originals
- Bills from chemists supported by proper prescription
- Receipt and pathological test reports from a pathologist
- Medical practitioner / surgeon prescribing the test.
- Nature of operation performed and surgeon’s bill and receipt.
The claims are serviced at both network as well as non-network hospitals.
What are the dos and don’ts for cashless and non-cashless hospitalisation?
- Intimate your TPA before admission to network hospital.
- Ensure that you have ID Card at the time of admission to a hospital.
- Provide complete information in prescribed format.
- Carry necessary medical and investigation reports.
- Register / reserve your admission as per the selected hospital’s procedure for admission
- Admission at network hospital is subject to availability of bed.
- Cashless facility is always subject to your policy terms and conditions.
Don’t claim the following expenses:-
- Telephone Fax
- Food & Beverages for relatives
- Toiletries etc
- Ambulance service (unless specified in the policy)
- Don’t conceal or misrepresent any data at the time of buying a policy.
Forward all the relevant reports and documents in original to TPA for claim reimbursement.
In case of surgeon / consultants bills, insist on a stamped, preferably numbered receipt.
How can I prevent rejection of my claim?
You can stick to the following rules to prevent rejection of your claim:-
- Read the list of coverage and exclusions in policy wordings (which comes to you with the policy).
- Ensure that you declare all the pre-existing diseases at the time of enrolment.
- Do not claim for any hospitalisation and diagnostic studies / investigation charges, which do not confirm existence of an illness or injury that requires hospitalisation.
- After filing your claim, make sure that you maintain minutes of your interaction with the insurer in black and white.
- Understand you policy in detail. Be informed about the ‘Fine print’ , exclusions and details pertaining to depreciation and deductions.
- Do not hesitate to ask details of deductions or rejections.
HEALTH INSURANCE CLAIMS
To provide prompt claims servicing to you Reliance General have appointed Third party administrator duly licensed by IRDA.
Their TPA will be available to provide you with services in a hassle free manner within the terms and conditions of your Health policy. They will provide you the following claims services:
- “Cashless Service” at all Reliance Network Providers for all eligible ailments/conditions.
- Processing and settlement of claims under the mediclaim policy with a time bound approach.
- 24 hours Call Centre Service.
As soon as a claim occurs, please intimate to the TPA Help line/Toll free number as mentioned in your Health Card.
Following information needs to be furnished by you while intimating a claim:
Your Contact Numbers
Policy Number and Membership ID number (as reflecting on the Health Card)
Name of Insured person who is Sick or Injured,
Nature of Sickness/Accident,
Date & Time of Loss in case of accident, commencement date of symptom of disease in case of sickness,
Location of Loss,
Place & contact details of the Insured Person.
Claims are broadly of two types:
Claims under the above categories can be further of two types:
Planned Hospitalization & Emergency hospitalization.
Max Bupa CEO: Dr Damien Marmion
In an interview to Moneylife, Dr Damien Marmion says the insurance regulator needs to be flexible in approving premium increases, to reduce the delay and allow consumers decide what is the right and wrong premium
Give us your views on premiums and medical inflation.
Inflation is rising, hospital salaries and other costs are up. Hospitals cannot keep operating at these costs. Process efficiency and shorter stays for patients will reduce costs. Customers from every segment are also using medical facilities more frequently today. These reasons will increase medical premiums. Many insurers hold premiums for a few years and then increase them steeply; it is better to have a smooth annual increase in premium. The Indian market needs to get used to annual premium increase—even though we would like to hold it (down) as much as possible. Insurers should work on improving operational efficiency.
Reliance General had gone in for a hefty increase in mediclaim premiums after three years.
It is not just about companies, the Insurance Regulatory and Development Authority (IRDA) needs to be flexible in approving premium increases.
What exactly do you mean by ‘IRDA needs to be flexible’?
Apollo Munich is increasing premiums from 1 April 2011. I think they filed for premium revision one year back. It takes a long time to get approval for price revisions. It is about the mindset, not intentional delay, of IRDA. They need to look at the loss ratio and operating costs. IRDA should look at the financials of the company; the product needs to be signed off by the company appointed actuary. We believe that premium pricing is the consumer’s domain, not IRDA’s. Let the consumer decide what is the right and wrong premium. If some insurer wants a policy with outrageous premium like Rs10 crore, the consumer will automatically reject it.
