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Health Insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. It provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses.

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Introduction

The term Health Insurance is used to describe a form of insurance that pays for medical expenses. It is used more broadly to include insurance that covers disability or long-term nursing or custodial care needs. In simple words, if you are covered under Health Insurance, you pay some amount of premium every year to an insurance company and if you have an accident or if you have to undergo an operation or a surgery, the insurance company will pay for the medical expenses.

Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly. The cost of health insurance premiums is deductible to the payer, and benefits received are tax-free.

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Types of Health Insurance Plan

Individual Mediclaim Plan

Individual Mediclaim plan is designed to suit all your health care needs. It takes care of the expensive medical treatment incurred during hospitalization resulting from serious illness or accident.

Your health is precious to you - it enables you to live your life the way you please. But a sudden illness or accident can put a stop to your way of living and empty your savings. Protect yourself with the Individual Mediclaim plan an all-round policy that covers you against medical expenses including hospitalization, in the event that you fall ill or have an accident. Now you don't ever have to worry about not having enough money for treatment in case things go wrong.

Family Floater Plan

In these times of rising medical costs, Family Floater Plan is the perfect health protection for you and your family. It takes care of the expensive medical treatment incurred during hospitalization resulting from serious illness or accident.

You want to protect your family, but rising medical expenses mean that an unforeseen accident or illness can put your savings and their future in jeopardy. Protect your family with the Family Floater plan and this all-round health insurance policy covers you and your family against medical expenses such as hospitalization, doctor's consultation, diagnostic tests, medicines, ambulance, etc. Now you never have to worry about running out of cash when it comes to your family's treatment.

A family floater plan providing health care solution to the proposer and his / her family under one sum insured under one policy. The sum insured floats over all the beneficiaries under this policy.

Senior Citizen Plan

Health care costs are high and getting higher. As the age of an individual increases, the health care costs increase manifold and become a burden on the individual. Senior citizens have to pay out of their hard-earned savings to meet the expenses. Health Insurance Plan for senior citizens protects you and your spouse in case you need expensive medical care.

The Indian health insurance market for senior citizens has grown and there are many companies that offer policies. Whatever the outcome, taking a policy for health is a great investment for elderly; though the premiums to be paid may be a higher than normal. A medical insurance for senior citizens provides such individuals with financial benefits besides offering monetary help in case of unforeseen medical emergencies. A health insurance policy empowers an elderly person to go for health check-ups, financial help during emergency health problems as well as long-term medical treatment. The policyholder enjoys tax benefits for premiums up to a certain level under Section 80D of the Income Tax Act. A good number of insurance companies in India are trying to overcome the challenges concerning the senior citizens.

Group Health Insurance Plan

In our day to day lives, we are exposed to many risks associated either with Accidents or Illnesses. And with the ever increasing costs associated with Hospitalization, it can mean a drain on your precious savings. With the Group Mediclaim Policy, you can provide your employees/members the optimum cover they require. Employees are the treasured elements of any institution, as they are an integral part of it. They are the core functioning members of an institution and their health is of prime importance. Staying healthy and protected in our busy world today is expensive, and that's where we need first health insurance.

Health of the employee is one of the major issues in today's highly competitive work environment. The employer must take the initiative to free the employee, from worries of an extremely costly medical treatment for their families and themselves. Taking care of the wellbeing of the employee and their family is the best work incentive that an employer can provide. The employer can provide the employees to lead a healthy, peaceful and successful life with the help of employee health Insurance plan.

Group Health insurance is issued without medical examination. Group insurance ensures that all the members of the group are insured regardless of their age, occupation and health status.

Critical Illness Plan

When a major illness strikes, it not only means large costs for medical care but it also puts immense pressure on the family to manage their living expenses while the patient recoups. In such a situation your Critical Illness insurance can come to your aid by not only covering hospitalization expenses but also providing you with lump sum compensation that can help you meet your day to day expenses like child's school fees, Car and House EMIs, credit card payments etc.

Critical Illness insurance covers you in the event you are diagnosed with any of the 20 critical illnesses covered. Upon diagnosis and a survival period of 30 days, the insurance company will pay you a lump sum compensation equivalent to the sum insured of your plan. You can use this money as you wish, to cover your medical bills or maintain your family.

Personal Accident Insurance Plan

Accidents are unforeseen and inevitable. Such mishaps take only seconds to turn life upside down. Moreover, the impact is felt on the emotional as well as financial grounds. It can even drain your lifetime savings, leaving your family in a difficult situation without resources or help. Hence, securing your family's future & enabling their basic day-to-day needs in your absence becomes utmost priority for you.

A Personal Accident Insurance ensures the financial stability for you and your family in the event of an accident. The policy covers death of individual, physical injuries and bodily burns. Personal Accident Insurance ensures you and your family's financial security at the hour of need. Death, Permanent Total Disability, Temporary Total Disability, Broken Bones, Burns and Ambulance costs are covered under the policy. The personal accident insurance plan can also be extended to include your entire family under a single policy. Personal Accident Insurance Policy ensures your protection across the boundaries.

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Facilities

Top Up of Health Insurance

The Health Insurance Top Up is a plan to enhance your current health insurance, providing you with better coverage and greater benefits. The health insurance top up plan ensures that you get an improved policy at an affordable premium, making it a more durable option to choose. Opting for a medical insurance top up can give you a wider coverage at a much lesser costs.

