Medical Insurance Concept's By - Prof. Manoj Kumar Pandey, MBA , AIII. Associate Professor - Insurance & Marketing,
Birla Institute of Management Technology (BIMTECH), Greater Noida (NCR).
The document discusses various types of insurance and risk management strategies. It provides information on auto, health, property, life and disability insurance. It also covers insurance terminology like premiums, deductibles, and factors that influence policy costs. Additionally, the document discusses estate planning tools like wills, trusts, and powers of attorney to transfer assets and minimize taxes after death.
This document provides information about becoming an MDRT insurance agent with LIC. It outlines the high earning potential, benefits like pension, career growth, prestige, and lifestyle rewards that come with being a top-performing LIC agent. Examples are given of current agents who have achieved Million Dollar Round Table status and earn over $100,000 annually from insurance sales commissions and renewal income. Qualifying for MDRT in the first year of agency is presented as an achievable goal with the right training and commitment.
World Financial Group (WFG) is a financial services company that provides opportunities for individuals to start their own independent financial services business by becoming WFG associates. As associates, they can offer clients financial planning services and products from various insurance and investment companies that WFG has agreements with. Becoming a WFG associate requires a $100 application fee and allows associates to operate their business with support from WFG's corporate headquarters but without franchise or territory fees. WFG trains associates and provides ongoing business support to help associates build their client base and grow their independent financial services business.
Health insurance policies provide coverage for medical expenses incurred during hospitalization. They typically cover costs associated with room and board, nursing care, surgeon fees, and other medical costs, up to the specified sum insured. Insurance companies have networks of hospitals where policyholders can receive cashless treatment and the insurance company will directly pay the hospital bills. Common types of health insurance in India include employer-provided plans, government schemes like ESI and CGHS, community-based and rural health insurance, and individual and family floater policies.
The document provides an overview of insurance, including definitions and key concepts. It explains that insurance is a protection against financial loss from unexpected events, where premiums collected are used to pay claims. Key principles include utmost good faith, insurable interest, indemnity, subrogation, contribution and proximate cause. It also describes various types of insurance policies like fire, marine, motor, liability, personal accident, health and life. Specific policies covered include machinery breakdown, contractors all risk, boiler and pressure vessel, and medi-claim.
This document summarizes various types of health insurance policies including Mediclaim, Group Mediclaim, Cancer Patients Aid Association policy, Critical Illness Insurance, Overseas Medical policy, and Corporate Frequent Travellers policy. It outlines what is covered and excluded in each policy type, such as reimbursement of hospitalization expenses, waiting periods, claim limits, and eligibility.
This document discusses group insurance, including its key concepts and features. Group insurance insures a group rather than individuals, with one policy covering many people. It provides security and benefits to employees. Premiums are lower than individual policies since risks are spread across a group. The document outlines various types of group insurance schemes in India like group term insurance, group savings-linked insurance, and group gratuity and superannuation schemes. It also discusses insurers' obligations to provide rural and social sector insurance.
This document provides an overview of insurance products in India. It discusses the definitions of insurance, the regulatory body IRDAI, and the major players in life and general insurance - LIC, GIC and their subsidiaries. It also summarizes various life insurance products like children's plans, pension plans, whole life plans, and unit plans. For general insurance, it briefly covers types like motor insurance, health insurance, home insurance, marine insurance, travel insurance, and commercial insurance.
The document discusses various types of insurance and risk management strategies. It provides information on auto, health, property, life and disability insurance. It also covers insurance terminology like premiums, deductibles, and factors that influence policy costs. Additionally, the document discusses estate planning tools like wills, trusts, and powers of attorney to transfer assets and minimize taxes after death.
This document provides information about becoming an MDRT insurance agent with LIC. It outlines the high earning potential, benefits like pension, career growth, prestige, and lifestyle rewards that come with being a top-performing LIC agent. Examples are given of current agents who have achieved Million Dollar Round Table status and earn over $100,000 annually from insurance sales commissions and renewal income. Qualifying for MDRT in the first year of agency is presented as an achievable goal with the right training and commitment.
World Financial Group (WFG) is a financial services company that provides opportunities for individuals to start their own independent financial services business by becoming WFG associates. As associates, they can offer clients financial planning services and products from various insurance and investment companies that WFG has agreements with. Becoming a WFG associate requires a $100 application fee and allows associates to operate their business with support from WFG's corporate headquarters but without franchise or territory fees. WFG trains associates and provides ongoing business support to help associates build their client base and grow their independent financial services business.
Health insurance policies provide coverage for medical expenses incurred during hospitalization. They typically cover costs associated with room and board, nursing care, surgeon fees, and other medical costs, up to the specified sum insured. Insurance companies have networks of hospitals where policyholders can receive cashless treatment and the insurance company will directly pay the hospital bills. Common types of health insurance in India include employer-provided plans, government schemes like ESI and CGHS, community-based and rural health insurance, and individual and family floater policies.