Did you face any issues in your product approvals?
We are a new company and, hence, there is some dispensation as products need to come through.
How much is your business in group insurance? PSU insurers have suffered big losses.
We have just started the group insurance business. After de-tariffication (and subsequent premium wars), PSU insurers had improper due diligence (for group insurance) and pricing issues. IRDA has taken a strong view. I know one example where a company had paid Rs1.50 crore in premium. Medical bills for the year reimbursed by the insurer was Rs3 crore. The insurer came back next year and offered the same premium of Rs1.50 crore. It is like taking the money out of the PSU insurer and putting it into the company taking insurance. The problem with the business of insurance is not bad risk, but bad pricing. Things are changing now. Group premium rates are going up, but the benefits are also coming down. Co-payments are increasing and parents may not be covered. We offer cover for parents as an option in group insurance.
Did IRDA consult insurers on health insurance portability?
They did not consult us; I don’t know about others. There are a lot of discussions happening right now in the General Insurance Council’s working group. Portability is not the solution to consumer complaints.
What is the main complaint from consumers?
The main complaint in health insurance is claim payment. We do underwriting at point-of-sale and not at point-of-claim. The due diligence—medical history check—is done at the time of underwriting. It may involve a medical test to ascertain pre-existing diseases (PED) as well as a detailed form to be filled up by the customer. Many insurers do PED investigation only when the claim comes and then reject the claim. This is a point of pain for customers. The insurer is trying to manage its risk. IRDA is there to manage consumer interests. The regulations that IRDA can lay down to handle consumer complaints are important.
Some medical conditions may not be discovered by a medical test. The customer may lie; the agent may fill the form. Your comments?
You cannot set up a business with the assumption that everyone is fraudulent. We have had only a couple of hundred claims until now, but they don’t have any specific pattern. We have not come across a fraudulent policyholder (regarding PED), but have found fraudulent bills. We give a welcome call to customers to go through all policy details and medical conditions to get confirmation. We offer a 15-day free-look period after issuing a policy (it is not mandatory).
Star Health has come out with a product with an 11-month PED waiting period. It has a senior citizen plan covering all PED from the second year.
It’s a good innovation in the market. We will have to see if they have got the pricing right and the risks that can come through. It is easier for large insurers, as they have a bigger pool to work on.
But Star Health is not a big insurer.
They have big business in the Rashtriya Swasthya Bima Yojna (RSBY) and other government schemes.
What about RSBY? You do have a product for the rural market.
We do want to bid for RSBY, but there are restrictions like being in business for a couple of years and company having revenues. It’s a shame, are we less able to deal with this than other insurers? We have low premium micro-insurance products for the rural market targeting the below-poverty-line segment. We are working with six NGOs and a couple of state governments.
Are RSBY and government schemes more for social obligation or profits?
RSBY is not very profitable. Star Health has shown that if done in a large enough way, it can be profitable. I believe more than 40% of ICICI Lombard’s business is from the rural market. They are not doing it for charity.
Many life insurers also have health products. Is that added competition?
It is a small part, yet important. About 15% to 20% of health insurance comes from a life insurance company. The benefit plan to indemnity (reimbursement) is an unknown factor for health insurance portability. The critical illness plan is not a substitute for mediclaim. It is an add-on.
You will complete one year of operations in the next few days. How do you see the policy renewal ratio? How do you see growth in the health insurance sector?
General insurance will show strongest growth (35%) in India. As a start-up, just 11 months old, we will be growing fast, but we have a long way to go. Up to December 2010, we had covered 40,000 lives and we collected premium of Rs15 crore. We have offices in nine cities; a couple more will be added. We have sold policies in 400 cities. Our survey shows that 74% of our customers have rated us ‘good’. We expect 70% of customers to renew which is more than the industry average of 60%. We are offering health benefits instead of no-claim-bonus to our customers—up to 10% of the policy value. There will be discounts for pharmacy, health check-up, gymnasiums and so on.
