PERSONAL FINANCE FINANCIAL PLANNING
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No one should have to choose between medicine and other necessities. No one should have to use the emergency room every time a child gets sick. And no one should have to live in constant fear that a medical problem will become a financial crisis.
- Brad Henry |
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TO KNOW THE LATEST GUIDELINES OF IRDAI ON HEALTH INSURANCE , CLICK HERE
CASHLESS EVERWHERE
TERMS & CONDITIONS FOR EXTENDING " CASHLESS EVERYWHERE " SCHEME :
Dated 28.01.2024 : In order to ease the burden of policyholders who get treated in a hospital not in the network of the Insurance Company, the General Insurance Council, in consultation with all the General and Health Insurance Companies, is launching the “Cashless Everywhere” initiative. Under Cashless Everywhere, the policyholder can get treated in any hospital they choose, and a cashless facility will be available even if such a hospital is not in the network of the Insurance Company. For availing the facility , the policyholders have to comply with the following terms & conditions generally :
1. For Planned Admission, the assigned TPA should receive the Intimation about the Planned Admission at least 48 hours prior to the proposed date of admission. The Intimation should be sent by email to the TPA mentioned in your policy.
2. For Emergency Admission, the assigned TPA should receive the Request for Cashless Facility in the Prescribed Form at least within 48 hours after the time of admission.
3. The Hospital where the treatment is to be taken should meet the requirements of the Policy T & C as well as the insurance Company’s internal guidelines.
4. Cashless Facility would be available only if the treatment is found admissible under the terms of the Policy.
5. The Request for Cashless Facility (in the Prescribed format) should be completed and signed by the Insured Person and the Hospital and submitted with all the requisite documents including a copy of the Insured Person’s Identification.
6. The Request for Cashless Facility should be sent to TPA by email as mentioned in the policy.
7. Hospitals which are not in the Company’s Network should provide the Letter of Consent to extend Cashless Facility.
8. Insurance Companies reserves the right to reject the request for Cashless Facility. If Cashless facility is denied, the Customer may submit the papers for claiming under reimbursement basis on completion of the treatment, and admissibility of the claim would be subject to the terms of the Policy.
9. In case of any query , one may contact the TPA mentioned in the policy.
10 . Any other condition may be stipulated by a specific insurance company
Dated 28.01.2024 : In order to ease the burden of policyholders who get treated in a hospital not in the network of the Insurance Company, the General Insurance Council, in consultation with all the General and Health Insurance Companies, is launching the “Cashless Everywhere” initiative. Under Cashless Everywhere, the policyholder can get treated in any hospital they choose, and a cashless facility will be available even if such a hospital is not in the network of the Insurance Company. For availing the facility , the policyholders have to comply with the following terms & conditions generally :
1. For Planned Admission, the assigned TPA should receive the Intimation about the Planned Admission at least 48 hours prior to the proposed date of admission. The Intimation should be sent by email to the TPA mentioned in your policy.
2. For Emergency Admission, the assigned TPA should receive the Request for Cashless Facility in the Prescribed Form at least within 48 hours after the time of admission.
3. The Hospital where the treatment is to be taken should meet the requirements of the Policy T & C as well as the insurance Company’s internal guidelines.
4. Cashless Facility would be available only if the treatment is found admissible under the terms of the Policy.
5. The Request for Cashless Facility (in the Prescribed format) should be completed and signed by the Insured Person and the Hospital and submitted with all the requisite documents including a copy of the Insured Person’s Identification.
6. The Request for Cashless Facility should be sent to TPA by email as mentioned in the policy.
7. Hospitals which are not in the Company’s Network should provide the Letter of Consent to extend Cashless Facility.
8. Insurance Companies reserves the right to reject the request for Cashless Facility. If Cashless facility is denied, the Customer may submit the papers for claiming under reimbursement basis on completion of the treatment, and admissibility of the claim would be subject to the terms of the Policy.
