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PLAN YOUR  MEDICAL INSURANCE 

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

    
 TO KNOW INSURANCE AVAILABLE    ON COVID 19  ,    CLICK    HERE 

IRDAI ALLOWS  MONTHLY PAYMENT OF HEALTH  INSURANCE PREMIUM 

Dated 22.04.2020  :     In view of  the present scenario   in the wake of spread of pandemic COVID-19 ,  Insurance Regulatory & Development Authority of India  ( IRDAI )  has allowed ed insurance companies  to collect health insurance premiums in instalments . 
As per IRDAI  notification dated  21.04.2020   , the premium instalment facility may be offered  by the  insurance companies either as a permanent feature  or may be offered as a temporary relief for a period of twelve months (one policy year) in respect of all the health insurance policies that are due for renewal up to 31st March, 2021. Further factors  effecting the change of premium mode  must be fair and reasonable . 

The availability of  instalment facility should be duly published on the websites of  the insurance companies 
 
To read the IRDAI Notifiaction   , CLICK HERE 

IRDAI ASKS INSURANCE COS TO AUTHORIZE IN TWO HOURS FOR COVID 19 

Dated 19.04.2020  :     In view of  the present scenario   in the wake of spread of pandemic COVID-19 ,  Insurance Regulatory & Development Authority of India  ( IRDAI )  has asked insurance companies to  expeditiously handle   health insurance claims pertaining to COVID -19  as follows    : 

1.   Decision on authorization for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorization request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.

 2.  Decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.

Further insurance companies  have been aked to intimate the instructions to their TPAs  also . 
​
To read IRDAI  Press Release dated 18.04.2020 , CLICK HERE 

CENTRAL GOVERNMENT  EXTENDS GRACE PERIOD  FOR  INSURANCE RENEWAL 

Dated 16.04.2020  :     In view of  lock-down   in the wake of spread of pandemic COVID-19 ,  Finance Ministry  has permitted  time up to 15th, May 2020   for making  renewal payment for health insurance policies and  Third party motor insurance which have lapsed   / lapsing during lock down period from 25.03.2020 to  03.05.2020  and  this will ensure a continued cover and hassle-free claims payment during the grace period.  

  If you are unable to make payment of   your  renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19), you can   make use of the relaxation   and pay renewal premium  to the insurers on or before the 15th May, 2020 to ensure continuity of the statutory motor vehicle third party insurance cover from the date on which the policy falls due for renewal, so that any valid claim triggered during the grace period can be paid.  

 For   Gazette Notification dated 15.04.2020     , CLICK HERE ​

 ORDINANCE  ON  HEALTH  INSURANCE RENEWAL 

Dated   03.04.2020 :   If your   Health  insurance has lapsed  on or after 25th, March 2020  and   are unable  to renew  it so far   , Relax .  
As per ordinance issued by Government of India on   01.04.2020 , “The policy holders whose health insurance policies fall due for renewal during the period on and from the  25th March, 2020 to the 14th April, 2020 and who are unable to make payment of their renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19),
are allowed to make such payment for renewal of policies to their insurers on or before the 21st April, 2020  to ensure continuity of the health insurance cover from the date on which the policy falls due for renewal.”.


Hence   you may go to   the website  of the insurance company and renew your policy on-line before 21.04.2020  to get the cover from the date  of   lapse .  

​To read Gazette notification dated    01.04.2020 ,  CLICK HERE 

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PLAN N PROGRESS COMPARES 
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IRDAI ALLOWS 30 DAYS ADDITIONAL GRACE  FOR   INSURANCE RENEWAL 

Dated 27.03.2020  :     In view of  lock-down   in the wake of spread of pendemic COVID-19 ,  Insurance Regulatory & Development Authority of India  ( IRDAI )  has permitted following relaxations for payment  of insurance  renewal : 

1. In case of Life Insurance policies , insurers are asked to enhance existing grace period of 30 days by another 30  days . 
2. In case of Health policies , the insurance companies may condone delay in renewal up to 30 days without deeming it as  brake in the policy . 

To read IRDAI  Press Release dated 23.03.2020 , CLICK HERE 

IRDAI ASKS HEALTH INSURANCE COS TO HANDLE CORONA VIRUS CASES  EXPEDITIOUSLY 

11.03 .2020 :    Insurance Regulatory and Development Authority of India ( IRDAI )  has asked all health insurance companies to  expeditiously  handle claims   submitted for Corona Virus cases ( CO VID 19 )  under health insurance policies covering hospitalization  .  Following are the guidelines issued by IRDAI on 04.03.2020 : 
"
  i)        Where hospitalization is covered in a product, insurers shall ensure that the cases related to Corona virus disease (COVID-19) shall be expeditiously handled.

    ii)        The costs of admissible medical expenses during the course of treatment including the treatment during quarantine period shall be settled in accordance to the applicable terms and conditions of policy contract and the extant regulatory framework.

    iii)        All the claims reported under COVID 19 shall be thoroughly reviewed by the claims review committee before repudiating the claims.

   In order to provide need based health insurance coverage, insurers are introducing products for various specific diseases including vector borne diseases. For the purpose of meeting health insurance requirements of various sections, insurers are advised to design products covering the costs of treatment for Corona Virus.     " 

To read  Circular  of IRDAI   dated 04.03.2020   , CLICK HERE 

RELIANCE HEALTH INSURANCE PROHIBITED FROM SELLING NEW POLICIES 

08.11.2019 :  As per Press Release   dated  06.11.2019 of Insurance Regulatory and Development Authority of India ( IRDAI   ) ,  Relaince health Insurance  Company Limited is prohibited from selling new health policies   and has been directed to transfer all its policy holder's assets and liabilities to reliance General Insurance Co Ltd with effective from 15.11.2019 . Further company has been prohibited from using its assets  for all purposes except for settling  policy holders claim  amount . 