The document provides an overview of insurance, including definitions and key concepts. It explains that insurance is a protection against financial loss from unexpected events, where premiums collected are used to pay claims. Key principles include utmost good faith, insurable interest, indemnity, subrogation, contribution and proximate cause. It also describes various types of insurance policies like fire, marine, motor, liability, personal accident, health and life. Specific policies covered include machinery breakdown, contractors all risk, boiler and pressure vessel, and medi-claim.
This document summarizes various types of health insurance policies including Mediclaim, Group Mediclaim, Cancer Patients Aid Association policy, Critical Illness Insurance, Overseas Medical policy, and Corporate Frequent Travellers policy. It outlines what is covered and excluded in each policy type, such as reimbursement of hospitalization expenses, waiting periods, claim limits, and eligibility.
This document discusses group insurance, including its key concepts and features. Group insurance insures a group rather than individuals, with one policy covering many people. It provides security and benefits to employees. Premiums are lower than individual policies since risks are spread across a group. The document outlines various types of group insurance schemes in India like group term insurance, group savings-linked insurance, and group gratuity and superannuation schemes. It also discusses insurers' obligations to provide rural and social sector insurance.
This document provides an overview of insurance products in India. It discusses the definitions of insurance, the regulatory body IRDAI, and the major players in life and general insurance - LIC, GIC and their subsidiaries. It also summarizes various life insurance products like children's plans, pension plans, whole life plans, and unit plans. For general insurance, it briefly covers types like motor insurance, health insurance, home insurance, marine insurance, travel insurance, and commercial insurance.
The document provides an introduction to various concepts in insurance including the life insurance contract, principles of insurance, utmost good faith, insurable interest, and different types of insurance policies like term insurance, whole life insurance, endowment policies, and annuities. It explains that a life insurance contract is a valid legal agreement between the insurer and insured where the insurer agrees to pay claims on the happening of an insured event in exchange for premiums paid by the insured.
This document discusses financial planning and the importance of saving money. It notes that most people struggle financially because they fail to plan and spend all of their income rather than saving. This leads to a "rat race" where people work hard but have no savings to fall back on. The document recommends building a solid financial foundation by prioritizing healthcare, protection, eliminating debts, emergency funds, and investments in order to become financially independent and secure. It emphasizes the importance of having a savings formula where income minus expenses equals savings.
Group insurance provides coverage to a large number of individuals under a single master policy between the insurer and a representative body. It offers benefits like life, health, and accident insurance to groups of people associated with an employer or organization. Grouping individuals allows insurers to offer lower rates due to the large volume of policies.
Health Insurance - a presentation by Richard Strauss Insurance BrokersRSIB
The document discusses the importance of health insurance and provides information about different health insurance plans. It explains that health insurance protects against medical expenses from illness or accidents. Individual plans cover hospitalization costs for one person, while family floater plans can be used by any family member. Critical illness plans provide a lump sum payment for over 30 serious illnesses. The document also outlines eligibility, benefits, and factors to consider when purchasing health insurance.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
A financial advisor analyzes a client's financial situation and goals in order to create an investment plan to help the client achieve their goals. They collect information from clients about expectations, current status, and desired achievements. They then analyze the client's current investment portfolio and prepare a customized plan. Imperial Finsol provides various financial planning services including asset management, financial planning, education planning, wealth creation, insurance planning, retirement planning, and risk management. They have offices in Pune and Nagpur and can be contacted via phone, email or their website.
There are three types of health insurance cover available in the market today. These are:
Mediclaim:
These policies cover you for hospitalization expenses. Actual hospitalization expenses are paid subject to a maximum limit of the sum assured opted for. All insurers offer policyholders cashless treatment in their network of hospitals. Policyholders can also pay upfront and then claim reimbursement from the insurer.
We recommend Mediclaim as a basic “must have” health insurance to our customers. Mediclaim can be individual or a family floater. In individual every person has his or her own individual policy. In a family floater the members of a family pay a single premium and have one insurance policy that covers the family. Sometimes parents and in-laws can also be included in the family cover. A floater cover provides a lot of flexibility for the family and normally works out more economical.
Fixed Benefit Cover
These is a new class of insurance products in the Indian market. These plans pay a pre-determined sum of money depending upon the number of days a person is in hospital and the type of surgery done. This amount may be more or less than the actual expenses you incur. We recommend this as an additional insurance to purchase after you have the basic mediclaim policy. Similar to the indemnity cover, fixed benefit cover has individual and family floater options. Fixed benefit policies will pay you the benefit even if the actual costs are reimbursed by a mediclaim policy.
Critical Illness plans
In these plans a fixed sum of money is paid if the person gets certain pre-specified diseases. Plans can cover anywhere from 9 to 35 diseases. In our view these plans are best bought after one has the basic medicliam and fixed benefit plans. They are ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure.
