Mediclaim

WHAT IS MEDICLAIM ? WHO COME UNDER IT?

Answer:

Mediclaim Insurance is a hospitalization benefit policy offered by public and private sector general insurance companies. The policy provides for reimbursement of Hospitalization / Domiciliary hospitalization expenses for illness/ disease suffered or accidental injury sustained during the policy period. The policy pays for expenses incurred under the following heads : A) Room, Boarding Expenses in the Hospital/ Nursing home. B) Nursing expenses. C) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees. D) Anesthesia, Blood, Oxygen, Operation theater Charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials, and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs and Cost of organs and similar expenses.

[Note: The liability in respect of all claims admitted during the period of insurance shall not exceed the sum insured for the person as mentioned in the schedule.]

Read more: http://wiki.answers.com/Q/What_is_mediclaim_insurance#ixzz1UMbrGXOy

Mediclaim Policy is an Insurance coverage wherein any of your Health related hospitalization bills can be claimed from the insurance company. There are two different ways to get your bills claimed either by cashless facility i.e your bills are directly paid to the hospital or you can pay your bills in the hospital and get an reimbursement after submission of the same to the insurance company.

Major exclusions of the policy are : Pre existing diseases will not be covered
There are a couple of diseases which will not be covered on the 1/2 year depending on the company.

24 hrs hospitalization or more is compulsory for a claim to be settled.
HOW TO CHOOSE A MEDICLAIM POLICY :

 

Mediclaim policy is intended to provide coverage to unexpected medical expenses that may lead to financial hardships. With growing popularity of the health insurance policy, it becomes nearly impossible for us to pick out a suitable policy at the affordable prices. Like all other forms of insurance, medical health insurance also comes with different policies and premium rates. A government organization or private insurance companies may provide medical health insurance. However, here are some tips and tricks shared with you, so that you can have no problem while choosing the mediclaim policy for your needs.

First, we should discuss that most of the mediclaim policies come with a minimum duration of 1 year and a maximum duration of 2 years. It is framed by evaluating the overall healthcare expenses and the monthly premium to be paid. These details are included in the insurance agreement and accordingly the benefits are paid by the insurance company. You can buy the mediclaim policy collectively or individually. Collective policies may include family insurance, group insurance or short-term health insurance. Family mediclaim policies include the entire family that is stay-at- home parents; students etc. while the Group insurance are usually bought by employers to cover all their employees at discount rates and greater benefits. However, in both the cases, the amount of premium is nominal.

Short term insurance offers coverage for short span of time like college years or in between jobs etc. Such kind of mediclaim policy usually preferred by self employed, entrepreneurs etc. At a low rate, an individual can opt to cover his or her spouse as well. This is flexible with a wide range of rates and premiums. Opting for the right scheme or policy may save you from incurring heavy expenses that may crop up from an unforeseen accident or hospitalization of the loved one.

There are many mediclaim policies, which cover a certain set of accidents and ailments. Any pre existing ailment like diabetes, poor eyesight etc is not included in the insurance. In this case, the insurance provider covers the hospitalization bills after a brief check whether the rates applied are in line with the agreement made. However, any cost other than the rates applied by the insurance company is to be carried out by the patient himself. Surgical costs, outpatient bills are covered only if the amount fits the amount quoted in the insurance agreement.

Mostly, the mediclaim providers have a list of network hospitals, which provide a discount or other benefits to the client if the treatment is taken from any one of the hospitals enlisted. The interesting fact is that, nowadays many insurance providers offer provide cover to homeopathic treatments, however, in that case, you gave to get treatments from certain specified hospitals. Such mediclaim policies also offer coverage for death of the person covered and the benefit amount would be received by the nominee.

Choose a policy, which is easily customization and offers you the reimbursement at the earliest.

MEDICLAIM FOR EMPLOYEES

The employers generally buy Mediclaim for the employees from the insurance provider in order to offer a large number of benefits to their employees. Employers mainly consider on offering his employees something necessary and important and in their list of benefits, mediclaim is considered as the most essential and important benefits available from the employers. Nowadays, mediclaim has become an important part of the health insurance and since the cost of the medical emergencies are soaring high day by day, the mediclaim policy has become all the more necessary. The employers offer various kinds health and medical benefits to their employees in the form of group medical cover or the mediclaim cover for employees.

Group mediclaim policy or the mediclaim policy for a group of employee covers reimbursement of hospitalization expenses incurred for sickness, diseases and accidental injuries. Apart from these, such mediclaim policies also offers comprehensive coverage to pre and post hospitalization expenses up to 30 days prior and 60 days after hospitalization. Additional benefits such as maternity cover can be added with basic policy on payment of extra premium. However, the area of coverage encompassed by the mediclaim policy differs from one company to another.

However, there is a misconception that the group mediclaim or the mediclaim policies intended for the employees is not enough for health care needs, it does not provide comprehensive coverage to all healthcare needs but it is equally true that the required coverage is always available under this policy. If you want to be protected from both sides, the best and smart decision will be to opt for both the individual as well as the group mediclaim policy. While one cover you from the required amount of expenses, the other will offer coverage for those which has not been provided by the former. This is affordable because for employee mediclaim you do not need to carry out the expenses of the premium, because that will be paid by your employer.

Group Mediclaim policy comes with a huge discount depending on the size of the group. As large as the group size will, the higher will be the discount is available.

Mostly, the group Mediclaim policies are offered by corporate body, institutions, association or any homogeneous groups. The minimum coverage is Rs.15, 000/- and the maximum is Rs.5,00,000/-. The premium of the mediclaim policies depends upon the age of the employee and sum insured. The age limit of the group mediclaim policy or the mediclaim policy for the employee is 5 years to 80 years and children above 3 months can be covered, if one or both parents are covered concurrently.

Today, there are various insurance companies are providing group plans. Check out and gather as many information about the coverage and premium cost. Ask directly to the employer if necessary, for such details. Sometimes the insurance companies ask to pay higher premiums to their customers after issuing policies. Hence, it is highly recommended to make a thorough research before you sign the contract.

INDIVIDUAL MEDICLAIM POLICY

Mediclaim is a kind of insurance policy that offers coverage to unexpected medical emergencies, which may end up with financial hardships. With the growing necessity of Mediclaim, Health insurance has emerged as one of the leading contributing sector to India’s economy. A government organization or private insurance companies offer medical health insurance, which is popularly known as Mediclaim.

Individual Mediclaim policy comes with a minimum duration of 1 year and the customer can only get it extended for a maximum duration of 2 years. Health insurance providers usually frame a detailed financial structure, on the basis of the estimation of overall healthcare expenses and the monthly premium to be paid. Such details are mentioned in the insurance agreement and the insurance company pays the benefits.]

Individual mediclaim policy is usually designed for the self employed, and small entrepreneurs, in which the covers of the medical expenses is available only to single person. Such mediclaim policies are available at a low rate, and the individual can opt to cover his or her spouse in that mediclaim policy as well. Individual medical insurance is highly flexible with the varied range of rates and premiums available for people from different profession. If you successfully opt for the right scheme or policy, it may save you from unexpected financial disaster due to heavy expenses stemming from an unforeseen accident or hospitalization of the loved one.

