Health Insurance


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Health Insurance is a protection against the financial loss arising on the happening of an unexpected illness. A person can avail this protection by paying a nominal premium. This insurance provides you affordable access to high-quality health care which would otherwise be an expensive.

All age groups should buy a health insurance. For younger age group, since the risk of falling ill is lower, the premium is absolutely nominal and hence a very attractive proposition. For middle and high age group taking a health insurance is even more important despite premium being bit higher. It is a wise decision to have an individual health insurance for any kind of medical emergency. This will save you from any kind of hassle or last-minute panic.

Individual health insurance plans are designed to cover only a single policyholder who is above 18 year of age. Family floater is a single limiting available to the entire family covered under the plan.

All Insurers have their unique plan. With the awareness going up, some company even offer over 1 Cr sum insured of course at a much higher price point. To decide, one should take a reasonable amount which one actually would like to insure and we assist our client in taking this decision.

Generally one can cover up to 6 people under one family health insurance plan (Self, spouse, 2 kids and 2 parents). One can insure extra children as well under the family floater plan.

You can get health insurance cover for all kind of medical treatments due to accidents or illness which needs in-patient hospitalization for a minimum 24 hours hospitalistion and some specified day care treatments. It does not cover outpatient expenditures like seeing a doctor for a viral fever or small expenses like dressing a wound.

Typically, General Insurance contracts are for a one-year period only. However some insures give an options to take a 2 or a 3 year policy and offer good discounts to renew for a multiyear policy.

It is a medical condition or disease that existed before one obtained the health insurance policy. Declaring any such condition where one is talking a medicine for any specific illness, has undergone any surgery, been ever hospitalized for an illness. The proposal form directly asks the customers on such condition. It is important that one answers all the questions correctly and declares any preexisting condition proactively. This will help in easier settlement of the claim which is the main purpose of buying an insurance plan. Once a preexisting condition is declared, the insurance company applies a maximum waiting period of up to 48 months after which such claims become payable. This is subject to break free and continues renewal for four years.

Yes. Apart from waiting period applied due to preexisting condition, there will be a 30 days waiting period starting from the policy inception date, during which period any claim will not be payable except for any emergency hospitalization due to an accident. There are some specified illnesses like hernia, cataract etc which also have 1 to two years waiting period.

Third Party Administration (TPA) is an entity that operates on behalf of the insurance company and is empowered by them to settle claims upto a certain limit directly with the hospitals. This kind of direct settlement with the insure is called cashless facility.

A Hospital, which has an agreement with a TPA for providing cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those who have not agreed to the TPA terms and conditions and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per normal procedure.

An emergency involves a lot of stress and one need not worry don’t need the additional burden of finding out the claim settlement process. It is very important to read the claims process from the policy document as soon you get the policy document. Normally one should make note of the nearest hospital in the network which allows cashless facility to avoid last moment panic. On reaching the hospital, one should declare the policy number and approach the insurance or TPA desk there. Normally one should keep

  • Photo ID
  • Policy No / Insurance Card provided by the insurance company along with policy
  • Don’t forget to carry some extra cash just in case there is a delay in cashless approval at odd hours. Insurance company refund this amount later as per policy terms

You may also reach out to us and our representative will help you with the process.

In an emergency situation or in a scenario where you might still require to be admitted in a non-network hospital, one should remember that treatment would be on a reimbursement basis only where you would have to first pay the medical bills. Normally the documents required at the time of presenting a claim are

  • Filled up claims form
  • All the original bills
  • All the original reports
  • Hospital discharge card

Insurance company after admission of the claim, reimburse the payable claim amount (after incorporating policy deductions) to the insured person.

Emergencies related to health can occur anytime irrespective of your age, gender & lifestyle. It is better to stay prepared for such instances rather than spending money out of your own pocket. Health insurance is a great risk management tool to prevent a medical emergency from turning into a financial emergency. Health insurance covers the medical expenses incurred by an insured person due to a sudden onset of illness or an accident. The family health insurance plans are designed to cover the entire family for the limit of insurance taken by them. This is usually called a family floater cover, because it acts as an umbrella covering your parents, spouse and kids, all under covered under a common Sum Insured.