Each of the insurance plans described here can be taken for a single Individual or may include dependents such as the spouse, minor children, parents, parents-in-law, grandparents and grandchildren.
This document provides information to help people retire ready, including:
- It explores current U.S. retirement trends, discusses retirement planning tools, and provides 10 timeless retirement planning tips.
- Sobering statistics are presented on health care costs, longevity, poverty rates, and disconnects between planned and actual retirement.
- Key retirement planning factors are outlined like age, income needs, savings, and health. Other important factors like caregiving and job options are also discussed.
- Tools for estimating savings needs, life expectancy, and safe withdrawal rates in retirement are reviewed to help people better plan.
The document provides an overview of how insurance works. It explains that insurance involves individuals pooling funds through premium payments to cover losses experienced by a few. When many individuals face the same risks, insurance allows for losses to be shared across the community in a manageable way for all. Premiums collected are invested, and surpluses are used to pay future claims or returned to policyholders. Examples illustrate how insurance protects against risks of fire or death by having many share the costs of losses affecting a few.
This document provides an overview of health insurance in India, including what it is, its importance, and common products. It discusses how health insurance works by pooling risks collectively. It outlines the rising costs of healthcare as a driver for health insurance penetration. Common plan types include individual, family floater, senior citizens, critical illness, daily hospital cash, and unit-linked plans. It also discusses government schemes like ESIS and CGHS, as well as community-based and employer-provided insurance options. Impediments to the industry like lack of data, pricing challenges, and government provision of care are also covered.
Star Comprehensive Insurance Policy ensures complete coverage for the whole family giving hospitalization benefits with no sub-limits or caps on room rent, no disease wise limits, OP dental and ophthalmic treatments, hospital cash benefit, delivery and new born baby cover, Pre and Post-hospitalization expenses covered etc.
Whole life insurance is a type of permanent life insurance that is designed to remain in force for the entire lifetime of the insured as long as premiums are paid. Premiums for whole life policies remain level and a portion of each premium is invested, allowing the policy to accumulate a cash value over time. There are two primary types of whole life policies: ordinary life, where premiums are paid until death, and limited-payment life, where premiums are paid over a shorter specified period. Whole life is commonly used for family protection, business planning, accumulation needs, and charitable gifts.
This document provides an overview of indexed universal life (IUL) insurance. It explains that IUL is a type of permanent life insurance that offers the potential for greater interest than traditional universal life due to interest being credited based on the upward movement of a stock market index, up to a cap rate. It also guarantees a minimum 2% interest rate. The document discusses when IUL may be a good choice, the interest crediting options available, and how policyholders can decide factors like coverage amount and premium payments.
The document describes the key features of a group mediclaim insurance policy for corporate clients. It covers medical expenses for employees, spouses, dependent children and parents as inpatients in hospitals in India. The policy provides coverage for room and board charges, surgery costs, diagnostic tests, medicines and other medical appliances. It also includes maternity coverage, pre-existing disease coverage after waiting periods, and day care treatments. Claims exceeding the sum insured can be paid through a corporate buffer.
This report examines the relationship between spas, wellness tourism, and medical tourism. It provides definitions for wellness tourism and medical tourism, analyzes industry data, and profiles organizational structures and promotion efforts in different countries. The report also includes case studies on 12 countries, a survey of spa industry professionals, and recommendations for how spas can better integrate into wellness and medical tourism markets going forward. Key findings include the lack of standardized definitions, varying levels of spa integration across countries, and opportunities for spas to take advantage of growing wellness and medical tourism industries.
A simple and revolutionary financial plan report that does something simple.Abhinay Gupta
This document provides an overview of Mr. XYZ's financial plan. It analyzes his current assets of Rs. 1.19 crores in fixed assets and Rs. 40 lacs in financial assets against total liabilities of Rs. 27.5 lacs, giving a current net worth of Rs. 1.32 crores. It then breaks down his annual income sources, expenses, savings and cash flows. Based on a risk assessment, it recommends an aggressive asset allocation of 70% in equities, 20% in debt and 10% in cash. Finally, it analyzes his financial goals for education, marriage, retirement and vacations, and provides suggestions to meet these goals through insurance plans and investment strategies.
This chapter discusses different types of life and health insurance. It describes life insurance, the underwriting process, and various life insurance policies like term life, whole life, and endowment. It also defines health insurance and explains key health insurance concepts such as deductibles, copays, coinsurance, and different types of health insurance plans including disability income, hospitalization, surgical, and regular medical. The primary purpose of life insurance is to financially protect a family if the primary income earner dies prematurely, while health insurance helps cover medical costs from sickness or injury.