However, you should ponder on the fact that individual mediclaim policy pays for only a certain set of accidents and ailments. Any chronic ailment like diabetes, poor eyesight etc is not encompassed by this policy. You can also get coverage for the hospitalization bills but these are only covered after the insurance company perform verification whether the rates applied commensurate with the normal amount charged by other hospitals in the area. Any extravagant costs have to be borne by the patient. Surgical costs, outpatient bills are covered, in case the amount fits to what quoted in the insurance agreement. Expenses beyond the authorized amount will have to be carried out by the patient.

Medical insurance companies usually select a list of hospitals and make a contract with them, according to which the hospital provide a discount or other benefits to the client if he is admitted in any of the network hospitals. However, it is not mandatory to opt for these hospitals. Nowadays, some insurance companies also provide insurance coverage to homeopathic treatments, if the patient is admitted in certain specified hospitals. In many cases, after the death of the insurance policy holder, the nominee will receive the benefit amount of the policy.

Individual mediclaim policy, which comes with a low premium rate and covers a majority of ailments and accidents, is considered as the best policy. Check out first and then opt for the policy, which pays at the earliest in case of an emergency. Many a times, a patient has to reimburse the amount, but make sure that the process is hassle free from all aspects.
HEALTH INSURANCE POLICY FOR RETIRED PENSIONERS

If you are nearing retirement and having exasperating thoughts about post retirement money management, here is a solution for you. There are many, who are mostly worries about the healthcare. Since healthcare, in recent years can dip your pockets deep, it is very natural to worry about it, when there will not be the regular supply of money after retirement. Therefore, the best idea is to make retirement plans and to invest in getting a health insurance policy. Before, you buy a health insurance policy, it’s better to collect some information about that.

Health insurance policy in India is available from the Government as well as from the private insurance providers. Most of these policies are available to people aged 65 years or older and main source of income is the post-retirement pension. Certain disabled individuals are also entitled to have the policy if they are retired pensioners.

The health insurance policy available for the retired pensioners offers different kind of coverage depending on your requirements. However, the basic medical expenses are offered by all of the. It does not typically pay the total cost of covered services or supplies but can pat a large amount to support you with your needs.

Mostly you can have four types of coverage.

The first type can help you pay for inpatient hospital care, skilled nursing facilities, hospice care, and some home health care. The best part of such type is that, a retired pensioner would not need to pay the monthly premium for it. You need to pay the premium, if you are working after 65 years of age.

The second type of insurance coverage helps in offering coverage to doctors’ services, outpatient hospital care, physical and occupational therapy and some home health care. Such insurance policies usually charge a payment of a nominal monthly premium. This type of insurance coverage can be customized depending on your requirement, and the premium depends according to the customization of the insurance coverage.

The third type of healthcare insurance policy includes coverage for drugs and meducation. You can also avail the plans, which cover medical and healthcare necessary services. However, plan can charge different co-payments, coinsurance, or deductibles for these services.

The fourth type of insurance plan provides coverage for prescription drug benefits. The prescription drug plans will generally require you to pay a monthly premium and co-payment or co-insurance for each prescription you fill. Plans vary by cost, number of drugs covered and pharmacies you can use, however, there is a standard amount of available coverage under this plan, which will be set by the insurance provider. Such kinds of drug plans work with all types of medical and health care plans including the Original Medicare Plan, Private Fee-for-Service Plans, and many other Plans (like HMOs).

In order to avail any of these healthcare benefits, you have to talk to the agents of the insurance providing firm. He can help you framing your healthcare plans and after retirement and can offer you advice for selecting the right policy and any customization required.

GROUP INSURANCE

Group insurance refers to a special kind of health care insurance plan in which individual employees or a group of employee is covered under one ‘master policy’. The employer purchases such kind of group insurance for his employees. The best part of the group insurance plan is that, it has so many contributors and as a result, it offers coverage for more than one service at a much lower cost of premium. Apart from the “from-profit” organizations, non-profit organization, labor unions, churches and other service groups can also get group insurance policy in order to make their employees covered from any sort of unforeseen health hazards, which may incur heavy expenses.

Each member under the group insurance scheme receives insurance certificates, which demonstrate their eligibility for receiving benefits. In this case, often the employer, who has to be a part of an HMO (health maintenance organization), holds the master policy. Similarly, the individuals (his employees) are also registered as members of the organization. There are many group insurance policies, which are associated with major medical groups such as Blue Cross or Blue Shield. According to the terms and conditions, laid by a medical policy, it may or may not restrict an individual’s choice of primary physician and specialists. However, HMO policies are a bit different, which often require a patient to use a specified physician, who is entitled to approve any visits to any eligible specialists, if required.

When it comes to financing for a group insurance policy, it is a flexible payroll deduction. However, there are some companies, which will bear the total cost of the policy as a benefit for employees. But, the problem crops up with many insurance policies, when their cost of premiums rise up significantly without any prior notification or warning. The problem is that, if a few participants of the group receive expensive treatments for serious medical conditions, the rest members of the group, has to bear the higher premium costs over time, although they are not having such treatments. To enjoy the benefits of group insurance policy, the insurance providers will ask for the physical exams before issuing a master policy. The most beneficial part of such physical tests is that, participants, having serious illness can be covered from treatments for per-existing conditions.

Group insurance benefits can vary widely from company to company. Typically, most of the policies cover basic emergency and routine medical procedures such as regular doctor’s appointments and hospital treatment for accidents. The difference between the coverage is made when any plan offers extended care in hospitals or rehabilitation centers.

Group insurance may or may not cover the employee’s spouse or dependents, while some policy plans offer assistance for vision care or dental work; but in this case, the policy coverage will be limited to specific procedures. Some policies also cover mental health needs under group insurance. Prescription drug expenses fall under group insurance benefits, but it will come with a co-pay provision. Under a co-pay plan, the individual enjoying the policy should be entitled to pay an established price for name brand and generic medications.

CASHLESS MEDICLAIM POLICY FOR FAMILY

Cashless Mediclaim policies nowadays are available for the entire family. It offers comprehensive medical coverage to all the family members under the same policy. Generally, the term family implies one self, one’s spouse and dependent children. Dependent children refer to those kids who are dependent on their parents’ income.

The age of these dependent children can differ from policy to policy as different insurance provider may have different age criteria for dependent children. However, the general rule says that the dependent children will vary from the age group of 21 or 25. It is highly recommended to clarify this point before applying for the cashless Mediclaim policy for your family. Generally, in the case of family insurance the parents are not covered. The family Mediclaim policy is not different from other Mediclaim policy. To buy any policy, the most important responsibility is to go through terms and conditions of the Mediclaim policy in detail so that you can understand clearly what all is covered under the family insurance plan.