A family floater insurance is especially convenient as it removes the hassle of maintaining multiple individual health policies for each family member. Further, this plan works out more economical that having multiple individual policies.

This insurance policy covers the costs of hospitalisation and takes care of the expenses such as room rent, ICU charges, Doctor fees, Nursing fees, Blood, Oxygen, ambulance etc. However minimum 24 hours hospitalisation is a must for the claim to be valid.

Any medical expenditure such as tests, scans, doctor consultation etc. incurred by the insured person just before the treatment and sometime after it, is allowed under the policies. Generally, the companies offer the coverage for medical expenses for 30-60 days before the date of hospitalisation /Day care treatment and 60-90 days after the discharge hospitalisations expenses. This period varies for different companies

The policy takes care of some admissible day care procedures which do not require 24 hours hospitalisation . Every insurance company has its own list of approved day care procedure. Some of the common examples are Cataract, Laparoscopic surgery which take just a few hours.

Any pre-existing medical condition before taking a policy has to be mandatorily declared to the insurance company and if the proposal is accepted by the insurance company, the preexisting diseases are covered after four years of break free continuation of the policy. Some companies offer lower time limit say 3 years or even two years form covering preexisting diseases, but such polices tend to be more expensive or come at an extra premium.

Some insurers offer an enhanced limit on the existing cover either as bundled to the main product or offered at an extra premium. If availed, once the basic sum insured of the policy is exhausted (in special conditions), entire sum insured amount is restored or made available in the same year without any additional premium.

Following chart will explain the applicability of this additional cover

Condition Claim Admissible?
Same Insured person claiming beyond the original sum insured again for the same Disease No
Same Insured person from the insured family floater group claiming beyond the original sum insured again for a different disease Yes
Different Insured person from the insured family floater group claiming beyond the original sum insured again for the same disease Yes
Different Insured person from the insured family floater group claiming beyond the original sum insured again for a different disease Yes

It is important to note that in most of the companies, this cover is triggered only once the base sum insured is fully exhausted.

When a baby is born, everybody becomes busy in welcoming the new-born, praying for his health and wellbeing and celebrating the occasion. Some of them are prone to complications that might involve extensive hospitalisation for a few days, which can have financial implication for his parents. A pan having this covers is often a great a financial help.

Some policies offer to pay a lump sum amount every day for the entire or part of the period of hospitalisation . This is not linked to medical expenditure and is meant to help the insured person take care of some out of pocket expenditures such as local conveyance, food for the attendant, etc. This may be an inbuilt cover, add on cover or can be separate policy altogether.

Some policies offer you a yearly free medical check-up as a wellness promotion gesture. Here a health check-up, which may cost a customer in thousands in the market is given free of cost on a certain frequency depending on the insurer. One will certainly miss on this benefit if not insured.

To let the customers, plan their expenditures better, some of the policies offer maternity cover to a certain limit which eases your burden of expenses. In this coverage the medical expenses incurred towards Hospitalisation due to maternity would be taken care. The maternity cover should definitely be opted by those who have got married recently and wish to have a children in the near future.

The insurance companies generally have an intermediate healthcare provider called TPA or Third Party Administrators who bring an ease and speed especially for small claims settlement. Under a Cashless Facility customer having insurance can get treated under a network hospital of the insurer where bill are settled by the insurance companies directly.

This facility works very well for planned hospitalisation . The process can be summarized into the following steps

  • Presenting doctor’s recommendation to the Network hospital’s TPA/Insurance desk
  • TPA seeks approval from the insurance companies – Takes with 4 to 24 working hours depending on complexity of treatment.
  • The hospitals on confirmation from TPA start the treatment without charging to the customer.
  • Before Discharge TPA send the final bill to the insurer and the insurer approved their final liability to the hospital
  • Customer pays for the non-medical and consumables expenditures only.