9. In case of any query , one may contact the TPA mentioned in the policy.
10 . Any other condition may be stipulated by a specific insurance company
NEW REGULATIONS DRAFTED :
Many changes are in the offing , No entry age limit
Pre-existing period to be reduced to 36 months
You may chose insurance company on which you
submit claims , if you have more than one policy
Dated 22.12.2023 : The IRDAI , in July , 2022 constituted a Regulation Review Committee (RRC) comprising representatives from all stakeholder groups for simplifying regulations of various insurance schemes including that of health insurance
Now the RRC has recommended new set of regulations called " Insurance Regulatory and Development Authority of India (Insurance Products) Regulations, 2023 " where is new set of regulations are drafted even for the health insurance schemes . On implementation ,
" IRDAI (Health Insurance) Regulations, 2016 " will be repealed .
After considering the recommendations of the RRC and also keeping the interest of the policyholders, the draft on Insurance Regulatory and Development Authority of India (Insurance Products) Regulations, 2023 has been prepared wherein Schedule III relates Specific Provisions applicable to Health Insurance products
One may go through the draft regulations and forward their comments / suggestions, if any, on the proposed regulations (Annexure-A) in the attached format (Annexure- B) on or before 5:00 PM on 03 January, 2024 to actuarial-policy@irdai.gov.in with a copy to urmi.jain@irdai.gov.in and narendra@irdai.gov.in. *
Some of the highlights of new health insurance regulations proposed :
1. CLASSIFICATION : Health Insurance products are classified into Indemnity/benefit based policies on the basis of type of product and Individual/Group products on the basis of market segment as specified by the Authority .
i. Indemnity based health insurance policy means an insurance policy that compensates an insured for the loss due to occurrence of a covered event up to the limit specified in the policy.
ii. Benefit based health insurance policy means an insurance policy that pays fixed amount on the occurrence of a covered event as specified in the policy.
2. WHO CAN ISUE HEALTH INSURANCE POLICY AND HOW LONG ?
A. Life Insurers may offer long term Individual Health Insurance products i.e., for term of 5 years or more. Life insurers may also offer cashless claims settlement facility on authorisation of the policyholder or the nominee. Provided that a life insurer shall not offer indemnity based products either Individual or Group.
B General Insurers and Health Insurers may offer individual health products with a maximum tenure of three years.
C. . Group health products can be offered with a maximum term of one year except the credit linked products where the term can be extended up to the loan period not exceeding five years.
D . Overseas or Domestic Travel Insurance policies may only be offered by General Insurers and Health Insurers,
3. PRICING : Premium shall remain unchanged for the policy tenure in respect of policies issued for a period up to three years. Insurers may offer facility of premium payment in instalment With respect to the policies issued for period beyond three years, the premium shall remain unchanged for first three years and subsequently insurers may review the pricing based on product experience, if required. .
In order to encourage entry into health insurance at an early age, insurers shall take due cognizance of entry at younger ages with continuous renewals thereafter.
4. PERIOD OF INSURANCE : General Insurers and Health Insurers may offer individual health products with a maximum tenure of three years. .Group health products can be offered with a maximum term of one year except the credit linked products where the term can be extended up to the loan period not exceeding five years.
5. ENTRY AGE : There shall not be any restriction on entry based on age in health insurance covers.
6. FREE LOOK PERIOD :
(i) All new individual health insurance policies issued by Life Insurers, General Insurers and Health Insurers, except those with tenure of less than a year shall have a free look period. The free look period shall be applicable at the inception of the policy and
(1) The insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable.
(2) If the insured has not made any claim during the free look period, the insured shall be entitled to--
(a) A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the stamp duty charges or;
(b) where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or;
(c)Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period.
7. PRE-EXISTING DISEASES : Health Insurance products shall cover pre-existing diseases either disclosed or undisclosed by the persons to be insured, immediately after the expiry of the 36 months or waiting period or such lower period as stipulated in the product. Insurers may endeavor to have lower pre-existing disease waiting period and specific waiting period in the health insurance products.
8. RENEWAL A health insurance policy shall be renewable except on grounds of established fraud, moral hazard or misrepresentation by the insured, provided the policy is not withdrawn.
(b) An insurer shall not deny the renewal of a health insurance policy on the ground that the insured had made a claim or claims in the preceding policy years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policy.
(c) The insurer shall provide for a mechanism to condone a delay in renewal up to the grace period from the due date of renewal without considering such condonation as a break in policy.
(d) For Individual products, the loadings on renewal shall be at entire portfolio and not on any individual policy claim experience. However, discount in premium may be provided by insurers to individual policyholders for good claims experience.