Although, the cashless Mediclaim policies for the families may differ from company to company, yet it is true that most of them will cover any medical expenses that are incurred during the time in which the patient being hospitalized or injured. The premiums of the cashless family mediclaim policy are also different according to the terms and conditions laid by the company. Therefore, it is imperative for you to go carefully through every clause of the cashless policy, before you sign it and get your entire family covered under it. No matter how affordable is your insurance policy, you need to stay abreast of all its terms and conditions. The family Mediclaim policy will thus bear any medical cost that may be incurred due to the treatment of any member of your family who is covered under the policy.

In recent years, mediclaim is a must for every individual. However, you can save money by opting for a family mediclaim policy instead of buying an individual mediclaim policy. Covering the entire family members under a single policy for a single sum is affordable and saves both time and money.

For your parents, you can avail cashless mediclaim policy up to the age of 60 years. If your family Mediclaim policy does not offer you the same, you can opt for a senior citizen mediclaim policy. Opting for the latter will give your parents the comprehensive coverage.

The premium of the cashless Mediclaim for family depends upon the various factors such as age of the person, size of the family and coverage offered under the policy. The premium cost also varies from company to company.

You will find a wide assortment of family mediclaim policies in the market that covers your entire family members. Offering a variety of benefits to ensure your family members, these policies are not too different from each other. Cashless Mediclaim policies for families, encompasses the cost of in-patient hospitalization treatment, pre hospitalization, post hospitalization, domiciliary hospitalization, day care procedures, ambulance charges, etc. Some of them are also available for critical illness.
ONLINE MEDICLAIM POLICY

Online mediclaim policy is a special kind of health Insurance coverage, which allows you to claim any of your health related hospitalization bills from the insurance provider via internet. Under the coverage of the online mediclaim policy, you can make your claims by two processes: first, by cashless facility i.e your bills are directly paid to the hospital and the second process is that, you can pay your bills in the hospital and get an reimbursement only after the submission of the actual bill and other details to the insurance provider. While a mediclaim policy can save financial loss in case of hospitalization for any unforeseen medical emergency, sickness, disease or accident, doing it online can save a great deal of manual labor.

In the recent years, when the, medical expenses are higher than any other expenses. It becomes even more appalling, when you will find that such expenses are increasing at a rapid scale. The latest family mediclaim insurance is ideal solution to get over such tensions and at the same time, it will help you to pay your bill. Since all the members of the family can come under the same policy, you do not need to bear multiple premiums and hence no more financial strain. A mediclaim or a health insurance policy also provides for reimbursement of hospitalization. Moreover, if an individual is bed ridden and needs an attendant or a nurse, he can cover the expenses easily with a mediclaim policy and you do not need to go to the insurer if you have the access of internet at your home.

Expenses associated with treatments such as dialysis, chemotherapy, radiotherapy etc are also covered by the mediclaim policy. With online facility, you can pay the hospital bill even when you are taken hospital or a nursing home and then discharged on the same day. Such kind of treatment will be considered to be taken under ‘Hospitalization Benefit Scheme’ of online mediclaim policy.

This policy is available in two variants – short term and long term and the coverage level, which is somewhat similar like other traditional mediclaim policies. Apart from providing covers for hospitalization expenses for illness and diseases, it also encompass the expenses for doctors fees, nursing expenses, medicines, blood, surgical appliances and other related expenses.

While applying for online mediclaim policy, you have to make sure that the coverage provided by the insurance provider is comprehensive enough. Any disease or sickness existing before the mediclaim is taken will not be covered. Each mediclaim policy has its own and unique list of specific exclusions. Check the list carefully before signing the contract paper. Most of the Insurance Companies do not offer mediclaim for obesity related illnesses, expenses arising from HIV or AIDS or the use of alcohol or drugs and expenses due to attempted suicide. The most basic expenses include the treatment due to war, riots or a terrorist attack is not insured by policies.

However, it is always advisable to talk to the financial advisor before applying for any policy.

MATURING INSURANCE POLICY

Perhaps getting an insurance policy is the best possible way to protect yourself from unexpected financial strain, which may crop up at any phase of your life. A lot of people across the world are relying on different kinds of insurance policy is order to evade heavy financial losses. However, many of them are facing challenges, when they do not get the coverage amount properly. The obvious reason is that, they do not have a proper idea about a mature policy and an immature policy. You may not get the most out of your life insurance policy if you do not let it get matured. Therefore, a clear understanding of both the matured and immature policy has to be understood before starting financial planning.

A mature insurance policy refers to a policy, which offers guaranteed cash value of the policy and that amount equals to the total face value of the policy. The cash value is gained from the premiums you pay on monthly basis. The rule of thumb is, the longer you pay your premiums, the closer you will get to having a mature policy. The mature insurance policies refer to the types of life insurance policies (e.g., whole, universal), however, the term life insurance policies are not included in it. Policies usually are set to mature, or endow, when the policyholder reaches age 100. However, maturing policies depend on the kind of policy you have chosen. However, the date of maturity depends on the face value of the property and the premium you pay.

Your policy matured at the time when you have paid every premium within a schedules date or age specified in the policy. After, your policy gets matured, the insurance company should pay you both the face value and cash value of the policy. In case you are alive when the policy matures, you can enjoy the benefit of the insurance company bearing all your expenses till you die. Moreover, you do not need to make premium payments once the policy is matured and the insurance company has issued you a check.

Very often, the insurance companies do not notify you when your insurance is about to mature. The reason is that the policy effectively terminates, when the insurance company pays you the value of the policy. Therefore, you are likely to stop paying premiums, which are the main source of income of the insurance provider. You can also continue insurance coverage after the insurance company pays you; however, in that case, you have to get a new policy.

If your life insurance policy matures on your 100 years of age and you do not want to wait till then, you can also take out your policy before it matures. Many people surrender their policies for the cash value. However, the insurance company pays out a benefit when the policyholder dies, if the policy did not mature by his lifetime. It is needless to say that a mature policy has more cash value, and you will get less from your policy if you cash it before maturity.

MEDICLAIM PORTABILITY

With the introduction of Mediclaim portability all over India, the Medical policyholders with IRDA or those who are enjoying the facility of Mediclaim can use the insurance policy with due convenience. The mediclaim portability will help the customer by providing the opportunity to find an insurance carrier, which, can appropriately commensurate with their needs and lifestyle. The best part of this mediclaim facility is that if a policyholder is not satisfied with his or her current provider, he or she can have the facility to switch to another health insurer or provider without any change in the premium outgo.

The convenience of Mediclaim portability will be available to policyholders who are currently insured for a sum of 1, 00, 000 and above. According to the present rule, the health cover given to any policyholder, under the plan of medical portability has to be renewed every year. In case, there is no claim in any year, the policyholder is entitled to a bonus in the form of an increased sum and for every claim-free year, this bonus gets accumulated.
The industry and the regulators are working on the minimum benefit that would be carried forward in case of change in the insurance provider, as two insurers do not generally have the same mediclaim policies. The regulator is also considering portability for car insurance or home insurance.
There are several benefits, which mediclaim portability can offer you. With overwhelming number of benefits, the policyholders can compare different policies provided by various insurance providers. The chief expenses, on which you can compare your policy are hospitalization expenses, day-care procedures, effects of cumulative bonus and various types of illnesses covered under critical illness domain.