* Some hospitals insist on security deposit from to initiate the treatment in case of emergency and this amount is later refunded back to the customer after discharge or the date hospital gets paid by the TPA whichever is later.

If you have not made any claims over a period, then you are entitled to a higher sum assured in the subsequent year called ‘No Claim Bonus’.

Health Insurance entitles you for tax deduction under section 80D of the Income Tax Act. An insured paying health insurance premium(s) for self, spouse, and dependent children through a mode other than cash is eligible to avail an annual deduction of Rs.25,000 from his/her taxable income. The same person can claim a deduction of Rs.30,000 for his / her senior citizens parents in case he is the proposer for them and also paying premium on their behalf.

A lifelong renewability feature enables you to renew your policy till the time one is alive. The insure is obliged to continue renewing the policy as long as premiums are paid on the policy within the due date. This is very effective especially for retired individuals, who may not have a major flow of income to support their medical emergencies. It also gets extremely difficult to get the health insurance cover on good terms especially once a person crosses the age of 60.

Any Insurance policy is issued on this principle. Both the policyholder and the insurer need to disclose all material and relevant information to each other before commencement of the insurance contract. The insures disclosed the exact terms of the contact through the sales brochures and/or the detailed insurance policy whereas the customer or the insured discloses the information relevant to the risk by filling up a proposal form.

The statements made by the proposer/insured are relied completely by the insurance Company in Good faith at the time of issuing the policy. However, if any information provided by the insured or the customer is found to be incorrect later, then the insurance company gets the right to cancel the policy and not pay any claim under this Principle.

Proposal form is the one of the most important document and statement about the risk being insured by the customer. The main information to be filled includes, Name, address, age, , education, occupation, general health, medical history and other information relevant to accept the risk

A pre-policy medical examination or check-up is a battery of tests and procedures that the prospective policyholder is required to undergo before the policy is accepted by the insurance company and health cover extended to him/her. These tests are generally required if the policyholder is above 45 years of age or the sum insured is on a higher side which required underwriting of the risk. This step also validates the information provided in the proposal form filled up by the customer.

Normally the policies having sum insured of 5 lacs and above have no per day room rent or ICU restriction. However as one moves to lower sum insured, insures generally put a 1% of sum insured as a Sub-limit to per day room rent and 2% sum limit on the ICU charges.

So, a 1% per day cap in a policy with a sum insured of Rs 3 lakh means that the insurer will only pay Rs 3,000 per day towards the room rent.

In case of emergency or especially in the remote areas where prior approval or the network hospital is not available, the customer may incur the medical expense

You may claim the money for an admissible claim by sending the hospitalisation papers and necessary bills to the insurance company. Once the documents are found in order and the claim accepted by the insurer, the amount is paid to the customer by NEFT or Cheque.

Co-pay in health insurance refers to the percentage of the hospital bill that you need to pay from your own pocket. Copayment of 10% under the policy means customer has to pay 10% of the eligible claim amount (after the deduction of non-payable items). A co-payment does not reduce the Sum Insured.

A medical illness or injury that you have before you start a new health care plan considered as a “pre-existing condition.” Conditions like diabetes, COPD, cancer, and sleep apnea, may be examples of pre-existing health conditions.

Emergencies related to health can occur anytime irrespective of your age, gender & lifestyle. It is better to stay prepared for such instances rather than spending money out of your own pocket. Health insurance is a great risk management tool to prevents a medical emergency from turning into a financial emergency. Health insurance covers the medical expenses incurred by an insured person due to a sudden onset of illness or an accident. The individual health insurance plans are designed to cover a single policyholder for the entire limit of insurance taken by her/him. A family can take individual cover of say of 5 lacs for each member which means every insured person is covered for medical expenditures incurred up to this limit every year.