Health insurance protects individuals from high medical costs by covering expenses. In India, health insurance reaches only 13% of the population through various schemes. These include private plans, employer-based coverage, community-based insurance, and government programs. The largest government scheme is the Central Government Health Scheme (CGHS), which provides services to central government employees and retirees in 17 cities. Another major program is Rashtriya Swasthya Bima Yojna (RSBY), which offers health insurance to below poverty line families. However, challenges remain in increasing awareness, improving claims processes, and reducing disputes over pre-existing conditions. Research shows that losing health insurance leads to 40% fewer emergency room visits and 61% fewer hospital
The document discusses the key objectives and process of underwriting in the insurance industry. It provides definitions of underwriting as examining and classifying risks to determine appropriate premiums. The objectives are outlined as providing equitable, profitable and deliverable insurance policies. Key aspects covered include risk factors considered, principles of utmost good faith and moral hazard, types of underwriters and their roles, and importance of sound underwriting. Rules for application forms and documentation requirements are also summarized.
Proposal For Health Care Services PowerPoint Presentation SlidesSlideTeam
If your company needs to submit a Proposal For Health Care Services PowerPoint Presentation Slides look no further. Our researchers have analyzed thousands of proposals on this topic for effectiveness and conversion. Just download our template, add your company data and submit to your client for a positive response. https://bit.ly/3gKs32s
Short, simple, and informative review of insurance coverages for medical offices. Learn about different insurance products for offices, malpractice, HIPAA info, and medical billing errors
This document provides contextual information about health insurance in India, including:
- The origin and development of health insurance in India, which began in the 1980s with government schemes and expanded to private policies.
- Key definitions of health insurance as providing financial protection against unexpected medical costs through risk pooling and premium payments.
- Statistics on health insurance coverage in India, which remains low at only a few percent of the population, with most costs paid through out-of-pocket expenses.
- An overview of the types of health insurance schemes currently operating in India through public sector insurers, private insurers, employers, and community-based programs.
The document provides an introduction to various concepts in insurance including the life insurance contract, principles of insurance, utmost good faith, insurable interest, and different types of insurance policies like term insurance, whole life insurance, endowment policies, and annuities. It explains that a life insurance contract is a valid legal agreement between the insurer and insured where the insurer agrees to pay claims on the happening of an insured event in exchange for premiums paid by the insured.
This document discusses financial planning and the importance of saving money. It notes that most people struggle financially because they fail to plan and spend all of their income rather than saving. This leads to a "rat race" where people work hard but have no savings to fall back on. The document recommends building a solid financial foundation by prioritizing healthcare, protection, eliminating debts, emergency funds, and investments in order to become financially independent and secure. It emphasizes the importance of having a savings formula where income minus expenses equals savings.
Group insurance provides coverage to a large number of individuals under a single master policy between the insurer and a representative body. It offers benefits like life, health, and accident insurance to groups of people associated with an employer or organization. Grouping individuals allows insurers to offer lower rates due to the large volume of policies.
Health Insurance - a presentation by Richard Strauss Insurance BrokersRSIB
The document discusses the importance of health insurance and provides information about different health insurance plans. It explains that health insurance protects against medical expenses from illness or accidents. Individual plans cover hospitalization costs for one person, while family floater plans can be used by any family member. Critical illness plans provide a lump sum payment for over 30 serious illnesses. The document also outlines eligibility, benefits, and factors to consider when purchasing health insurance.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
A financial advisor analyzes a client's financial situation and goals in order to create an investment plan to help the client achieve their goals. They collect information from clients about expectations, current status, and desired achievements. They then analyze the client's current investment portfolio and prepare a customized plan. Imperial Finsol provides various financial planning services including asset management, financial planning, education planning, wealth creation, insurance planning, retirement planning, and risk management. They have offices in Pune and Nagpur and can be contacted via phone, email or their website.
There are three types of health insurance cover available in the market today. These are:
Mediclaim:
These policies cover you for hospitalization expenses. Actual hospitalization expenses are paid subject to a maximum limit of the sum assured opted for. All insurers offer policyholders cashless treatment in their network of hospitals. Policyholders can also pay upfront and then claim reimbursement from the insurer.
We recommend Mediclaim as a basic “must have” health insurance to our customers. Mediclaim can be individual or a family floater. In individual every person has his or her own individual policy. In a family floater the members of a family pay a single premium and have one insurance policy that covers the family. Sometimes parents and in-laws can also be included in the family cover. A floater cover provides a lot of flexibility for the family and normally works out more economical.
Fixed Benefit Cover
These is a new class of insurance products in the Indian market. These plans pay a pre-determined sum of money depending upon the number of days a person is in hospital and the type of surgery done. This amount may be more or less than the actual expenses you incur. We recommend this as an additional insurance to purchase after you have the basic mediclaim policy. Similar to the indemnity cover, fixed benefit cover has individual and family floater options. Fixed benefit policies will pay you the benefit even if the actual costs are reimbursed by a mediclaim policy.