Apart from the service factor, policyholders can also compare insurance providers on the basis of the denial of their policy renewal and the increasing costs of their renewal premiums. However, it can be said, that such kind of Mediclaim portability will be most useful for the people aged 65 or more. Most of the senior citizens currently having serious problems in changing insurance providers, primarily because the new insurance providers consider the policy as completely new one, and the diseases and accidents, which might have been covered by the previous company, are treated as pre-existing.
With mediclaim portability, the policyholder can now switch their insurance provider if they are getting rude replies from their executives and are not satisfied with any of their services without any change in the premium.
In a country like India where medical insurance policyholders is merely 6-7%, the new mediclaim portability, when put into practice by the insurance regulator, can give the industry a nudge. The new mediclaim portability is more competitive and it is expected to offer customer friendly service to the policyholders.

However, before opting for mediclaim portability it is always advisable to consult with the insurance agent. He will help you to pick out a proper policy for yourself and if required he will help you to get the policy customized.

HOW TO FILE A CLAIM AFTER HOSPITALIZATION

Mediclaim is one of the best ways to relieve the stress of acquiring money during the situations of medical emergencies. It becomes easier now after the introduction of the cashless mediclaim policy. However, filing a claim after hospitalization requires several considerations and in this article, we are going to share all those process, which are essential to file a claim after hospitalization.

A Mediclaim can be filed in the following situations:

  1. Emergency hospitalization
  2. Planned hospitalization

Emergency Hospitalization

During the situation of emergency hospitalization, in case the insured person is admitted in any of the network hospitals of the insurance provider, the hospital will ask for the compensation to the insurance provider as per the rules set by the network hospital and the insurance provider. They will then contact the TPA and send a request for authorization. The insurance provider may or may not approve the claim, however, it is based on the terms and conditions of the contract signed by the hospital and the TPA. Generally, the time taken to process an emergency case is 6 hours. It is the responsibility of the customer to follow up with the TPA in order to be informed about the status of your request. In case you have bought your policy through a specialized health insurance advisor or agent or a broker, they will provide you the required assistance in coordinating the claim from the insurance provider.

Planned hospitalization:

During the situation of emergency hospitalization, in case the insured person is admitted in any of the network hospitals of the insurance provider, the hospital will ask for the compensation to the insurance provider as per the rules set by the network hospital and the insurance provider. They will then contact the TPA and send a request for authorization. The insurance provider may or may not approve the claim, however, it is based on the terms and conditions of the contract signed by the hospital and the TPA. Generally, the time taken to process an emergency case is 6 hours. It is the responsibility of the customer to follow up with the TPA in order to be informed about the status of your request. In case you have bought your policy through a specialized health insurance advisor or agent or a broker, they will provide you the required assistance in coordinating the claim from the insurance provider.

Planned hospitalization:

In most cases, planned hospitalization is the result of the recommendation from a doctor that you would need to be hospitalized. In such cases, you will have the time to decide, where you will get admitted. The insurance provider will provide you a list of network hospitals available with the TPA, from which you can select the one of your choice. It is recommended that you complete the cashless service formalities at least 3-4 days before you are hospitalized. To file the claim, you gave to follow the given rules here.

  • Firstly, you have to complete the pre authorization form, which is available from the insurance desk of the hospital, or you can download it from the website of your TPA.
  • Being a patient you have to fill the form accordingly. A part of the form will need to be filled by the doctor, who recommended your hospitalization.
  • The pre authorization form should be submitted at the insurance desk of the hospital. After the submission, the form will be verified by the representative at the insurance desk of the hospital and then fax it to the TPA.
  • After verification, the TPA will process the form further but the insurance provider can either accept it or reject the request.
  • You will have to follow up with the TPA to stay abreast of the status of your requests.
  • If the insurance provider does not approve the amount send by the hospital, the individual has to pay the amount to make up the difference.

 

WHAT IS PRIVATE HEALTH INSURANCE

 

Indemnity Health Plans

Indemnity health plans reimburses the insured for services received, only when the insured files a claim. It comes with three options, two of which are similar reimbursement plans. One option will pay 100 percent of the claim, while another option depend on the bill and it pays about 80% of the bill. For paying the remaining balance, you will be responsible. If you are opting for the third option, you will get a specific amount of money for services of a day for a maximum number of days. With this plan, you will get maximum flexibility of all private health plans and can get treatments for doctor regardless of location. This is the most expensive plan, and it requires the insured to complete the claims accurately and to submit them in time, or else the insured may need to bear the entire bill.

Benefits of the Private health insurance plans

Private health insurance plans come with several benefits. First, you can have a peace of mind knowing that you can properly control your plan and any changes in terms of agreement will be done with your consent. Moreover, with this insurance plan, you can customize it, in order to include services that you want to pay for and eliminate those that are not needed. You can also keep your insurance plans accordingly, no matter, where you move or change jobs. More than that, a private health insurance plan can also give you incentives for joining health clubs or using alternative health treatments.

However, such plans also come with some disadvantages. The most significant problem of such plans are the payment for the premiums, which are rising at a tremendous rate (12 percent annually). In many cases, the applicant may be denied of coverage due to current medical status or a pre-existing condition.

WHO IS AN INSURANCE NOMINEE

The term “insurance nominee” refers to a person, or a company, in whose name the shares are held, but he is not the actual owner of the policy. Insurance nominees are supposed to hold the shares on behalf of the actual shareholder. Holding an insurance nominee is a convenient means of preserving anonymity of the actual shareholder and for institutional investors in order to consolidate the administration or individual holdings or their private clients.

While buying the insurance policy, most of the people give names of their beneficiaries and then never give the subject another thought. It is highly recommend by the insurance experts that you should ponder and review your policies’ beneficiary designations periodically (annually or whenever there is a birth, death, graduation, divorce, etc) in order to verify if your current needs, goals and circumstances are properly covered by the policy terms and conditions.

In India, the insurance providers always expect you to name the nominee and name their designation. For example, “Padmini, my wife, whose date of birth is 12 July 1977 and address is Plot 12, street 14, Guntur, and my children Ram, and Suresh”. Such phrases are easy to comprehend that who you wish to nominate and give the money.

However, the process of nominee has some serious considerations. First of all, the process is a rigid one. If your current children are identified as nominee by name, and then you get a third child later, he will not have any share in the policy. In that case, you have to update the policy completely to revise your beneficiary designations, so that the youngest child will get the share.

In addition to that, if a named beneficiary dies before you, the beneficiary’s heirs may be excluded from receiving proceeds. Suppose, all your three children are married, and have children. In case one of your children passed away before you, the spouse and kids of that child of yours will be excluded from receiving proceeds.

If you have a married child, and you have planned to include his family in the nomination, you have to mention it. Like, “Mr Suresh, my son, his spouse Mrs Lalitha Suresh and their daughter Ms Anuradha.” This has more clarity than saying only “Mr Suresh”.

Focus on using better language in a will that ensure omitting unintended beneficiaries by name. If beneficiaries are designated to be “all children of the insured,” future children will automatically be included.

However, the process of revising the insurance nominee can bring several disadvantages.

