TYPES OF POLICIES
 INDIVIDUAL POLICY
 FAMILY PACKAGE POLICY
 FAMILY FLOATER POLICY
 TOP UP/EXCESS POLICIES
 GROUP HEA...
SCOPE OF COVER
Hospitalisation Expenses
Pre & Post Hospitalisation Expenses
Domiciliary Hospitalisation Expenses
Ambulance...
Critical Illness cover
Reimbursement of cost of medical check
up
Reinstatement /restoraton of sum insured
after a claim
Cu...
EXCLUSIONS
Pre-existing conditions until 48 months of
continuous coverage have elapsed
Circumcision
Vaccination, inoculati...
Dental treatment
Convalescence, general debility,
congenital external disease or defects,
sterility, venereal disease, int...
Expenses for diagnosis, x-ray or
laboratory examinations or other
diagnostic studies not consistent with
treatment or posi...
Service charges, surcharges,
admission/registration fees
All Non-medical expenses
LIMITATIONS
Hospital should have minimum 10 beds,
Operation theatre, fully qualified Doctor
& nurses in class “c” towns an...
▀ Room, Boarding & Nursing expenses are
reimbursable upto the limit prescribed.
▀ Waiting period of 30 days (except for
ac...
▀ Reasonable Expenses clause
▀ PPN Hospitals
 Gather full information on insurance covers
available
 Select the insurance cover which is suitable for
you
 Give corr...
If a claim is to be lodged --
 Give intimation to the insurer or TPA atleast 24 hours
prior to admission in the hospital ...
 Don’t buy health insurance covers through unreliable
sources though such covers may be cost effective and
may be with ea...
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Health insurance

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Health insurance

  1. 1. TYPES OF POLICIES  INDIVIDUAL POLICY  FAMILY PACKAGE POLICY  FAMILY FLOATER POLICY  TOP UP/EXCESS POLICIES  GROUP HEALTH INSURANCE POLICY
  2. 2. SCOPE OF COVER Hospitalisation Expenses Pre & Post Hospitalisation Expenses Domiciliary Hospitalisation Expenses Ambulance Charges Hospital Daily Cash Maternity Cover Domiciliary Treatment Charges
  3. 3. Critical Illness cover Reimbursement of cost of medical check up Reinstatement /restoraton of sum insured after a claim Cumulative Bonus/No claim Bonus
  4. 4. EXCLUSIONS Pre-existing conditions until 48 months of continuous coverage have elapsed Circumcision Vaccination, inoculation, change of life, cosmetic or aesthetic treatment Cost of spectacles, contact lenses and hearing aids
  5. 5. Dental treatment Convalescence, general debility, congenital external disease or defects, sterility, venereal disease, intententional self injury, use of intoxicating drugs/alcohol. Treatment for Human T-cell Lymphotrophic virus type III or condition similar kind referred to as AIDS.
  6. 6. Expenses for diagnosis, x-ray or laboratory examinations or other diagnostic studies not consistent with treatment or positive existence of ailment. Injury or disease caused by nuclear weapon/materials External and or durable medical/nonmedical equipment
  7. 7. Service charges, surcharges, admission/registration fees All Non-medical expenses
  8. 8. LIMITATIONS Hospital should have minimum 10 beds, Operation theatre, fully qualified Doctor & nurses in class “c” towns and 15 beds in other towns & cities or Should have been registered as Hospital/Nursing Home with the local authorities.
  9. 9. ▀ Room, Boarding & Nursing expenses are reimbursable upto the limit prescribed. ▀ Waiting period of 30 days (except for accident) ▀ Waiting period for specified diseases ▀ Limits applicable for specified diseases ▀ Co-payment
  10. 10. ▀ Reasonable Expenses clause ▀ PPN Hospitals
  11. 11.  Gather full information on insurance covers available  Select the insurance cover which is suitable for you  Give correct information as asked for in the proposal form  Invariably register nominees name in the proposal form  Examine the policy when received and if the terms and conditions are not acceptable, return the policy to the insurer within Free Look period of 15 days.
  12. 12. If a claim is to be lodged --  Give intimation to the insurer or TPA atleast 24 hours prior to admission in the hospital for availing cashless facility or  Immediately on admission if cashless facility is not required  Keep in mind the limitations in the policy especially in regard to room charges, etc. at the time of admission  After discharge from hospital, submit all relevant papers to TPA for reimbursement in a week’s time. Papers relating to post hospitalization expenses can be submitted later on. 
  13. 13.  Don’t buy health insurance covers through unreliable sources though such covers may be cost effective and may be with easy terms  Don’t under-estimate the importance of the questions in the proposal forms and refrain from furnishing correct answers  Do not suppress any information that are required to be provided  Do not neglect payment of renewal premium in time.  Avoid delay in intimating of claim or submitting claim papers.

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