(e) No Insurer shall resort to fresh underwriting by calling for medical examination, fresh proposal form etc. at renewal stage where there is no change in Sum Insured offered. Provided that where there is an improvement in the risk profile, the Insurer may endeavor to recognize that for removal of loadings at the point of renewal.
9 . MIGRATION AND PORTABILITY :
General insurers and health insurers offering indemnity based health insurance policy shall offer an option to the policyholders to migrate to a suitable alternative health insurance policy available at the time of modification or withdrawal of the policy. Further, indemnity based health insurance policy offered to specific age groups such as senior citizens, students, children under family floater policies, shall also offer an option to such lives to migrate to a suitable alternative health insurance policy available at the specific exit age.
All health insurance policies issued by General and Health Insurers shall allow the migration and portability of policies.
5. MULTIPLE POLICIES :
In case of multiple benefit based health insurance policies which provide fixed benefits, each insurer shall make the claim payments independent of payments received under other similar polices.
b) If two or more indemnity based health insurance policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies.
(i) In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.
(ii) Where the insured has multiple indemnity based health insurance policies, ordinarily, the insured is entitled to claim for treatment cost incurred only under one policy. However, claim or claims disallowed under the earlier chosen policy/policies due to sum insured being inadequate or any other reason may be made from the other policy/policies, if admissible under the other policy/policies.
6. SENIOR CITIZENS :
All Insurers and the TPAs representing the insurers, shall establish a separate channel to address the health insurance related claims and grievances of senior citizens. The details of such channel shall be available in the website of the Insurers
Many changes are in the offing , No entry age limit
Pre-existing period to be reduced to 36 months
You may chose insurance company on which you
submit claims , if you have more than one policy
Dated 22.12.2023 : The IRDAI , in July , 2022 constituted a Regulation Review Committee (RRC) comprising representatives from all stakeholder groups for simplifying regulations of various insurance schemes including that of health insurance
Now the RRC has recommended new set of regulations called " Insurance Regulatory and Development Authority of India (Insurance Products) Regulations, 2023 " where is new set of regulations are drafted even for the health insurance schemes . On implementation ,
" IRDAI (Health Insurance) Regulations, 2016 " will be repealed .
After considering the recommendations of the RRC and also keeping the interest of the policyholders, the draft on Insurance Regulatory and Development Authority of India (Insurance Products) Regulations, 2023 has been prepared wherein Schedule III relates Specific Provisions applicable to Health Insurance products
One may go through the draft regulations and forward their comments / suggestions, if any, on the proposed regulations (Annexure-A) in the attached format (Annexure- B) on or before 5:00 PM on 03 January, 2024 to actuarial-policy@irdai.gov.in with a copy to urmi.jain@irdai.gov.in and narendra@irdai.gov.in. *
Some of the highlights of new health insurance regulations proposed :
1. CLASSIFICATION : Health Insurance products are classified into Indemnity/benefit based policies on the basis of type of product and Individual/Group products on the basis of market segment as specified by the Authority .
i. Indemnity based health insurance policy means an insurance policy that compensates an insured for the loss due to occurrence of a covered event up to the limit specified in the policy.
ii. Benefit based health insurance policy means an insurance policy that pays fixed amount on the occurrence of a covered event as specified in the policy.
2. WHO CAN ISUE HEALTH INSURANCE POLICY AND HOW LONG ?
A. Life Insurers may offer long term Individual Health Insurance products i.e., for term of 5 years or more. Life insurers may also offer cashless claims settlement facility on authorisation of the policyholder or the nominee. Provided that a life insurer shall not offer indemnity based products either Individual or Group.
B General Insurers and Health Insurers may offer individual health products with a maximum tenure of three years.
C. . Group health products can be offered with a maximum term of one year except the credit linked products where the term can be extended up to the loan period not exceeding five years.
D . Overseas or Domestic Travel Insurance policies may only be offered by General Insurers and Health Insurers,
3. PRICING : Premium shall remain unchanged for the policy tenure in respect of policies issued for a period up to three years. Insurers may offer facility of premium payment in instalment With respect to the policies issued for period beyond three years, the premium shall remain unchanged for first three years and subsequently insurers may review the pricing based on product experience, if required. .