Critical Illness plans
In these plans a fixed sum of money is paid if the person gets certain pre-specified diseases. Plans can cover anywhere from 9 to 35 diseases. In our view these plans are best bought after one has the basic medicliam and fixed benefit plans. They are ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure.
Each of the insurance plans described here can be taken for a single Individual or may include dependents such as the spouse, minor children, parents, parents-in-law, grandparents and grandchildren.
This document provides information to help people retire ready, including:
- It explores current U.S. retirement trends, discusses retirement planning tools, and provides 10 timeless retirement planning tips.
- Sobering statistics are presented on health care costs, longevity, poverty rates, and disconnects between planned and actual retirement.
- Key retirement planning factors are outlined like age, income needs, savings, and health. Other important factors like caregiving and job options are also discussed.
- Tools for estimating savings needs, life expectancy, and safe withdrawal rates in retirement are reviewed to help people better plan.
The document provides an overview of how insurance works. It explains that insurance involves individuals pooling funds through premium payments to cover losses experienced by a few. When many individuals face the same risks, insurance allows for losses to be shared across the community in a manageable way for all. Premiums collected are invested, and surpluses are used to pay future claims or returned to policyholders. Examples illustrate how insurance protects against risks of fire or death by having many share the costs of losses affecting a few.
This document provides an overview of health insurance in India, including what it is, its importance, and common products. It discusses how health insurance works by pooling risks collectively. It outlines the rising costs of healthcare as a driver for health insurance penetration. Common plan types include individual, family floater, senior citizens, critical illness, daily hospital cash, and unit-linked plans. It also discusses government schemes like ESIS and CGHS, as well as community-based and employer-provided insurance options. Impediments to the industry like lack of data, pricing challenges, and government provision of care are also covered.
Star Comprehensive Insurance Policy ensures complete coverage for the whole family giving hospitalization benefits with no sub-limits or caps on room rent, no disease wise limits, OP dental and ophthalmic treatments, hospital cash benefit, delivery and new born baby cover, Pre and Post-hospitalization expenses covered etc.
Whole life insurance is a type of permanent life insurance that is designed to remain in force for the entire lifetime of the insured as long as premiums are paid. Premiums for whole life policies remain level and a portion of each premium is invested, allowing the policy to accumulate a cash value over time. There are two primary types of whole life policies: ordinary life, where premiums are paid until death, and limited-payment life, where premiums are paid over a shorter specified period. Whole life is commonly used for family protection, business planning, accumulation needs, and charitable gifts.
This document provides an overview of indexed universal life (IUL) insurance. It explains that IUL is a type of permanent life insurance that offers the potential for greater interest than traditional universal life due to interest being credited based on the upward movement of a stock market index, up to a cap rate. It also guarantees a minimum 2% interest rate. The document discusses when IUL may be a good choice, the interest crediting options available, and how policyholders can decide factors like coverage amount and premium payments.
The document describes the key features of a group mediclaim insurance policy for corporate clients. It covers medical expenses for employees, spouses, dependent children and parents as inpatients in hospitals in India. The policy provides coverage for room and board charges, surgery costs, diagnostic tests, medicines and other medical appliances. It also includes maternity coverage, pre-existing disease coverage after waiting periods, and day care treatments. Claims exceeding the sum insured can be paid through a corporate buffer.
This report examines the relationship between spas, wellness tourism, and medical tourism. It provides definitions for wellness tourism and medical tourism, analyzes industry data, and profiles organizational structures and promotion efforts in different countries. The report also includes case studies on 12 countries, a survey of spa industry professionals, and recommendations for how spas can better integrate into wellness and medical tourism markets going forward. Key findings include the lack of standardized definitions, varying levels of spa integration across countries, and opportunities for spas to take advantage of growing wellness and medical tourism industries.
A simple and revolutionary financial plan report that does something simple.Abhinay Gupta
This document provides an overview of Mr. XYZ's financial plan. It analyzes his current assets of Rs. 1.19 crores in fixed assets and Rs. 40 lacs in financial assets against total liabilities of Rs. 27.5 lacs, giving a current net worth of Rs. 1.32 crores. It then breaks down his annual income sources, expenses, savings and cash flows. Based on a risk assessment, it recommends an aggressive asset allocation of 70% in equities, 20% in debt and 10% in cash. Finally, it analyzes his financial goals for education, marriage, retirement and vacations, and provides suggestions to meet these goals through insurance plans and investment strategies.
This chapter discusses different types of life and health insurance. It describes life insurance, the underwriting process, and various life insurance policies like term life, whole life, and endowment. It also defines health insurance and explains key health insurance concepts such as deductibles, copays, coinsurance, and different types of health insurance plans including disability income, hospitalization, surgical, and regular medical. The primary purpose of life insurance is to financially protect a family if the primary income earner dies prematurely, while health insurance helps cover medical costs from sickness or injury.