  • You can face complication if you have a complicated marriage. If you and your spouse have more than one marriage and children from both sides, you should be careful while putting the names of your insurance nominee.

A small mistake can end up with the surviving spouse of your first wife getting all the money intended for the children from your first marriage. So be careful and talk to the insurance provider before putting the insurance nominee’s name.

 

WHICH MEDICLAIM POLICY COVERS PREGNANCY

 

In the present scenario, the average cost of having a baby is $6,378 for a normal delivery, $10,638 for a cesarean section. Such a huge cost can definitely take out a huge amount from your wallet and therefore, the best way to ensure your pregnancy will be to purchase a comprehensive health insurance policy, which covers pregnancy and other related costs as well. Nowadays, a lot of mediclaim policies come with a comprehensive plan covering pregnancy as well. It will keep you happy by making sure you obtain insurance before you become pregnant and you need not to bear the huge sum of money at a time. Here are some ways, which will give you required idea about the mediclaim policy that covers pregnancy.

  • In order to get insured at the time of pregnancy, you should try to have a mediclaim policy before you get pregnant. In case you do not have any kind of insurance policy, then it would be better to get insured through a group plan. It can relieve the tension of giving premium every month for different insurance coverage. The new health plan, which you have purchased as a group policy can offer you reimbursement at the right time of your pregnancy.

 

To get insured at the time of pregnancy, you have to find out what kind of coverage is appropriate for covering you during the time of pregnancy. Select a health plan, which will be covering you for birth, adoption and pregnancy and also the doctors check up and hospitalization fees during pregnancy. Opt for a mediclaim policy, which covers maternity, prevention and well-baby care at affordable premium rates.

  • Many a times, employers offer group insurance policies for the employees, which cover the pregnancy of their spouse. Most of the women also get insurance policy for maternity. You can also ask your employer if the health insurance they offer covers maternity.
  • If you are pregnant, you must avoid switching jobs. If you begin a new job during a pregnancy, there are high chances of not getting the coverage, when required; rather you might have to wait up for a couple of months.
  • There are a number of mediclaim policies, which are designed accordingly to suit the low-income requirements. You can also opt for these if you have not purchased any insurance policy before.
  • For low rates insurance policy you can contact your state insurance department for more information. Most of the government insurance policy offers insurance coverage to cover your pregnancy. You can also ask for what other types of low-cost insurance plans they offer.

Mediclaim policies aimed for providing coverage, normally covers prenatal visits for blood work and ultrasounds and maternity care to pediatric visits and also the immunizations costs for your baby. According to such policies, the newborn would usually be covered for the first 30 days under the mother’s insurance policy. Such policies will consider the newborns as a dependent within 30 days of birth. Finally, do not waste time for getting insured or else you may have to pay a large amount.

 

HOW TO PLAN YOUR INSURANCE

 

Planning insurance is an important part of financial planning. Therefore, a smart idea is always to begin a systematic planning of your life insurance. First of all, you should know that life insurance is the best way to begin building an estate.

While planning your insurance, you must have a clear idea about two types of life insurance: whole and term. Each of these insurances has its own benefits. According to your purpose, you can have the liberty to choose the policy you want. Therefore, a proper advice is all the more essential to plan the insurance, which could reap profits. A financial adviser can help you calculate an appropriate value for your life insurance policy as well as the kind you should choose. You can also have a talk with your personal financial advisor or can also seek assistance from a life insurance agent of the particular insurance provider. Here is a brief outline regarding the ways of making a proper plan for your insurance. Check them out-

Consider your needs and then decide what type of life insurance can meet your needs properly. Accordingly, you can choose, whole or term life insurance. The financial advisor can help you, but you have to make a thorough research about the pros and cons of both the insurance.

  • Review your assets with a financial adviser. A financial adviser will help you choose the sum; you should invest for the life insurance policy. You have to keep in touch with the advisor to stay abreast about the updates and changes regarding the terms and condition of your policy.
  • Before buying any policy from any insurance provider, no matter it’s a whole or term life insurance, you have to make a thorough research about the companies. You can talk to them personally or can use the online resource to know about the firm and the insurance policy they offer. You can also check out the testimonials in the website for the customer reviews’. It will help you to get a clear idea about the services provided by the insurance firm.
  • You should buy a life insurance from the specific firm that sell life insurance. Not all insurance companies specialize in life insurance. Buying it from other firms may cause problems in the long run. Such firms may not offer you the amount of policy when it matures.
  • After you buy the policy, you must meet the insurance agent once a year to report changes in income, age and overall health. If any changes occur, the financial advisor will help you to bring changes in the policy when required.
  • Consult with your financial planner bi-annually for a thorough discussion about the inflation rates and the face value of your life insurance policy. If you want to increase the amount of the policy, ask your advisor to help you.
  • Communicate openly with an attorney and take advice regarding estate planning and the beneficiaries of your assets.

Financial planning nowadays can be disastrous without planning an insurance. Therefore, give your future a safety lock by planning your insurance first.

FAMILY FLOATER HEALTH INSURANCE

 

Family Floater Health Insurance is a comprehensive healthcare plan, which offers you the best insurance coverage by taking care of your family’s health and at the same time saves on your taxable income. Usually, the family floater insurance plans secure your family against financial emergencies if any unforeseen situations crop up like serious illness, surgery and accidents as well as against terrorist activities. Under this insurance coverage, you can share the entire sum insured among the family members and that too without any individual upper limits.

To understand the comprehensive family floater insurance, you have to take a look to the policy details and its benefits mentioned below.

  • The policy offers comprehensive coverage to your family members
  • Cashless claims facility is available across the country
  • Continue to enjoy quality service even during claim settlements
  • No sub-limits on room rent, doctor fees, and hospital charges or for any disease (except some diseases)
  • No co-payments for any disease or any hospitalization expenses
  • All the more, many insurance providers also provides health check-up coupon at free of cost for any one insured family member, which will be valid during the life period of the policy
  • No health check-up up to the age of 45 years (age as on last birthday)
  • Avail tax benefits under Section 80D of the Indian Income Tax Act 1961
  • You can buy the policy online and pay in EMIs without any extra charges
  • Options for one or two year covers (auto renewal) available
  • Get additional Sum Insured for every claim free year
  • Keep your family secured even against expenses for hospitalization due to terrorist
    activities

Let us now discuss, what is covered under this family floater insurance policy. Generally, a basic family floater insurance cover medical expenses incurred as an in-patient during hospitalization for more than
24 hours, which includes room charges, doctor and surgeon’s fee, medicines bills, medical expenses incurred 30 days prior and 60 days post hospitalization and day care expenses incurred on named advanced technological surgeries and procedures requiring less than 24 hours of hospitalization, which includes Dialysis, Radiotherapy and Chemotherapy). Apart from this, you can also get reimbursement for pre-existing diseases for four continuous years of coverage with the insurance provider. This policy also covers you for hospitalization in case of Swine Flu / H1N1 influenza.

Terms of Renewability
The best part of the Family Floater Health Plan can be renewed instantly.