In order to encourage entry into health insurance at an early age, insurers shall take due cognizance of entry at younger ages with continuous renewals thereafter.
4. PERIOD OF INSURANCE : General Insurers and Health Insurers may offer individual health products with a maximum tenure of three years. .Group health products can be offered with a maximum term of one year except the credit linked products where the term can be extended up to the loan period not exceeding five years.
5. ENTRY AGE : There shall not be any restriction on entry based on age in health insurance covers.
6. FREE LOOK PERIOD :
(i) All new individual health insurance policies issued by Life Insurers, General Insurers and Health Insurers, except those with tenure of less than a year shall have a free look period. The free look period shall be applicable at the inception of the policy and
(1) The insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable.
(2) If the insured has not made any claim during the free look period, the insured shall be entitled to--
(a) A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the stamp duty charges or;
(b) where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or;
(c)Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period.
7. PRE-EXISTING DISEASES : Health Insurance products shall cover pre-existing diseases either disclosed or undisclosed by the persons to be insured, immediately after the expiry of the 36 months or waiting period or such lower period as stipulated in the product. Insurers may endeavor to have lower pre-existing disease waiting period and specific waiting period in the health insurance products.
8. RENEWAL A health insurance policy shall be renewable except on grounds of established fraud, moral hazard or misrepresentation by the insured, provided the policy is not withdrawn.
(b) An insurer shall not deny the renewal of a health insurance policy on the ground that the insured had made a claim or claims in the preceding policy years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policy.
(c) The insurer shall provide for a mechanism to condone a delay in renewal up to the grace period from the due date of renewal without considering such condonation as a break in policy.
(d) For Individual products, the loadings on renewal shall be at entire portfolio and not on any individual policy claim experience. However, discount in premium may be provided by insurers to individual policyholders for good claims experience.
(e) No Insurer shall resort to fresh underwriting by calling for medical examination, fresh proposal form etc. at renewal stage where there is no change in Sum Insured offered. Provided that where there is an improvement in the risk profile, the Insurer may endeavor to recognize that for removal of loadings at the point of renewal.
9 . MIGRATION AND PORTABILITY :
General insurers and health insurers offering indemnity based health insurance policy shall offer an option to the policyholders to migrate to a suitable alternative health insurance policy available at the time of modification or withdrawal of the policy. Further, indemnity based health insurance policy offered to specific age groups such as senior citizens, students, children under family floater policies, shall also offer an option to such lives to migrate to a suitable alternative health insurance policy available at the specific exit age.
All health insurance policies issued by General and Health Insurers shall allow the migration and portability of policies.
5. MULTIPLE POLICIES :
In case of multiple benefit based health insurance policies which provide fixed benefits, each insurer shall make the claim payments independent of payments received under other similar polices.
b) If two or more indemnity based health insurance policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies.
(i) In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.
(ii) Where the insured has multiple indemnity based health insurance policies, ordinarily, the insured is entitled to claim for treatment cost incurred only under one policy. However, claim or claims disallowed under the earlier chosen policy/policies due to sum insured being inadequate or any other reason may be made from the other policy/policies, if admissible under the other policy/policies.
6. SENIOR CITIZENS :
All Insurers and the TPAs representing the insurers, shall establish a separate channel to address the health insurance related claims and grievances of senior citizens. The details of such channel shall be available in the website of the Insurers
PREMIUMS FOR HEALTH INSURANCE POLICIES : COMPARE BEFORE BUYING
05.08.2020 : To buy a Health insurance policy , you have to pay a fee called premium to the insurance company affront . Now IRDAI has allowed the monthly / quarterly / half yearly payment on the policies . Each insurance policy carries its own premium to be paid for a person of particular age . As each insurance policy was differing in coverage / inclusions / exclusions / co-pay / pre-existing diseases coverage / waiting period etc , it was difficult to compare the premiums of two policies even when the covered amount is same .
Bu during the the last six months , Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with three standard policies to be mandatorily issued by all general and health insurance companies that deal in Health insurance . The three policies are
1. Arogya Sanjeevani Policy 2. Corona Kavach Policy . 3 Corona Rakshak Policy .
Terms of each policy is well defined by IRDAI and hence will carry the same features for the policies issued by different insurance companies . However they are free to quote premiums as they wish and hence IRDAI does not control the premiums to be paid by the customers . Yet it was expected that the premiums would be in the same range for a particular policy for a person of particular age .