Will online policies carry discounts?
They will be at the same price. It will be another channel, apart from brokers, direct sales force, third-party distributors and in-house tele-sales.
How does your cashless facility work?
We have 760 hospitals for cashless facility. In half of these, we have done quality checks. We don’t have any third-party administrators. We don’t need 24-hour notifications, but the sooner, the better. We have 24×7 customer care to help the process. Our ‘Gold’ and ‘Platinum’ policyholders have a doctor as a relationship manager.
Tell us about your international medical emergency product.
It is for those travelling for business outside of India up to 180 days in a year. It is not travel insurance; it is a mediclaim for India and abroad. Bupa has built up a global network of 5,000 hospitals and medical consultants across 190 countries where direct payment of all hospital bills is done. For other hospitals, it will be on a reimbursement basis.
People who were in intuition about cashless mediclaim policy benefit must wake up knowing the fact that this facility is been discontinued from July,2010. As many people are not aware of this fact still now was the reason made me write this article…
Many insurance providers have detained the direct payment of treatment charges to more then 100 hospitals in New Delhi and respective areas from July 1. And the discontinuation is said to be growing all over the country now.
These facilities will not be entertained to fellow mediclaim policy holders in metros like Mumbai, Bengaluru and Chennai.
Insurance companies like United India, New India, Oriental Insurance and National Insurance which are managed by General Insurance Public Sector Association, have already taken the step of discontinuing the cashless transactions at number of hospitals.
This step was taken because many hospitals were making fake claims, by showing higher-than-normal charges and thereby cheating the insurance companies. In an report provided by the insurers, says that they collected Rs 900 crore (Rs 9 billion) towards medical insurance premium and had to shell out Rs 1,200 crore (Rs 12 billion) towards claim settlement, in the Mumbai region alone. The reason being these losses was false claims and inflated bills.
Ultimately, the sufferer is the common man! As numerous hospitals in India are avoiding the cashless transaction because of insurer’s brutal decision, the poor medical insurance policy holder will have to shed money from his pocket for any health treatment he does in any hospital.
Whenever you seek a home loan, you are essentially promising to share a part of your future earning with a bank. Typically, most of us would seek the maximum loan amount available – which is fine.
Banks typically arrive at a maximum loan amount based on our income – by apportioning a certain number towards typical monthly expenses. What happens in case of unforeseen expenses? What happens in case you or someone close to you suffers from a medical emergency? Sure, we would use up all your savings – but when even those are not sufficient, we may be inclined to borrow more. With an unforeseen medical expense, we run the risk of taking more debt than we can service. To prevent such a scenario, it is best to opt for a re-imbursement health insurance product – commonly called “mediclaim”
The STAR Medi Premier Insurance is a mediclaim policy that gives you financial security in case of diagnosis of certain illnesses between the policy term. The diagnosis may need large of money to be paid at very short notice and that is where this policy is beneficial, apart from providing cover for hospitalization due to illnesses and accidents.
The policy shares two sections. Section I provides protection against unexpected health care, and Section II ensures a lump sum payment of the sum insured.
- Hospitalisation expenses are covered.
- Boarding and nursing expenses.
- Surgeon’s fees, Consultant’s fees, Anesthetist’s fees.
- Cost of medicines and drugs.
- Emergency ambulance charges for transporting the insured patient.
- Pre-hospitalisation expenses upto 30 days before the date of admission into the hospital.
- 50% Lump-Sum Compensation of the sum assured is provided under Section II in addition to payment of hospitalisation under Section I.
- Such hospitalisation expenses would be paid only till the date of diagnosis of the Major Illness.
- Only one lump sum payment will be process during the Insured Person’s lifetime no matter how many Major illness or treatments the policyholder has suffered.
- Survival Period – To become worthy for lump sum compensation, the diagnosis should be 90 days from the commencement date of the policy.