Health Insurance Top Up is what you can turn to when you feel you want more from your medical insurance policy. A top up plan supplements your primary health insurance cover. Additional coverage at low costs means that a health insurance top up plan is exactly what you may be looking for.

It supplements your existing mediclaim policy, insuring you for a larger sum insured limit at lower cost. You can stay covered for the whole life since there is no-exit age.

Why does everyone need a Top Up plan for Health Insurance?

Health insurance will protect you and your family against any financial contingency arising due to a medical emergency. However a top up plan on your base policy is of equal importance due to various reasons…

  • It supplements your existing medical insurance
  • It covers you against medical emergency in case of exhaustion of your basic cover.
  • It covers you against medical emergency in case of change in job.
  • It supplements your savings when the treatment costs exceed your saving.

Is there any tax exemption under the policy?

Yes, you can avail upto Rs.15,000 as tax benefit under 'Section 80D'. In case of senior citizens, you can avail upto Rs.20,000 as tax benefit under 'Section 80D'.

Portability of Health Insurance

When you change your health insurance policy from one insurance company to another, you don't have to lose the benefits that you have accumulated. In the past in health insurance policies, such a move resulted in your losing benefits like the waiting period for covering "Pre-existing Diseases". Now IRDA protects you by giving you the right to port your policy to any other insurer of your choice. It has laid down that your new insurer shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period. This applies not only when you move from one insurer to another but also from one plan to another with the same insurer.

Rights

  • You can port your policy from and to any general insurance company or specialized    health insurance company.
  • You can port any individual / family policies.
  • Your new insurer will give you the credit relating to waiting period for
       pre-existing conditions that you have gained with the old insurer.
  • Your new insurer will insure you at least up to the sum insured under the old    policy.
  • The two insurers will complete the porting as per the timelines prescribed by the    IRDA.

Conditions

  • You can port the policy only at the juncture of renewal. That is, the new    insurance period will be with the new insurance company
  • Apart from the waiting period credit, all other terms of the new policy including    the premium are at the discretion of the new insurance company
  • At least 45 days before your renewal is due, you have to

    • Write to your old insurance company requesting a shift.
    • Specify company to which you want to shift the policy.
    • Renew your policy without a break (there is a 30 day grace period if porting    is under process).
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Third Party Administrator

About Third Party Administrator

The Third Party Administrators (TPAs) are intermediaries who connect insurance companies, policyholders and health care providers. Once the policy has been issued, all the records will be passed on to the TPAs and all further correspondence of the insured will be with the TPAs and not with the insurance companies.

With the advent of TPA, the insurance companies aim at ensuring higher efficiency, standardization of charges, greater awareness and penetration of health insurance to a larger section of the people. The TPA undoubtedly aims to give the health insurance industry the required boost in India.

Services of TPA

The services provided by TPA are as follows:

  • TPAs provide ID cards to all their policyholders in order to validate their identity    at the time of admission.
  • TPAs undertake pre-authorization before a surgical procedure to ease claim    processing.
  • TPAs provide assistance through their 24 hours call center that provides   information regarding policyholder's data, provider network, claim status,    benefits available with existing cardholder, etc. and all these details are furnished    on request.
  • Each policyholder is provided with a list of empanelled hospitals where in he/she    can avail cashless hospitalization.
  • On behalf of the insurance companies TPA administers and settles claims for    hospitals and policyholders.

Functions of TPA

The specialized functions of the TPA include:

  • The TPA keeps and maintains all the records of medical insurance policies of an    insurer.
  • The TPA issues identity cards to all the policyholders. The policyholders will have    to show the identity cards to the hospital authorities before availing any services    from the hospital.
  • In case of a claim, policyholders will have to inform the TPA on a 24 hour toll-free    line provided by them.
  • After informing the TPA, the policyholder will be directed to a hospital where the   TPA has a tied up arrangement. However, policyholders have the option to be   admitted at another hospital of their choice in which case, payment will be on    reimbursement basis.
  • TPA pays for the treatment; they issue an authorization letter to the hospital for    the admission of the policyholder in the hospital.
  • At the point of discharge, all the bills will be sent to the TPA while they are    tracking the case of the insured at the hospital.
  • TPA makes the payment to the hospital.
  • TPA sends all the documents necessary for consideration of claims, along with the    bills to the insurance company.
  • The insurance company then reimburses the TPA.

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Claims Settlement Process

Cashless

For planned hospitalization at authorized network hospitals, the TPA has to be notified in advance for availing cashless treatment or within the stipulated time limits for emergencies. The insurance desk at hospitals will generally help with all the paper work. The TPA has to approve the claim amount and the hospital settles the amount with the TPA / Insurer. There will be exclusions which will have to be settled directly at the hospital by the insured.

Reimbursement

Reimbursement facility can be availed at both the network and non-network hospitals. The hospital bills are directly settled at the hospital after the insured avails the treatment. The insured can then claim reimbursement for hospitalization by submitting relevant bills / documents for the paid amount to the TPA.

There are also some health insurance providers who do not employ TPAs and manage claims settlement directly which is called In-House TPA.

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Our Health Insurance Partners

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