Health insurance protects individuals from high medical costs by covering expenses. In India, health insurance reaches only 13% of the population through various schemes. These include private plans, employer-based coverage, community-based insurance, and government programs. The largest government scheme is the Central Government Health Scheme (CGHS), which provides services to central government employees and retirees in 17 cities. Another major program is Rashtriya Swasthya Bima Yojna (RSBY), which offers health insurance to below poverty line families. However, challenges remain in increasing awareness, improving claims processes, and reducing disputes over pre-existing conditions. Research shows that losing health insurance leads to 40% fewer emergency room visits and 61% fewer hospital
The document discusses the key objectives and process of underwriting in the insurance industry. It provides definitions of underwriting as examining and classifying risks to determine appropriate premiums. The objectives are outlined as providing equitable, profitable and deliverable insurance policies. Key aspects covered include risk factors considered, principles of utmost good faith and moral hazard, types of underwriters and their roles, and importance of sound underwriting. Rules for application forms and documentation requirements are also summarized.
Proposal For Health Care Services PowerPoint Presentation SlidesSlideTeam
If your company needs to submit a Proposal For Health Care Services PowerPoint Presentation Slides look no further. Our researchers have analyzed thousands of proposals on this topic for effectiveness and conversion. Just download our template, add your company data and submit to your client for a positive response. https://bit.ly/3gKs32s
Short, simple, and informative review of insurance coverages for medical offices. Learn about different insurance products for offices, malpractice, HIPAA info, and medical billing errors
This document provides contextual information about health insurance in India, including:
- The origin and development of health insurance in India, which began in the 1980s with government schemes and expanded to private policies.
- Key definitions of health insurance as providing financial protection against unexpected medical costs through risk pooling and premium payments.
- Statistics on health insurance coverage in India, which remains low at only a few percent of the population, with most costs paid through out-of-pocket expenses.
- An overview of the types of health insurance schemes currently operating in India through public sector insurers, private insurers, employers, and community-based programs.
Medical billing involves submitting bills to insurance companies in a standardized format for medical services provided by doctors to patients. The main parties involved are the patient, provider, billing office, and insurance company. The responsibilities of the billing office include properly coding bills, ensuring compliance with insurance rules, maintaining records, filing claims, and following up. Billing offices have various departments like coding, claims processing, and accounts receivable. There are two main types of insurance companies - federal programs like Medicare and Medicaid, and private commercial insurers like Aetna and Blue Cross Blue Shield.
Chapter 01 concepts and principles of insuranceiipmff2
The document defines insurance as a social device where individuals transfer risk to an insurer who pools losses to make statistical predictions and provide payments from premium contributions. Legally, it is a contract where an insurer provides security to an insured against specified events in exchange for a premium proportionate to the risk. Key elements are risk transfer from insured to insurer, insurance as a business to meet costs and make profit, and an insurance contract as a legally enforceable agreement. Fundamental principles include utmost good faith, indemnity, subrogation, contribution, and proximate cause. There are various types of insurance and governing laws regulate the insurance sector in India.
The document summarizes four types of plants: gymnosperms, angiosperms, ferns, and mosses. Gymnosperms reproduce through cones and do not produce fruit, while angiosperms reproduce through flowering and fruit-bearing plants like roses and berries. Ferns have roots, stems, and large frond-like leaves and have existed for over 300 million years. Mosses have simple stems and leaves and reproduce via spores inside capsules.
The scene opens in black and white with a woman panting and covered in blood, creating tension for the viewer about what has happened. No music is used, adding to the tense atmosphere without revealing the setting or who is approaching. Heavy footsteps grow closer to the women while the character remains unseen, generating mystery and curiosity for the audience around who this person is and why he wants to kill her. The scene ends with titles/credits, potentially drawing in viewers with recognizable names and allowing thought on the mysterious events.
Gorgona Island is home to many poisonous and dangerous creatures including snakes, lizards, poisonous frogs, eels, blowfish, swordfish, sea snakes, stingrays, sharks, and more. The island has caves and is known for its biodiversity despite its small size. Many creatures that live on the island are poisonous or dangerous to humans.
Un eclipse lunar ocurre cuando la Tierra se interpone entre el Sol y la Luna, proyectando su sombra sobre la Luna. La Luna entra en la sombra de la Tierra y adquiere un color rojizo debido a la refracción de la luz solar en la atmósfera terrestre. Los eclipses lunares solo ocurren durante las fases de luna llena y son visibles desde cualquier lugar nocturno de la Tierra donde la Luna esté sobre el horizonte.
Rajan Naidoo's curriculum vitae details his educational background and extensive work experience in information technology and desktop support roles over 15+ years. He has held positions such as Senior Customer Engineer, Services Supervisor, Team Leader and Customer Engineer supporting large corporate clients. Naidoo has also completed many technical courses building his skills in areas like Windows, networking, and project management.