To check how the premiums are quoted by different insurers , we compared premiums quoted by six insurance companies for each of the above policy . To our surprise , we found that the variations were huge and some times some companies quoted 10 times the premium quoted by another company for the same coverage . If the variation is so huge among just 6 companies , you can imagine the difference of premium you get if you look in to more and more insurance companies. To go through our survey on premiums , click below on each of the insurance plans .
1. Arogya Sanjeevani Policy Premiums
2. Corona Kavach Policy Premiums
3 Corona Rakshak Policy Premiums
Once you go through the above articles , you will come to know the actual variation in premium of each policy issued by various insurers .
Now it becomes necessary for you to get quotes from as many as possible companies before deciding on a insurance policy . Otherwise you will end up with paying a huge premium .
05.08.2020 : To buy a Health insurance policy , you have to pay a fee called premium to the insurance company affront . Now IRDAI has allowed the monthly / quarterly / half yearly payment on the policies . Each insurance policy carries its own premium to be paid for a person of particular age . As each insurance policy was differing in coverage / inclusions / exclusions / co-pay / pre-existing diseases coverage / waiting period etc , it was difficult to compare the premiums of two policies even when the covered amount is same .
Bu during the the last six months , Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with three standard policies to be mandatorily issued by all general and health insurance companies that deal in Health insurance . The three policies are
1. Arogya Sanjeevani Policy 2. Corona Kavach Policy . 3 Corona Rakshak Policy .
Terms of each policy is well defined by IRDAI and hence will carry the same features for the policies issued by different insurance companies . However they are free to quote premiums as they wish and hence IRDAI does not control the premiums to be paid by the customers . Yet it was expected that the premiums would be in the same range for a particular policy for a person of particular age .
To check how the premiums are quoted by different insurers , we compared premiums quoted by six insurance companies for each of the above policy . To our surprise , we found that the variations were huge and some times some companies quoted 10 times the premium quoted by another company for the same coverage . If the variation is so huge among just 6 companies , you can imagine the difference of premium you get if you look in to more and more insurance companies. To go through our survey on premiums , click below on each of the insurance plans .
1. Arogya Sanjeevani Policy Premiums
2. Corona Kavach Policy Premiums
3 Corona Rakshak Policy Premiums
Once you go through the above articles , you will come to know the actual variation in premium of each policy issued by various insurers .
Now it becomes necessary for you to get quotes from as many as possible companies before deciding on a insurance policy . Otherwise you will end up with paying a huge premium .
TO KNOW ALL ABOUT
AROGYA SANJEEVANI PLAN ,
A STANDARD HEALTH INSURANCE POLICY TO BE ISSUED BY ALL INSURANCE COMPANIES , CLICK HERE
PLAN N PROGRESS COMPARES
RETIREE BANKERS HEALTH INSURANCE -
IBA GROUP INSURANCE VERSUS AROGYA SANJEEVANI PLAN
AROGYA SANJEEVANI PLAN ,
A STANDARD HEALTH INSURANCE POLICY TO BE ISSUED BY ALL INSURANCE COMPANIES , CLICK HERE
PLAN N PROGRESS COMPARES
RETIREE BANKERS HEALTH INSURANCE -
IBA GROUP INSURANCE VERSUS AROGYA SANJEEVANI PLAN
READ OUR ARTICLES ON TOPICS IN HEALTH INSURANCE
COVID INSURANCE FLOATER POLICIES SENIOR CITIZENS INSURANCE
LATEST AROGYA SANJEEVANI PLAN HOSPITAL CASH PLANS
COVID INSURANCE FLOATER POLICIES SENIOR CITIZENS INSURANCE
LATEST AROGYA SANJEEVANI PLAN HOSPITAL CASH PLANS
NEW ARTICLE
SECURING HEALTH FOR SENIOR CITIZENS
WITH OR WITHOUT ENTRY AGE RESTRICTION
TO READ THE ARTICLE CLICK HERE
TO GET ANSWERS FOR FAQs on MANAGEMENT OF POLICIES , CLICK HERE
SECURING HEALTH FOR SENIOR CITIZENS
WITH OR WITHOUT ENTRY AGE RESTRICTION
TO READ THE ARTICLE CLICK HERE
TO GET ANSWERS FOR FAQs on MANAGEMENT OF POLICIES , CLICK HERE
TITBITS : From a recent report of Sample Survey Office , it is revealed that 80 percent of Indians , who mainly rely up on private health care , do not have any medical insurance . The government has brought only about 12 % of population under health protection schemes like Rashtriya Swasthya Bima Yojana . In the absence of health insurance , 75 % of Indians use their hard earned savings while 18% have to borrow . In order to escape from financial gloom in the events of medical emergencies , one has to definitely require some form of Health insurance .