TATA AIG Criticare provides you an insurance benefit cover for following 11 critical illnesses and surgeries. They are-
- First Heart Attack
- Cancer (excluding Skin Cancer)
- Coronary Artery Surgery
- Kidney Failure
- Major Organ Transplant
- Total Blindness
- Major Burns
- Multiple Sclerosis
It provides lump sum benefit up to Rs. 15,00,000/- on diagnosis of any mentioned critical illness in the plan. It also offers you unique opportunity to take a second opinion on your illness, from a panel of exports doctors in USA.
Premium paid for insurance (up to Rs.10,000/-) is eligible for tax benefit under section 80D of the Income Tax Act,1961.
Available for the people aged between 18 and 60 years. The renewal is permitted up to 64 years.
Medi Classic from Star Health insurance is one of the best health insurance in the market. It takes care of your all hospitalization expenses incurred as a result of any sickness, diseases or accidental injury.
The policy covers the insured person for in-patient hospitalization expenses for a more than 24 hours of hospitalization. It includes room rent and boarding expenses (up to 2% of the sum insured, subject to a maximum of Rs.4000/- per day), nursing expenses, surgeon fees, consultant fees, specialist fees, anesthetist fees, operation theatre charges, medicines, drugs, etc. It also covers the ambulance charges for transporting the insured person to the hospital, subject to a maximum of Rs. 750/- and overall limit is up to Rs.1500/- per policy period.
Pre hospitalization expenses are covered up to 30 days prior to hospitalization. A lump sum calculated at 7% towards hospitalization expenses, subject to a maximum of Rs.5000/-. The cover is also provided for non allopathic treatment up to Rs.25,000/- per case, subject to a maximum of 25% of of sum insured per policy period.
The optional benefits are available on payment of additional premium. The benefit includes daily hospital cash, patient care, new born baby cover ,etc.
The policy provides no claim discount ranging from 5% to 25% for every claim free year. Premium amount is eligible for tax benefit under section 80D of the Income Tax Act,1961.
This policy can be taken on an individual basis and for family. Any individual age between 5 months and 80 years can opt for this insurance. The sum insured ranges are Rs.50,000/- to Rs.10,00,000/-.
Apollo Munich medical insurance is one of the best option available in the market. It offers wide range of coverage option at very affordable premium rates.
Apollo Munich offers various health insurance to the individuals, families and corporate groups. It includes Easy Health insurance, Insure Health and Maxima. These plans can be renewed for lifetime. Easy health insurance comes in three different variants-Standard, Exclusive and Premium. Insure Health and Maxima are in the category of comprehensive health insurance policy. These plans provides complete protection to the customer for their healthcare needs.
These plans covers the insured person for in patient hospitalization, pre and post hospitalization, domiciliary hospitalization, day care procedures, organ donors treatment and other related expenses. Ayush benefit covers the medical expenses for in-patient Ayurveda, Unani, Sidha and Homeopath treatment.
Apollo Munich offers the benefits such as cashless hospitalization service at over more than 4000 network hospitals across India. Also, the cumulative bonus is offered on every policy renewal for every claim free year. The premium paid is eligible for tax benefit under section 8OD of the Income Tax Act,1961.
Also, there are value added services like healthline and health risk assessment tool. It helps to add extra cushion on existing health insurance.
Iffko Tokio’s Individual Medishield is a best mediclaim that covers insured for all medical expenses due to any sickness, illness or injury.
The policy covers in-patient hospitalization expenses such as room and boarding expenses, doctor fees, surgeon fees, operation theatre charges, intensive care unit, nursing expenses, anesthesia, oxygen administration charges, etc. In addition to hospital expenses, a daily hospital allowance will be provided. Pre and post hospitalization expenses are covered up to 60 days prior and after hospitalization.
The policy also offers emergency assistance services like medical consultation, evaluation and referral, emergency medical evacuation, care for minor children ,etc. In the event of emergency, ambulance charges are covered for transporting the insured person from home to the nearest hospital. Health check up costs are covered once in a block of 4 claim free years.
The policy coverage can be extended for critical illness for double the basic cover sum insured at 40% of the basic cover premium.
The policy offers cashless hospitalization service in over more than 3000 network hospitals across India. A cumulative bonus of 5% is provided on sum insured for every claim free year subject to a maximum of 50% of the sum insured. Premium paid is eligible for tax benefit under section 80D of the Income Tax Act,1961.