This insurance policy covers the costs of Hospitalisation and takes care of the expenses such as room rent, ICU charges, Doctor fees, Nursing fees, Blood, Oxygen, ambulance etc. However minimum 24 hours Hospitalisation is a must for the benefits of the policy to trigger.

The policy takes care of some admissible day care procedures which do not require 24 hours hospitaliation. Every insurance company has its own list of approved day care procedure. Some of the common examples are Cataract, Laparoscopic surgery which take just a few hours.

Any medical expenditure such as tests, scans, doctor consultation etc. incurred by the insured person just before the treatment and sometime after it, is allowed under the policies. Generally, the companies offer the coverage for medical expenses for 30-60 days before the date of Hospitalisation/Day care treatment and 60-90 days after the discharge Hospitalisations expenses. This period varies for different companies

Any pre-existing medical condition before taking a policy has to be mandatorily declared to the insurance company and if the proposal is accepted by the insurance company, the preexisting diseases are covered after four years of break free continuation of the policy. Some companies offer lower time limit say 3 years or even two years form covering preexisting diseases, but such polices tend to be more expensive or come at an extra premium.

Some insurers offer an enhanced limit on the existing cover either as bundled to the main product or offered at an extra premium. If availed, once the basic sum insured of the policy is exhausted (in special conditions), entire sum insured amount is restored or made available in the same year without any additional premium.

Following chart will explain the applicability of this additional cover

Condition Claim Admissible?
Following chart will explain the applicability of this additional cover No
Following chart will explain the applicability of this additional cover Yes

It is important to note that in most of the companies, this cover is triggered only once the base sum insured is fully exhausted.

Some policies offer you a yearly free medical check-up as a wellness promotion gesture. Here a health check-up, which may cost a customer in thousands in the market is given free of cost on a certain frequency depending on the insurer. One will certainly miss on this benefit if not insured.

Some policies offer to pay a lumpsum amount every day for the entire or part of the period of hospitalisation. This is not linked to medical expenditure and is meant to help the insured person take care of some out of pocket expenditures such as local conveyance, food for the attendant, etc. This may be an inbuilt cover, add on cover or can be separate policy altogether

To let the customers, plan their expenditures better, some of the policies offer maternity cover to a certain limit which eases your burden of expenses. In this coverage the medical expenses incurred towards hospitalisation due to maternity would be taken care. The maternity cover should definitely be opted by those who have got married recently and wish to have a children in the near future.

When a baby is born, everybody becomes busy in welcoming the new-born , praying for his health and wellbeing and celebrating the occasion. Some of them are prone to complications that might involve extensive hospitalisation for a few days, which can have financial implication for his parents. A pan having this covers is often a great a financial help.

  • Any claims within first 30 days from start of the cover
  • Hospitalisation for evaluation purposes.
  • OPD treatments.
  • Maternity and Childbirth expenses unless specifically covered by the policy
  • Dental expenses, except for Dental surgery required due to Accident
  • Any procedure which is for cosmetic purpose.
  • Rehabilitation for treatments, which get cures by rest
  • Unproven treatments like Acupressure, acupuncture etc.
  • Surgery for Correction of Eye Sight – Lasik, is not covered. Some companies offer to cover this only in the event of number correction in excess 15 Diopters
  • Accidents caused by hurting own-self, due to alcohol or drug abuse, adventure sports.
  • Treatment for psychosomatic, psychiatric disorders.
  • Treatment of HIV/AID's, Sexually transmitted diseases..
  • External Medical Equipment.
  • Genetic Disorders.
  • Treatment of Obesity.
  • Vaccination.
  • Service Charge, Registration Charge in a Hospital
  • Consumables such as Connton, bandages etc. unless specifically covered by the policy

Temporary exclusion includes cataract, hernia, piles, stone and sinusitis which are not covered in the first year of the policy but are covered in subsequent years

Pre-Existing diseases are covered usually after 4 years of the policy being in force depending on the policy terms and conditions.