Este documento describe los diferentes climas de España, incluyendo el clima oceánico, el clima continental y el clima mediterráneo. El clima oceánico se caracteriza por temperaturas suaves y abundantes precipitaciones durante todo el año. La vegetación típica incluye bosques de hoja caduca, helechos, musgos y prados. El clima continental tiene temperaturas extremas con inviernos fríos y veranos calurosos, y precipitaciones escasas. La vegetación es escasa en las zonas altas. El clima
The scene opens in a diner in America, establishing the setting. The audience learns through mature language that the main characters, a couple, have been in a long-term relationship. While they seem like a normal couple to others, their dialogue hints at deeper issues and a woman's behavior changes drastically by the scene's end, surprising viewers.
El documento describe los diferentes elementos que componen un plano, incluyendo las marcas de orientación que indican los puntos cardinales, los signos y símbolos convencionales utilizados para representar objetos, la leyenda que explica el significado de los símbolos, la escala que indica la reducción de la realidad en el plano, y la toponimia que muestra los lugares y calles. Además, explica los diferentes tipos de planos como el ortogonal para ciudades con calles en ángulo recto, el lineal para localidades alargadas asoci
Fibromyalgia 2016 is an international conference on fibromyalgia and chronic pain that will take place August 22-23, 2016 in Sao Paulo, Brazil. The conference will include presentations by renowned scientists from around the world on advances in chronic pain medication and treatment. Accepted abstracts will be published in OMICS Group journals focused on fibromyalgia, pain relief, arthritis, emergency mental health and alternative medicine. Participation provides an opportunity to network globally and exchange ideas to further progress in the field.
Nafeel Lebbethamby is seeking a job and provides his resume. He has worked as a laborer for 3 years, driver for 4 years, and team leader for 4 years at ETS Company. He has a Municipal Pest Control Card. He is Sri Lankan and studied up to O/Ls, passing subjects like Math, English, and Science. He is skilled in teamwork, works well across groups, and is responsible. He knows languages like Tamil, Sinhala, Hindi, and English.
The document discusses health insurance and medical benefits for employees in India. It notes that while not legally required, many employers provide some level of healthcare for workers. Group medical insurance is presented as a comprehensive solution that outsources this non-core activity while providing benefits to both employers and employees. The future of health insurance in India is promising as awareness and demand are growing, though more widespread coverage is still needed as most people currently pay medical costs out-of-pocket.
The document provides an overview of the roles and responsibilities of a health insurance specialist. It discusses how insurance specialists assist physician practices by gathering patient information, obtaining authorizations, filing claims, and tracking reimbursements. It also outlines the qualifications needed for the role, including skills in medical terminology, coding, insurance regulations, and use of billing software. Additional sections cover topics like common health plans, insurance terminology, the claims process, coding, fee schedules, and communicating with patients about financial matters.
The document discusses various compensation models used by managed care organizations (MCOs) to influence physician behavior and control costs, including capitation, withholds, bonuses, and risk sharing. It provides examples of how capitation, withholds, and bonuses are implemented. It also discusses the advantages of capitation for physicians in terms of financial autonomy and cash flow stability. Finally, it summarizes the rise and fall of large physician practice management companies in the 1990s that aimed to aggregate physician practices but often struggled with integration and cost prediction issues.
This document provides an overview of various health insurance concepts and options in the United States, including definitions of common health insurance terms, examples of different health insurance plans (HMO, PPO, HDHP/HSA), and descriptions of public health insurance programs like Medicare and Medicaid. Key types of private health insurance discussed are individual/family plans, employer-sponsored plans, and short-term plans. Eligibility, costs, and regulations associated with these various health insurance options are summarized.
This document discusses various considerations related to physician employment contracts and practice mergers and acquisitions. It begins with an overview of general issues and then discusses specific topics like employment agreements between physicians and group practices or hospitals, compensation models, practice buy-ins, and mergers. Key parties in these arrangements are identified, as well as the typical professionals that comprise a consulting team. Factors around different alignment models and trends driving consolidation are also summarized.
Minimum Essential Coverage (MEC) plans with limited benefits and healthcare concierge services are described. MEC plans provide the minimum level of health insurance required under the Affordable Care Act to avoid penalties, through benefits like preventive care visits and generic prescriptions. Additional services include telemedicine, medical bill negotiation, and discounts. Employers can offer MEC plans to comply with ACA mandates while controlling costs. The document provides details on specific MEC plan options and support services available.
This document discusses healthcare systems and dental payment mechanisms in India and the United States. It provides details on:
1) The public and private healthcare sectors in India, including government insurance schemes like CGHS and ESIS.
2) Types of dental payment plans in the US, including private fee-for-service, insurance plans (HMOs, PPOs), and public programs like Medicaid and Medicare.
3) Reimbursement methods for dentists in the US, including UCR fees, fee schedules, and capitation. Major dental insurance plans like Delta Dental are also summarized.