The entry age is 5 years to 55 years and renewable is up to 70 years. The sum insured ranges are Rs.1Lakh, Rs.1.5Lakh, Rs.2Lakh, Rs.2.5Lakh, Rs.3Lakh, Rs.3.5Lakh, Rs.4Lakh, Rs.4.5Lakh and Rs.5Lakh. It offers family discount of 5% for 2 member and 10% for 3 or more members.
Bajaj Allianz Insta Insure is one of best mediclaim for you and your family. It covers your entire family members under a single sum insured for a single premium. In case of death of the proposer, the death benefit of Rs.1Lakh is provided. The main feature of this policy is that instant availability and commencement of the cover.
The policy takes care of the all hospitalization expenses due to a serious illness or accidents. It pays an amount equivalent of 2% of admissible hospitalization expenses towards pre and post hospitalization expenses. It also covers ambulance charges in case of an emergency, subject to a maximum of Rs.1000/-. Pre-existing diseases are covered after 4 continuous policy years.
Bajaj Allianz Insta Insure is available on cashless basis in over more than 2400 network hospitals across India. Premium paid for this policy is eligible for tax benefit under section 80D of the Income Tax Act,1961.
This policy is available for individual aged between 3 months to 45 years. The proposer’s aged should be above 18 years. The policy can be renewed up to the age of 70 years. The maximum 2 adults and 2 children’s can be covered under this policy. There is no medical examination up to age 45 years.
Purchasing mediclaim from Apollo Munich can be a best decision in terms of features and benefits. Apollo Munich mediclaim policies available for individuals and families at very affordable rates. These plans comes in three variants such as Standard, Exclusive and Premium depending on the premium and benefits offered under the plan. The minimum sum insured is Rs.1Lakh and maximum is Rs.10Lakh. Standard Plan is a most affordable plan which exclusively starts at Rs.3 per day.
These policies cover insured for in-patient hospitalization expenses such as room rent, boarding expenses, doctor/surgeon/specialist fees, nursing care, operation theater charges, ICU charges, cost of medicines and drugs, blood, oxygen, diagnostic expenses, surgical appliances, pacemaker, etc. The coverage is also provided for pre and post hospitalization, day care procedures, domiciliary treatment, organ donors expenses, etc. Additional cover for critical illness is offered under Exclusive and Premium Plan.
Another expenses such as daily cash for accompanying an insured child, maternity expenses, outpatient dental treatment, spectacles, contact lenses, hearing aid, etc.
Cost of health check ups are covered up to 1% of sum insured, subject to a maximum of Rs.5,000/- per insured person and provided only once at the end of a block of every continuous three claim free years. Optional cover is also offered on payment of additional premium.
Cashless claim hospitalization service is provided at over more than 4200 network hospitals across India, including the 42 Apollo Hospitals.
United India Insurance is one of leading general insurance companies in India, offering a various insurance product to the customers. Family Medicare Policy is one of products that covers all family members against medical expenses due to any disease or accident.
This mediclaim covers following expenses-
- Room rent, boarding expenses and nursing expenses up to 1% of sum insured per day. It also includes nursing care, RMO charges, IV Fluid/Blood
- Transfusion/Injection administration charges.
- In case of admitted in ICU, the double the sum insured per day.
- Surgeon/Anesthetists/Consultants/Medical Practitioner/Specialist Fees
- Anesthetists, blood, oxygen, operation theatre charges, surgical appliances, cost of medicines and drugs, diagnostic materials, x-ray, dialysis,
- chemotherapy, radiotherapy, artificial limbs, pacemaker and other similar expenses.
- Hospitalization expenses (excluding cost of organ) incurred for donor in respect of organ transplant.
- Pre and post hospitalization are covered up to 30 days prior to hospitalization and 90 days after hospitalization.
- Critical illnesses are covered under a sub limit of each hospitalization.
- No claim discount of 3% after three continuous claim free policy years, subject to a maximum of 15%.