What is not covered by the policy

The family floater policy does not cover the following

  • Any illness contracted within 30 days of the inception date of the Policy, except those
    that are incurred as a result of an accident.
  • Treatment of the following diseases or illness or ailments:

ü Cataract

ü Benign Prostatic Hypertrophy

ü Myomectomy, Hysterectomy unless because of malignancy

ü Hernia, Hydrocele

ü Fistula in Anus, Piles

ü Arthritis, Gout, Rheumatism

ü Joint replacement, unless due to accident

ü Sinusitis and related disorders

ü Stone in the urinary and biliary systems

ü Dilatation & Curettage

ü Skin and all internal tumors or cysts or nodules or polyps of any kind, including breast lumps.

 

CASHLESS MEDICLAIM

 

If sudden illness or medical injury is the worst things in anyone’s life, then the huge cost incurred as a result, is nothing less than making it appalling. Very often people rush to the nearest ATM or borrow from friends and relatives for meeting up the initial deposits but in the long run it does not help. Therefore, the best way out is to get a Cashless mediclaim policy, which if managed properly can be a big relief during such unexpected medical emergencies.

The concept of cashless mediclaim came into existence with values added under Health Insurance after the introduction of TPA concept. TPA refers to the professional medical experts, who are appointed to create relationships with hospitals, to discuss on rates for treatments on direct billing and payment arrangements.

Before the introduction of cashless policy, mediclaim policyholders were supposed to pay the hospital for their treatment and then submit bills to the insurance company for reimbursement. After the introduction of Cashless mediclaim, the mediclaim holder does not need to pay cash directly to the hospitals. It is a is a mechanism where the TPA or the Insurance Company has a direct arrangement with a set of hospitals (which are collectively called network hospitals) for direct billing and payment of bills according to the terms and conditions of the policy. With cashless mediclaim, the policyholders are at the comfortable position to be an insured individual and if the emergency crops up, they can get hospitalized with a network hospital without bothering about settling the hospital bill.

 

To understand the concept of cashless mediclaim properly, you have to be well aware about the mechanism of its work. First, Health insurance providers establish contracts with a set of hospitals after reviewing the facilities, quality of service, and negotiate the surgery or treatment wise rates with them. Cashless service is available only to those hospitals, which are in the network of a particular Health insurance provider. To know the list of all the hospitals which are included in your health insurance provider’s network, you can check the name of your TPA (Third Party Administrators) mentioned in your policy and accordingly visit its websites or call their toll free number to have a personal talk with them.

For the application of the cashless mediclaim, the customer has to inform the admission desk or the Insurance desk of the Hospital about the Insurance Coverage. He may also need to fill a pre-authorization form and ensure signatures at appropriate places supervised by authorized personnel in the hospital. Then it is the hospital’s responsibility to send a fax of the pre-authorization form for approval to the Cashless team of the Insurance provider.

The Cashless team Insurance provider may approve or deny the claim according to the terms and conditions of the policy. After approving the form, the cashless team will send an authorization note by fax, mentioning the initial amount authorized. This is the amount, which the Insurance provider is bound to send to the Hospital. The same is applicable during the discharge also. The customer has to bear the amount, which is not authorized.

 

VIDYARTHI – MEDI-CLAIM FOR STUDENTS

 

 

National Insurance Company Limited

Apart from many other health insurance policies National Insurance Company Limited also has a health insurance policy exclusively for students called “Vidyarthi – medi-claim for students”.

The SALIENT FEATURES of this policy are:

  • It provides health and personal accident cover to students
  • It also provides for continuation of the insured student’s education in case of death or permanent total disablement of the guardian due to an accident
  • Students from the age of 3 years to 25 years can take this policy
  • Expenses of hospitalization for minimum period of 24 hours are admissible
  • The above time limit is not applicable to specific treatments such as day care treatment for stitching of wounds, close reduction and application of POP casts, dialysis, chemotherapy, radiotherapy, eye surgery, ENT surgery, laparoscopic surgery, angiographies, endoscopies, lithotripsy and tonsillectomy
  • Pre-hospitalization expenses incurred up to 30 days prior to hospitalization are covered
  • Post-hospitalization expenses incurred up to 60 days after hospitalization will be reimbursed
  • Pre-existing will be covered after 3 continuous claim free years

 

SCOPE OF COVER UNDER VIDYARTHI:

HOSPITALIZATION BENEFIT
A Room, boarding expenses as provided by hospital/nursing home which also includes nursing care, RMO charges, IV Fluids/blood transfusion/injection charges
B Surgeon, anesthetist, medical practitioner, consultants, specialist’s fee, nursing expenses
C Anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, diagnostic material and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of stent and implants

SCOPE OF COVER FOR PERSONAL ACCIDENT TO STUDENT AND GUARDIAN OF STUDENT:

  • If insured person sustains any bodily injury resulting from accident caused by external violent and visible means then the company will pay the sum insured
  • If the injury as above within 12 calendar months is the cause of death then the company will give capital sum insured
  • If the injury as above within 12 calendar months is the cause of total and irrecoverable loss of sight of both eyes or total and irrecoverable loss of use of two hands or two feet, or of one hand and one foot or of such loss of sight of one eye and such loss of use of one hand or one foot, the capital sum insured is payable
  • If the injury as above within 12 calendar months is the cause of total and irrecoverable loss of sight of one eye or total and irrecoverable loss of use of a hand or foot, 50% of capital sum insured is payable

EXCLUSIONS UNDER HOSPITALIZATION:

National India Insurance is not liable to make any payment in respect of any expenses incurred in connection with:

  • All diseases/injuries those are pre-existing when the cover incepts for the first time
  • Any disease other than diabetes and hypertension that is contracted during the first 30 days from the commencement date of the policy except in case of hospitalization due to an accidental injury
  • If the insured is aware of the existence of a congenital internal disease/defect before inception of the policy, it is treated as pre-existing
  • Injury or disease caused due to war invasion
  • Circumcision unless necessary for treatment of a disease
  • Cost of spectacles, contact lenses and hearing aids
  • Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from accidental injury and which requires hospitalization for treatment
  • Convalescence general debility “run down” condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol
  • All expenses arising out of any condition due to AIDS
  • Charges incurred at a hospital/nursing home for diagnostic, X-ray or laboratory examinations not consistent with any ailment, sickness or injury
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease
  • Injury or disease caused by nuclear weapons or materials
  • Treatment arising from pregnancy, childbirth, miscarriage, abortion or complications of caesarean section
  • Any treatment other than allopathic system of medicine

EXCLUSIONS UNDER ACCIDENT:

  • Death from intentional self injury, suicide or attempted suicide
  • Death whilst under influence of intoxicating liquor or drugs
  • Death whilst engaging in aviation or ballooning or traveling in an aircraft other than as a passenger
  • Death caused by venereal disease or insanity
  • Death arising from committing any breach of law with criminal intent
  • Death due to war, invasion, civil war, rebellion, mutiny, seizure, captures, etc
  • Death from ionizing radiations or contamination by radioactivity from any nuclear fuel or nuclear waste
  • Death or disablement caused by prolonged conditions during childbirth or pregnancy