PLAN YOUR HEALTH INSURANCE PRUDENTLY
MEDICAL INSURANCE - Basics
What is covered under Health Insurance Policy ?
A Medical Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
e. Ambulance charges
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
For the list of TPA approved by IRDAI , CLICK HERE
What is covered under Health Insurance Policy ?
A Medical Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
e. Ambulance charges
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
For the list of TPA approved by IRDAI , CLICK HERE
KNOW ABOUT TAX ON RETIREMENT BENEFITS , CLICK HERE
FOR INCOME TAX NEWS , CLICK HERE NEWS ON INTEREST RATES CLICK HERE
ARTICLE ON INVESTMENT OPTIONS FOR RETIREES , CLICK HERE WHAT IS SYSTEMATIC INVESTMENT PLAN ? CLICK HERE
NEW ARTICLES ON
SMALL FINANCE BANKS PAYMENT BANKS
UNIFIED PAYMENT INTERFACE BHARAT BILL PAYMENT SYSTEM
BHIM APP AADHAR
e-INSURANCE Account ( eIA )
WHAT IS NEW ON PLAN N PROGRESS ?
FOR INCOME TAX NEWS , CLICK HERE NEWS ON INTEREST RATES CLICK HERE
ARTICLE ON INVESTMENT OPTIONS FOR RETIREES , CLICK HERE WHAT IS SYSTEMATIC INVESTMENT PLAN ? CLICK HERE
NEW ARTICLES ON
SMALL FINANCE BANKS PAYMENT BANKS
UNIFIED PAYMENT INTERFACE BHARAT BILL PAYMENT SYSTEM
BHIM APP AADHAR
e-INSURANCE Account ( eIA )
WHAT IS NEW ON PLAN N PROGRESS ?
Additional Benefits and other Riders
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER SECTION 80D OF INCOME TAX ACT
Deduction allowed on Medicliam Policies under 80 D is Rs. 50,000/- for senior citizens and up to Rs. 25,000/- for others from the financial year 2018-19 . For senior citizens , if no insurance amount is paid , hospital expenditure up to Rs 50,000 is allowed . An assessee can claim additional Rs 50,000 for his / her parents if they are senior citizens and Rs 25,000 in other cases . Overall claim cannot exceed Rs 1,00,000 . All payments should have been made in any mode other than cash . Cost of preventive health check up up to Rs 5,000 can be claimed within the overall limit and it could have been made in cash also .
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER SECTION 80D OF INCOME TAX ACT
Deduction allowed on Medicliam Policies under 80 D is Rs. 50,000/- for senior citizens and up to Rs. 25,000/- for others from the financial year 2018-19 . For senior citizens , if no insurance amount is paid , hospital expenditure up to Rs 50,000 is allowed . An assessee can claim additional Rs 50,000 for his / her parents if they are senior citizens and Rs 25,000 in other cases . Overall claim cannot exceed Rs 1,00,000 . All payments should have been made in any mode other than cash . Cost of preventive health check up up to Rs 5,000 can be claimed within the overall limit and it could have been made in cash also .
ISSUERS OF HEALTH COVERS
Mediclaim policies are issued by specialized Health / Medical Insurance companies , Life Insurers as well as General Insurers .
To get the list and visit their websites , Click Here
Mediclaim policies are issued by specialized Health / Medical Insurance companies , Life Insurers as well as General Insurers .
To get the list and visit their websites , Click Here
What is not covered in Health insurance ?
What is not covered in a policy ?