- Cost of health check up at the end of block of every three years where no claims made during the block.
- Optional cover such as hospital daily cash benefit and ambulance charges at a nominal extra premium.
HDFC Ergo’s Health Suraksha is a best mediclaim for you and your family. It covers yours all hospitalization and other related expenses for any sickness and accidental injuries.
- Cashless hospitalization facility at over more than 4200 network hospitals across India.
- Option to take cover on individual sum basis and on family floater basis.
- No pre-medical examination up to the age of 45 years.
- Cumulative bonus of 5% for every claim free year, subject to a maximum of 50%
- Family discount of 10%. if 3 or more family members are covered under the same policy on single sum insured basis.
- Premium paid is eligible for tax benefit under section 80D of the Income Tax Act,1961.
- Hospitalization Cover- It covers room rent, boarding expenses, nursing expenses, ICU charges, medical practitioner, cost of medicines and other related expenses.
- Pre and Post Hospitalization- It covers medical expenses up to 60 days prior to hospitalization and 90 days after hospitalization.
- Day Care Procedures- It covers around 141 day care procedure which do not require ore than 24 hours of hospitalization due to technological advance treatment.
- Domiciliary Hospitalization- It covers medical expenses for treatment taken at home, subject to a condition.
- Organ Donor Expenses- It covers medical expenses for an organ donor’s treatment in the event of organ transplantation.
- Ayush Benefit- It covers medical expenses for treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
- Ambulance Charges- It covers ambulance charges in the event of emergency.
- Covers individuals aged up to 65 years.
- Sum insured ranges are Rs.2Lakh, Rs.3Lakh and Rs.3Lakh.
The word insurance truly mentions security. Security against life, health, family,vehicle,homes, shops,etc. In earlier years, there was no need to this kind of thing for the protection. I am talking about days of our grandfathers or may be even before that. The life was so great and slow, nothing to worry about any future, would involve in their daily occupational jobs like farming and living life in their own way.
But it is said that nothing is permanent. The time has change now. Today we live in a much advance world. The change is faster than time. The daily routine got so much fix that we cant even take out some time to enjoy. People work in office as well as in home too. Social life is like getting extinct from their life. No time to eat even hygienic food on time. Just grabs some cafeteria served items and forget about its effects.
As “no time” kind of thing ruling our life. We almost neglect our health and when any weird kind of stuff happens! Doctor is the second word that comes in our mind. First is the expense if the condition got severe.
We can’t change this situation, neither can we escape from it. We have to work, look at our family and their future, about your dreams, and so to earn this, we have to get a job that offers salary far from your expectation but if salary is well then the work load will also be high.
In fulfilling your daily task, you forget about your health! So it’s better to have an insurance that cover you from any issue related to your health. Medical Insurance is an ideal policy that protects you financially from any critical illness or fatal injury through road accident. By paying some amount of premium for limited time, you actually saves a lot of money. If in case your encounter any serious illness or injury, you do not have pay any money for the treatment of that illness. Medical insurance policy actually pays all your hospitalization expenses. So get smart and get one policy for yourself and even for your family. Insurance is not a bad option to invest in. It sooner or later benefits you.
List of few Insurance Companies offering Medical Insurance:
- ICICI Lombard
- National Insurance
- Bajaj Allianz Health Insurance
- Bharti Axa Health Insurance
- United India Health Insurance
- Oriental Mediclaim Insurance
National Insurance offers medicalim policy which covers the individual and familiy under the single policy. It covers all hospitalization expense fro sickness, illness and accidental injuries. Medicalim policy has been devised under the aegis of the government of India.
The policy covers the hospitalization expenses such as room rent, boarding and nursing expenses, surgeon fees, consultant fees, specialist fees, anesthetists, medical practitioner, operation theatre charges, ICU charges, anesthesia, cost of blood, oxygen, surgical appliances, diagnostic materials, x-ray, dialysis, chemotherapy, radiotherapy, pacemaker, artificial limbs, cost of organ etc. Pre-existing diseases are covered after 4 continuous claim free policy years.
Premium paid towards the policy is eligible for tax benefit under section 80D of the Income Tax Act,1961.