If you have not made any claims over a period, then you are entitled to a higher sum assured in the subsequent year called ‘No Claim Bonus’.

The insurance companies generally have an intermediate healthcare provider called TPA or Third Party Administrators who bring an ease and speed especially for small claims settlement. Under a Cashless Facility customer having insurance can get treated under a network hospital of the insurer where bill are settled by the insurance companies directly.

This facility works very well for planned hospitalisation . The process can be summarized into the following steps

  • Presenting doctor’s recommendation to the Network hospital’s TPA/Insurance desk
  • TPA seeks approval from the insurance companies – Takes with 4 to 24 working hours depending on complexity of treatment.
  • The hospitals on confirmation from TPA start the treatment without charging to the customer.
  • Before Discharge TPA send the final bill to the insurer and the insurer approved their final liability to the hospital
  • Customer pays for the non-medical and consumables expenditures only.

* Some hospitals insist on security deposit from to initiate the treatment in case of emergency and this amount is later refunded back to the customer after discharge or the date hospital gets paid by the TPA whichever is later.

Health Insurance entitles you for tax deduction under section 80D of the Income Tax Act. An insured paying health insurance premium(s) for self, spouse, and dependent children through a mode other than cash is eligible to avail an annual deduction of Rs.25,000 from his/her taxable income. The same person can claim a deduction of Rs.30,000 for his / her senior citizens parents in case he is the proposer for them and also paying premium on their behalf.

A lifelong renewability feature enables you to renew your policy till the time one is alive. The insure is obliged to continue renewing the policy as long as premiums are paid on the policy within the due date. This is very effective especially for retired individuals, who may not have a major flow of income to support their medical emergencies. It also gets extremely difficult to get the health insurance cover on good terms especially once a person crosses the age of 60.

Any Insurance policy is issued on this principle. Both the policyholder and the insurer need to disclose all material and relevant information to each other before commencement of the insurance contract. The insures disclosed the exact terms of the contact through the sales brochures and/or the detailed insurance policy whereas the customer or the insured discloses the information relevant to the risk by filling up a proposal form.

The statements made by the proposer/insured are relied completely by the insurance Company in Good faith at the time of issuing the policy. However, if any information provided by the insured or the customer is found to be incorrect later, then the insurance company gets the right to cancel the policy and not pay any claim under this Principle.

Proposal form is the one of the most important document and statement about the risk being insured by the customer. The main information to be filled includes, Name, address, age, , education, occupation, general health, medical history and other information relevant to accept the risk

A pre-policy medical examination or check-up is a battery of tests and procedures that the prospective policyholder is required to undergo before the policy is accepted by the insurance company and health cover extended to him/her. These tests are generally required if the policyholder is above 45 years of age or the sum insured is on a higher side which required underwriting of the risk. This step also validates the information provided in the proposal form filled up by the customer.

Normally the policies having sum insured of 5 lacs and above have no per day room rent or ICU restriction. However as one moves to lower sum insured, insures generally put a 1% of sum insured as a Sub-limit to per day room rent and 2% sum limit on the ICU charges.

So, a 1% per day cap in a policy with a sum insured of Rs3 lakh means that the insurer will only pay Rs 3,000 per day towards the room rent.

In case of emergency or especially in the remote areas where prior approval or the network hospital is not available, the customer may incur the medical expense

You may claim the money for an admissible claim by sending the hospitalisation papers and necessary bills to the insurance company. Once the documents are found in order and the claim accepted by the insurer, the amount is paid to the customer by NEFT or Cheque.

Co-pay in health insurance refers to the percentage of the hospital bill that you need to pay from your own pocket. Copayment of 10% under the policy means customer has to pay 10% of the eligible claim amount (after the deduction of non-payable items). A co-payment does not reduce the Sum Insured.

A medical illness or injury that you have before you start a new health care plan considered as a “pre-existing condition.” Conditions like diabetes, COPD, cancer, and sleep apnea, may be examples of pre-existing health conditions.