We would have bought medical insurance by paying substantial premium . When we submit our claims , we would be shocked to learn that our claim is rejected or substantially reduced as the policy doesn't cover the illness / treatment we have undergone . Hence we should carefully go through the policy document while / before purchasing an insurance to know what the health insurance covers and what is not covered .
Each policy has its own sets of inclusions and exclusions and we give below some general exclusions which are normally covered in an insurance policy . But carefully study the policy document while purchasing the health insurance .
General Exclusions :
a. All pre-existing diseases . But some policies allow after certain lapse pf period called waiting period which is between 24 to 60 months . Many policies will also not cover the new ailments arising out of pre-existing conditions . Even if they allow , some policies would have limited the cover to certain percentage .
As per IRDAI GUIDELINES ( click here to read the IRDAI CIRCULAR )
Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prosthetic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders. Some policies do not allow treatment for certain diseases like cataract for a period of 24 months to 48 months , even when it was not a pre-existing condition.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
j. Cosmetic procedure / Fertility treatment
k. Off-label medicines
l. Health issues on account of war , radiations etc .
Further some policy require prior authorization from them before hospitalizations for certain types of ailments .
Hence as a precaution , go through the policy while buying a health policy and follow the procedure / terms & conditions while undergoing a treatment and making a claim . Normally insurance companies offer a free- look period of say 15 days after issue of the policy . If you are not satisfied with the policy terms , you may surrender the policy and look for a fresh policy .
We would have bought medical insurance by paying substantial premium . When we submit our claims , we would be shocked to learn that our claim is rejected or substantially reduced as the policy doesn't cover the illness / treatment we have undergone . Hence we should carefully go through the policy document while / before purchasing an insurance to know what the health insurance covers and what is not covered .
Each policy has its own sets of inclusions and exclusions and we give below some general exclusions which are normally covered in an insurance policy . But carefully study the policy document while purchasing the health insurance .
General Exclusions :
a. All pre-existing diseases . But some policies allow after certain lapse pf period called waiting period which is between 24 to 60 months . Many policies will also not cover the new ailments arising out of pre-existing conditions . Even if they allow , some policies would have limited the cover to certain percentage .
As per IRDAI GUIDELINES ( click here to read the IRDAI CIRCULAR )
Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prosthetic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders. Some policies do not allow treatment for certain diseases like cataract for a period of 24 months to 48 months , even when it was not a pre-existing condition.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
j. Cosmetic procedure / Fertility treatment
k. Off-label medicines
l. Health issues on account of war , radiations etc .
Further some policy require prior authorization from them before hospitalizations for certain types of ailments .
Hence as a precaution , go through the policy while buying a health policy and follow the procedure / terms & conditions while undergoing a treatment and making a claim . Normally insurance companies offer a free- look period of say 15 days after issue of the policy . If you are not satisfied with the policy terms , you may surrender the policy and look for a fresh policy .
TIPS FOR BUYING MEDICLAIM POLICIES
1. Various Insurance companies offer health / mediclaim Policies . But the terms , diseases covered and premiums vary . Hence first write down your needs like whether you have parents & children to be covered , Medical history of your family members , and the amount of coverage you require . Please remember the medical costs are increasing year after year and what looks like suffice today may not cover fraction of your requirement after 5 years . Hence keep cushion while having the amount fixed .
2. You check the hospitals in your city , especially which are convenient to you , are covered under cashless facility by TPA .
3. Compare the premiums from three or four insurance companies for the least . and you can find huge variation from company to company and chose the one which suits your budget and requirements .
4. Floaters policies covering all the members of your family are cheaper than taking individual policies and hence get a policy which can cover your family members .
5. Check whether premiums are kept at the same level as offered for at least for few years . Otherwise every year you will have to pay higher demanded premiums .
6. Check up to what your age the policy will cover . There are policies which cover up o maximum age of 80 years . Otherwise at the ripe age when you require insurance , umbrella of insurance would be removed .
7. Check towards the conditions on pre-existing diseases . Lesser period will be better .
8. If you have already covered by a Mediclaim policy taken by yourself or your employer and if you feel the amount covered is not sufficient , you may go in for a Top up Health Insurance or Super top up health insurance which will cover you beyond the amount covered by your initial policy .
9. Health policies get income tax rebates under SEC 80D . For details , CLICK HERE
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