Entry age is 18 years to 59 years and can be renewed up to the age of 80 years. Spouse, dependent children above 3 months to 25 years and dependent parent can be covered under the single policy.
Minimum sum insured amount is Rs.50,000/- and can be increased in the multiples of Rs.25,000/- up to Rs.5,00,000/-.
1.Cashless hospitalization facility through TPA
2.No pre medical examination up to the age of 50 years
3.Cumulative bonus on policy renewal
Cholamandalam General Insurance is rendering complete health insurance ( Mediclaim ) plan(family floater) to look after the medical expenses for you and your family members.
It deals with hospitalisation expenses for sudden sickness/illness or diseases. Expenses such as embarkment expenses,room charges, operation charges, doctor’s fee, nursing expenses, cost of medicine, etc.
It also handles pre and post hospitalisation charges for 90 days. And pre-existing diseases are covered after 3 continuous claim free policy year.
The policy blankets over 141 minor surgeries for less than 24 hour hospitalisation under day care procedure.
Cashless hospitalisation facility at over 1300 network hospitals across India.
24X7 emergency assistance service for hassle-free and faster claim settlement.
Tax benefit on premium paid under section 80D of the Income Tax Act, 1961.
Health related problems generally strike us unexpectedly, which lend us making hospital expenses purposefully. According to a survey, Just about one in every fifty Indians, is covered through some form of individual medical insurance. Moreover, it has been practiced that 2 out of every 5 individuals hospitalized end up either adopting money or selling assets to cover healthcare costs especially in India. This state of affairs is set to broaden further as private health care spends in India are measured to increase by 2 to 3 times over the next 12 years.
Therefore, you need a solution that makes you relax by providing financial protection to you and your loved ones against uneven hospitalisation events.
What should you know when opting for a Medical Insurance:-
- Does the plan guarantee you insurability at renewal no matter what your health status is?
- Does the plan promises that no new exclusions are added or no increase in premiums occurs just because a claim is made?
- Does the plan clearly state exclusions at the time of taking the policy and also offer you cover against pre-existing conditions?
ICICI Prudential Insurance furnish you with MediAssure, a health insurance plan with guarantee for your family-
- Sum Assured cover till age 75 years.
- Sum Assured coverage for accepted pre-existing illnesses after 2 years.
- Sum Assured price for 3 years.
Also, this policy insures all your hospitalisation needs with the flexibility to choose your location and quality of treatment.
National Insurance Mediclaim reimburse for the all kind medical expenses for any illness, disease or accidental injury.
Entry level age is18 to 59 Years
Children’s between 3 months and 5 years can be covered under parents policy.
Policy renewal is up to 80 Years
Sum assured ranges between Rs.50,000/- and Rs.5,00,000/-
Hospitalization Expense- It includes room, boarding expenses, nursing expenses, medical practitioner, consultant fees, specialist fees, anesthetists, operation theatre charges, ICU charges, cost of blood, oxygen, medicines, drugs, diagnostic materials cost, x-ray, dialysis, chemotherapy, radiotherapy, pacemaker, surgical appliances, artificial limbs, etc.
Pre and post hospitalization expenses are covered up to 30 days prior to hospitalization and 60 days after.
Pre-existing diseases are covered after 4 continuous claim free year.
Ambulance charges and cost of health check ups.
Cashless hospitalization facility at network hospitals across India.
Cumulative bonus of 5% on sum assured for every claim free year, subject to maximum 50%.
Tax benefit on premium paid under section 80D of the Income Tax Act,1961.
Everybody is well known the profits of having a mediclaim policy. A sudden sickness or accident can ruin your financial budget and at this stage mediclaim policy is always helpful.
In the current scenario, medical expenses are very high and its increasing everyday. The latest family mediclaim insurance is ideal solution to save money and cover entire family under single sum insured. This means no more multiple premiums and no more financial strain.
This policy is available in two variants – short term and long term and the coverage level is similar like other traditional mediclaim policies. It provides covers for hospitalization expenses for illness and diseases. It includes expenses for doctors fees, nursing expenses, medicines, blood, surgical appliances and other related expenses.