ADDITIONAL BENEFITS of taking a health insurance policy from National Insurance Company Limited are:

  • It is a public sector company so it is perceived to be safer by quite a few people
  • Sum insured under this policy shall be progressively increased by 5% in respect of each claim free year subject to a maximum of 10 claim free years of insurance
  • The policyholder also has the option of taking a 5% discount in the premium instead of the cumulative bonus
  • In case of claim taken by the person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of sum insured at the next renewal. The basic sum insured will be maintained and will not be reduced

VARISTHA – MEDI-CLAIM FOR SENIOR CITIZENS

 

National Insurance Company Limited

Apart from offering health insurance policies for individuals, families and students, National Insurance Company Limited also has a health insurance policy for the senior citizens called the “Varistha – mediclaim for senior citizens” policy. The SALIENT FEATURES of this policy are:

  • This policy caters to the needs of senior citizens by covering their hospitalization and domiciliary hospitalization expenses as well as expenses for treatment of Critical illnesses
  • The diseases covered under critical illness are coronary artery surgery, cancer, renal failure of failure of both kidneys, stroke, multiple sclerosis, major organ transplants like kidney, lung, pancreas or bone marrow, paralysis and blindness at extra premium
  • Fixed sum insured for each policyholder
  • Under hospitalization and domiciliary hospitalization cover the sum insured is Rs.1 lac
  • Under critical illness cover the sum insured is Rs.2 lacs
  • If the applicant did not have an insurance policy in her/his name then s/he will have to undergo medical check up at her/his own cost for blood/urine sugar, blood pressure, echo-cardiography and eye check up including retinoscopy
  • Company’s overall liability in respect of claims arising due to cataract is Rs.10000 and that of benign prostatic hyperplasia is Rs.20000
  • Company’s liability in respect of claims admitted during the period of insurance shall not exceed sum insured
  • Liability of the company under domiciliary hospitalization clause is limited to 20% of sum insured
  • Ambulance charges up to a maximum limit of Rs.1000 in a policy year will be reimbursed
  • Expenses of hospitalization for minimum period of 24 hours are admissible
  • The above time limit is not applicable to specific treatments such as day care treatment for stitching of wounds, close reduction and application of POP casts, dialysis, chemotherapy, radiotherapy, eye surgery, ENT surgery, laparoscopic surgery, angiographies, endoscopies, lithotripsy and tonsillectomy
  • Domiciliary hospitalization benefit means medical treatment for a period exceeding 3 days for such illnesses/diseases/injury which in the normal course would require care and treatment at a hospital/nursing home but taken whilst at home
  • When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the hospital/nursing home and the insured is discharged the same day, the treatment will be considered to be taken under hospitalization benefit section
  • Pre-hospitalization during period up to 30 days prior to the disease will be considered as part of claim
  • Post-hospitalization during period up to 60 days prior to the disease will be considered as part of claim
  • Two pre-existing diseases namely diabetes and hypertension will be covered from the inception of the policy on payment of additional premium
  • Insured shall bear 10% of any admissible claim that is a part of Compulsory Excess
  • Insured has to bear additional 10% of all admissible claims if the claim arises out of any pre-existing disease for which the insured opted cover and paid additional premium
  • No claim will be paid if a critical illness incepts during the first 90 days of the inception of the policy
  • The insured needs to survive for 30 successive days after the diagnosis of the critical illness in order to make the claim

AGE LIMITS:

  • The age group for fresh entry in to the scheme is between 60 years and 80 years
  • The renewal age limit will be extended up to 90 years in which case the premium of 76-80 age band will be loaded by 10% up to 85 years and 20% up to 90 years of age

SCOPE OF COVER UNDER VARISTHA:

HOSPITALIZATION BENEFIT LIMIT
A 1. Room, boarding expenses as provided by hospital/nursing home

2. If admitted in ICU

Up to 1% of sum insured per day

Up to 2% of sum insured per day; overall limit of 25% of sum insured per illness/injury

B Surgeon, anesthetist, medical practitioner, consultants, specialist’s fee, nursing expenses Up to 25% of sum insured per illness/injury
C Anesthesia, blood, oxygen, OT charges, surgical appliances subject to upper limit of 7% of sum insured, medicines, drugs, diagnostic material and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of stent and implants Up to 50% of sum insured per illness/injury

PREMIUM CHART:

SUM INSURED PREMIUM 60-65 YEARS PREMIUM 66-70 YEARS PREMIUM 71-75 YEARS PREMIUM 76-80 YEARS
MEDICLAIM Rs.1 lac 4180/- 5196/- 5568/- 6890/-
CRITICAL ILLNESS Rs.2 lac 2007/- 2130/- 2200/- 2288/-
TOTAL 6187/- 7326/- 7768/- 9178/-

ADDITIONAL POINTS TO THE PREMIUM CHART:

  • For fresh entrants to National Insurance the above premium will be loaded by 10%
  • If a person suffers from any of the terminal diseases referred under critical illness cover then s/he will never be covered for that in this policy even on payment of additional premium
  • Cover for Paralysis and Blindness may be given under Critical Illness by loading the Critical Illness premium by 15% in each case or 25% in case of both covers together

EXCLUSIONS:

The company shall not pay any benefit to the insured that suffers an event-giving rise to a Critical Illness that is caused by any of the following:

  • Indigestion of drugs other than those prescribed by a medical practitioner
  • Indigestion of medicines, prescribed or not, for treatment of drug addiction and any related to it
  • Any attempt to commit suicide or any self inflicted injury
  • Where the insured at any time suffered from the condition known as AIDS or HIV
  • The company will not be liable for a Critical Illness or its symptoms of which were present in the insured at any time before inception of the policy or that manifests within a period of 90 days from such date
  • No claim will be payable if the insured smokes 40 or more cigarettes/cigars or equivalent tobacco intake in a day
  • No claim will be payable if a critical illness is caused by ionizing radiations or contamination by radioactivity from any nuclear fuel or nuclear waste or any war/invasion

ADDITIONAL BENEFITS of taking this health insurance policy for senior citizens from National Insurance Company Limited are:

  • It is a public sector company so it is perceived to be safer by quite a few people
  • No medical check up is required if the insured was covered under any health insurance policy of National Insurance Company or any other insurance company uninterruptedly for preceding three years
  • Sum insured shall be progressively increased by 5% in respect of each claim free year subject to a maximum of 10 claim free years of insurance
  • The policyholder also has an option to take a 5% discount each year instead of increasing the sum insured each year
  • The insured shall be entitled for reimbursement of the cost of medical check up once at the end of block of every 3 underwriting years provided there are no claims during that block. But the cost of reimbursement will not exceed amount equal to 2% of the amount of average sum insured excluding the cumulative bonus

PARIVAR – MEDI-CLAIM FOR FAMILY

 

National Insurance Company Limited

Apart from many other health insurance policies National Insurance Company Limited also has a health insurance policy for a family called the “Parivar – mediclaim for family” policy. The SALIENT FEATURES of this policy are:

  • It is a family floater policy that covers the entire family under a single sum insured
  • The policy covers reimbursement of hospitalization expenses for illnesses/diseases contracted or injury sustained by the insured
  • Total expenses incurred for any one illness is limited to 50% of the sum insured per family
  • Expenses of hospitalization for minimum period of 24 hours are admissible
  • The above time limit is not applicable to specific treatments such as day care treatment for stitching of wounds, close reduction and application of POP casts, dialysis, chemotherapy, radiotherapy, eye surgery, ENT surgery, laparoscopic surgery, angiographies, endoscopy, lithotripsy and tonsillectomy
  • Pre-hospitalization expenses incurred up to 15 days prior to hospitalization are covered
  • Post-hospitalization expenses incurred up to 30 days after hospitalization will be reimbursed
  • Any pre-existing diseases will be covered only after 4 continuous claim free years
  • Sum insured can be taken from Rs.2 lac to Rs.5 lac and then may be increased in multiples of Rs.50000

AGE LIMITS:

  • Persons between the age of 3 months to 60 years are eligible to take this policy
  • Fresh entrants beyond the age of 60 years will not be covered
  • The policy can be extended up to the age of 65 years if it is renewed without a break

SCOPE OF COVER UNDER PARIVAR:

HOSPITALIZATION BENEFIT LIMIT
A 1. Room, boarding expenses as provided by hospital/nursing home which also includes nursing care, RMO charges, IV Fluids/blood transfusion/injection charges

2. If admitted in ICU

Up to 1% of sum insured per day

Up to 2% of sum insured per day

B Surgeon, anesthetist, medical practitioner, consultants, specialist’s fee, nursing expenses Actual
C Anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, diagnostic material and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of stent and implants Actual

PREMIUM CHARTS:

UP TO 35 YEARS:

SUM INSURED SELF SPOUSE 1ST CHILD 2ND CHILD 2A+2C 2A+1C
25% 20% 20%
2 lacs 2469/- 617/- 494/- 494/- 4074/- 3580/-
2.5 lacs 2956/- 739/- 591/- 591/- 4877/- 4286/-
3 lacs 3444/- 861/- 689/- 689/- 5683/- 4994/-
3.5 lacs 3870/- 968/- 774/- 774/- 6386/- 5612/-
4 lacs 4297/- 1074/- 859/- 859/- 7089/- 6230/-
4.5 lacs 4723/- 1181/- 945/- 945/- 7794/- 6849/-
5 lacs 5151/- 1288/- 1030/- 1030/- 8499/- 7469/-

36-45 YEARS:

SUM INSURED SELF SPOUSE 1ST CHILD 2ND CHILD 2A+2C 2A+1C
30% 20% 20%
2 lacs 2683/- 805/- 537/- 537/- 4561/- 4025/-
2.5 lacs 3213/- 964/- 643/- 643/- 5462/- 4820/-
3 lacs 3743/- 1123/- 749/- 749/- 6363/- 5615/-
3.5 lacs 4207/- 1262/- 841/- 841/- 7152/- 6311/-
4 lacs 4670/- 1401/- 934/- 934/- 7939/- 7005/-
4.5 lacs 5135/- 1541/- 1027/- 1027/- 8730/- 7703/-
5 lacs 5598/- 1679/- 1120/- 1120/- 9517/- 8397/-

46–50 YEARS:

SUM INSURED SELF SPOUSE 1ST CHILD 2ND CHILD 2A+2C 2A+1C
35% 20% 20%
2 lacs 4290/- 1502/- 858/- 858/- 7508/- 6650/-
2.5 lacs 5200/- 1820/- 1040/- 1040/- 9099/- 8060/-
3 lacs 6108/- 2138/- 1222/- 1222/- 10690/- 9468/-
3.5 lacs 6942/- 2430/- 1388/- 1388/- 12149/- 10760/-
4 lacs 7776/- 2722/- 1555/- 1555/- 13608/- 12053/-
4.5 lacs 8610/- 3013/- 1722/- 1722/- 15067/- 13345/-
5 lacs 9444/- 3305/- 1889/- 1889/- 16526/- 14637/-

51-55 YEARS:

SUM INSURED SELF SPOUSE 1ST CHILD 2ND CHILD 2A+2C 2A+1C
40% 20% 20%
2 lacs 4485/- 1794/- 897/- 897/- 8073/- 7176/-
2.5 lacs 5436/- 2174/- 1087/- 1087/- 9785/- 8698/-
3 lacs 6386/- 2554/- 1277/- 1277/- 11495/- 10218/-
3.5 lacs 7258/- 2903/- 1452/- 1452/- 13064/- 11612/-
4 lacs 8129/- 3252/- 1626/- 1626/- 14633/- 13007/-
4.5 lacs 9001/- 3600/- 1800/- 1800/- 16202/- 14402/-
5 lacs 9873/- 3949/- 1975/- 1975/- 17771/- 15796/-

56-60 YEARS:

SUM INSURED SELF SPOUSE 1ST CHILD 2ND CHILD 2A+2C 2A+1C
40% 20% 20%
2 lacs 5127/- 2051/- 1025/- 1025/- 9228/- 8203/-
2.5 lacs 6236/- 2495/- 1247/- 1247/- 11226/- 9978/-
3 lacs 7346/- 2938/- 1469/- 1469/- 13223/- 11754/-
3.5 lacs 8375/- 3350/- 1675/- 1675/- 15076/- 13401/-
4 lacs 9406/- 3762/- 1881/- 1881/- 16931/- 15049/-
4.5 lacs 10436/- 4175/- 2087/- 2087/- 18785/- 16698/-
5 lacs 11466/- 4586/- 2293/- 2293/- 20638/- 18345/-

EXCLUSIONS:

National India Insurance is not liable to make any payment in respect of any expenses incurred in connection with:

  • All diseases/injuries those are pre-existing when the cover incepts for the first time
  • Any disease other than diabetes and hypertension that is contracted during the first 30 days from the commencement date of the policy except in case of hospitalization due to an accidental injury
  • If the insured is aware of the existence of a congenital internal disease/defect before inception of the policy, it is treated as pre-existing
  • Injury or disease caused due to war invasion
  • Circumcision unless necessary for treatment of a disease
  • Cost of spectacles, contact lenses and hearing aids
  • Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from accidental injury and which requires hospitalization for treatment
  • Convalescence general debility “run down” condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol
  • All expenses arising out of any condition due to AIDS
  • Charges incurred at a hospital/nursing home for diagnostic, X-ray or laboratory examinations not consistent with any ailment, sickness or injury
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease
  • Injury or disease caused by nuclear weapons or materials
  • Treatment arising from pregnancy, childbirth, miscarriage, abortion or complications of caesarean section
  • Any treatment other than allopathic system of medicine

EXCEPTIONS:

  • Pre-existing diseases like diabetes and hypertension will be covered from the inception of the policy on payment of additional premium by the insured
  • Insured shall bear 10% of any admissible claim if s/he is suffering from either diabetes or hypertension
  • S/he shall bear 25% of the admissible claim in case s/he is suffering from both diabetes and hypertension

Another benefit of taking a health insurance policy from National Insurance Company Limited is that t is a public sector company so it is perceived to be safer by quite a few people.