The Authority  has  assured   the existing  policy holders  that all their interests would be  adequately protected and all genuine claims would  continue to be duly honored.

For  IRDAI  Press Release .    CLICK HERE 

INDIA  STANDS 145TH AMONG 190 COUNTRIES IN HEALTHCARE ACCESS AND QUALITY   

Dated 23.05.2018 :   Media  reported today that  India is ranked 145th among 195 countries studied  by an international  organization for healthcare and access  .   Report said that  standing of India is much behind  neighboring countries like  China ,Bangaladesh ,  Bhutan and Sri Lanka . However it is better than that of Pakistan , Nepal and Afghanistan . 

Report also noted that the  healthcare access in India has improved in last 25 years  ( 1990 to  2016 )  from an index of  24.7 to 41.2  . In India  , it is noted that    states like Kerala and Goa   has better healthcare access  compared with national average while states of  Uttar Pradesh , Assam are lagging behind . 

We observe that  access of healthcare   has improved in India in last 15 years with improved medical facility and many states offering   free healthcare or   insurance  to the citizens at affordable prices . Case in point is Yashaswani in Karnataka   .   We have improved  our medical facilities   in many urban centers  and such facilities are attracting many overseas patients  on account of affordability compared  with their  own countries . But  sadly such facilities are still not affordable  to many Indians  of middle class and poorer section .  Unless one has   sufficient  insurance  , many  may not afford  the medical facility they need . 

READ   OUR ARTICLES ON    TOPICS IN HEALTH INSURANCE 

​COVID INSURANCE                                                        FLOATER POLICIES                              SENIOR CITIZENS  INSURANCE 

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FORTIS INCIDENCE - AN EYE OPENER 

Dated 22.11.2017  : Newspapers / media reported that a girl named Ms Adya  who was admitted to Fortis Hospital - Gurugram by her father Mr Jayant Singh   recently for complications  from dengue fever   was billed by the hospital for more than Rs 16 lakhs for a treatment given for 15 days  in ICU of the hospital . It is also  reported that girl didn't survive  in spite of costly medical treatment she got  .    Though the father had  insurance for Rs 10 lakhs  ,  he has to make arrangement  for additional  payment for the bill .  It is reported that Haryana government  will investigate the matter with regard to allegations of excess charges . The hospital authorities maintained that the entire treatment and billing was as per protocol . 

As the news spread in the media  , the eyes of media and public opened up on the prohibitive cost of private health care in India .  We could hear debate ranging over various matters  related to health care system in India  . We analysed that major concerns  raised   were with following aspects of the health care . 

1.   Quality of  public sector hospitals 
2. Cost of private  sector hospitals   and a need to regulate them  . 
3.  Ethics of corporate hospitals run on commercial mode and of doctors . 
​4. Role of governments  in controlling hospitals 
5. Regulations like KPME Act , though which Karnataka government is trying to  regulate private  hospitals .   

The above aspects are very relevant  these days  and require  deep debates and action by governments , doctors and hospitals .  Collective action by  governments , medical associations , hospitals and doctors may help  the  common man  getting medical attention in a cost effective way . However ,as  for as we are concerned  , we individually  have to take appropriate steps to safeguard ourselves  against unforeseen medical calamity  that may happen  and the result of the same on our lives including financial disaster . While medical calamity make us lose our beloved ones , financial mess that may create may ruin the lives of  living members of the family .  We may take  precautions in our daily life  to  save ourselves  from health problems by changing our life style  . But  we may have to fight  against accidents and unexpected diseases . Further we may have to ensure ourselves  financially  secure for any need  in such situations .   Some of the points below may be worth noting :

1. We are more and more dependent on private hospitals and doctors these days . 
2. The cost of  private health care is going up  day by day .   Take example of Fortis - Rs 16 lakhs for 15 days of treatment .
 There is no guarantee that future costs will not increase . 
3. We require  either sufficient  funds ear-marked for our medical contingencies or   insurance to cover our  family . 
4. The Mediclaim policy  we had taken 5 years ago  for a"' LARGE " amount  may or may not  become sufficient now and  may become very small part  of expenses in future . Hence we may need our own additional funds for meeting expenses .    
5. We may not have choice  to select hospitals  in emergencies as   the patient has to be  immediately rushed to a nearby  hospital .  Costs may be prohibitive there . 
6 . Many hospitals  do not share the cost aspect of treatment  . 
7 . At the end we  may have to  face  a not so   affordable large bill .
​
While paying  for medical emergencies from our own funds or borrowed funds may cripple  our finances  , buying a health / mediclaim  policy may be more prudent .  With tax rebate under section 80d of Income Tax act  , it becomes more attractive . However before buying insurance , we need    to assess our own family status , our income and affordability of paying premium by us .  For full guide how to buy insurance cover  , visit  TIPS FOR BUYING  MEDICAL  INSURANCE ​  at the end of the page below  . 

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 
​​

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 


An 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.

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.

 

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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.

Exclusions
The following are generally excluded under Mediclaim  policies: 

a.     All pre-existing diseases 

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.

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.

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

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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