Mediclaim policy is a essential for the peoples because it saves financial loss in case ofhospitalization for any sickness, disease or accident.But it costs is much higher than other insurance and still it is rising.
Mediclaim premium calculator is very useful tool in such a condition because it helps to calculate the your mediclaim costs.This online service is absolute free and specially designed for customer convenience.
There are various mediclaim premium calculators are offered by insurance companies and private websites.You can easily determine the cost of plan that you go for by doing just simple work on such a calculator.Private websites also allows you to compare various insurance companies and their plans.
You may have come across many a time with the short forms in mediclaim articles/quotes like HMO,PPO,POS,HSA, but could not make it, what the abbreviation stands for?
There are many types of health/mediclaim policy.
A) HMO (Health Maintenance Organization).
You go to your family doctor for any health services. If there is an urgency in going to a specialist, your family care doctor will help you in referring one. Mediclaim companies will not insure you without the referral from your family doctor and therefore, you will have to pay yourself for such specialist services
B) PPO (Preferred Provider Organization Plan).
Through this plan you can analysis to any primary, specialist, or medical facility without referral and get totally covered. It is the Mediclaim companies that covers you when your child breaks a bone accidentally and you approach directly to the orthopedic doctor, without consulting your primary doctor.
C) POS (Point of Service).
This plan essentially includes both an HMO and a PPO plan. Mediclaim companies give you the option from the two plans for every medical case. The plan offers extra covered preventative programs, however, you may have to pay more from your pocket, if you choose a doctor outside your plan.
D) HSA (Health Savings Account).
This plan is much more superior than the above mentioned mediclaim plans. The plan covers eyeglasses, dental, cosmetic procedures, over-the-counter medications, etc. It is a tax-deferred savings account as long as withdrawals are concern for medical expenses. Funds outstanding at the end of the year are carried forward into an IRA account.
Day-care Treatment- The Medical disbursement through serious technologically advanced day-care surgeries with no 24 hour hospitalisation is required.
Ambulance Charges for shifting the insured patient from home to hospital are been covered up to the limits mentioned in the mediclaim policy.
Ayurvedic / Homeopathic system of medicine are covered to the extent of 25% of Sum Insured provided the treatment is taken in the Government Hospital.
Pre-existing diseases are covered only after 4 continuous and claim free renewals with the insurance company.
1. Diseases contracted within 30 days of insurance.
2. Dental treatment except arising out of accident.
3. Debility and General Run Down Conditions.
4. Sexually transmitted diseases and HIV (AIDS).
5. Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness.
6. Vaccination and Inoculation.
7. Pregnancy and child-birth.
8. War, Act of foreign enemy, ionising radiation and nuclear weapon.
9. Treatment outside India.
11. Domiciliary Treatment.
12. Experimental or unproven treatment.
13. All external equipments such as contact lenses, cochlear implants etc.
Mediclaim Premium is based on age of the proposer and geographical area of treatment.
1. Discount in premium for family cover.
2. Loyalty Discount.
3. Good Health Discount.
4. Cumulative Bonus.
5. Cost of Health Check up.
6. Income Tax Benefit under Section 80D of IT Act.
Mediclaim insurance is a meant to covers all medical expenses in the case of hospitalization due to certain serious sickness, disease or an accident. For this reason mediclaim insurance is always advisable for yourself and your family members. But some times you can not require that the purchase of high cost mediclaim insurance policy. Short term mediclaim insurance have been formulated for such a conditions to get the considerable medical coverage.
Short term mediclaim insurance policy is a temporary solution and purchased for only short period of time that is three months to one year. Generally, it covers all major health problems like other standard health plans. This gives you freedom to choose doctor or specialist you wish and the expenses are covered under this policy like doctors fees, hospital charge, surgery, medicine, diagnostic test and other emergency service.
This short term plan is affordable plan and it doesn’t cover any pre-existing disease, because the premium costs are considerably ow and paid on monthly basis. It provides only cover for the conditions stands which itself within the span of the policy.
Short term medical insurance cover is ideal for those under the jobs, temporary employee, college students or just graduates.