This document provides guidance on billing qualifying dental procedures to medical insurance policies to expand patient access to care and increase practice revenue. It outlines categories of medically necessary dental procedures that can be billed to medical insurance, including diagnostic procedures, traumatic dental injury treatments, surgical procedures, and non-surgical treatments. The document emphasizes the importance of using proper medical coding and clearly explaining the medical necessity of any dental procedures billed to medical insurance.
This challenge presents an opportunity for dental practices to increase their patient base and boost revenue by billing qualifying dental procedures to medical policies instead. Doing so not only helps patients access care to resolve complex oral health issues but also does so cost-effectively while preserving what dental benefits they might have.
The document discusses the critical role that insurance verification plays in orthopedic practices. It outlines several challenges orthopedic practices face, including declining reimbursement rates, costs of new implants, and changes from the Affordable Care Act. Thorough insurance verification through benefit verification and pre-certification is important for orthopedic practices to address these challenges and ensure maximum reimbursement for provided services. The verification process includes finding the best insurance resources, obtaining accurate benefit details, and seeking pre-approvals to reduce denials and write-offs.
This document summarizes insurance eligibility, coverage, and benefits for residential behavioral health settings. It finds that 84% of admissions in 2009 were insurance-based. It describes differences between in-network and out-of-network coverage for major insurance providers, as well as plan types like PPO, HMO, EPO, and POS. The document also outlines eligibility criteria, covered benefits, and patient financial responsibility. Finally, it reviews behavioral health levels of care and pre-admission screening information required.
This document discusses health insurance in India, including what it is, reasons for rising healthcare costs, why it is essential, and the current market and challenges. It outlines that health insurance covers medical expenses, is an agreement between an individual/group and insurer for specific medical coverage in exchange for premiums. While healthcare spending is increasing in India, only a small portion of the population has coverage, representing an opportunity for the insurance industry and hospitals to partner in promoting various insurance policies and educating the public on benefits of health insurance.
Health insurance provides coverage for medical expenses and loss of earnings due to illness or injury. It depends on the conditions, benefits, and treatment options covered by the policy. Premiums are paid in advance for future health coverage. There are different types of health insurance plans such as group, individual, and family floater plans. While perceptions of health insurance in India are mixed, it has become necessary due to rising medical costs, the need to share health risks, and securing one's family's health. Government initiatives aim to increase health insurance penetration and affordability, but challenges remain around healthcare delivery and costs, consumer awareness, and claim ratios.
The Affordable Care Act expands health insurance coverage through provisions like the individual and employer mandates and Medicaid expansion. This will increase the number of insured Americans but also strain emergency care systems due to pre-existing shortages of physicians and practices accepting Medicaid. While the ACA aims to improve quality and reduce costs through mechanisms like accountable care organizations, there are concerns these may not adequately address the needs of emergency departments and specialists. The ACA also faces challenges in ensuring new coverage translates to improved access to care.
The document discusses the importance of medical revenue cycle management (RCM) for physician practices. It outlines key factors that affect practice revenue, including proper billing/coding, credentialing, preauthorizations, and accounts receivable (A/R) management. The document uses an example to show that while a lower RCM fee may seem better, a service that improves reimbursements by 5% and charges a slightly higher fee of 5.75% can provide greater overall revenue to the practice. Effective RCM requires ongoing attention to timely claim filing, proper use of modifiers, credentialing updates, eligibility verification, and A/R monitoring through metrics like payment rates and days in A/R. Outsourcing RCM to an experienced
Should an Employer Be Self-Funded?
That is quite a question. In the past we cautioned that claims savings was not guaranteed by self-funding. And with a small difference in fixed fees vs. fully insured retention, there was not much incentive for smaller employers to take the risk, given that they were more susceptible to wide fluctuations in claims cost.
Review our research and analysis on self-funding to help determine if the program is the right fit for your business. Contact McGohan-Brabender to discuss self-funding in detail.
https://www.mcgohanbrabender.com/
SOUTH ASIAN JOURNAL OF BUSINESS AND MANAGEMENT CASES, Volume 8 Number 2 Augus...BIMTECH Greater Noida
This document provides the contents of Volume 8 Number 2 of the August 2019 issue of the South Asian Journal of Business and Management Cases. The editorial introduces a strategic shift in the journal to prioritize case studies that are more strongly linked to theoretical concepts, frameworks, and models to better bridge the gap between theory and practice. The issue includes several teaching cases analyzing real-world business situations through various lenses like service mindset, innovation, sustainability, and branding.
SOUTH ASIAN JOURNAL OF BUSINESS AND MANAGEMENT CASES, Volume 8 Number 3 Decem...BIMTECH Greater Noida
This document provides the contents of Volume 8 Number 3 of the South Asian Journal of Business and Management Cases from December 2019. It includes:
1) An editorial on strategies for business schools to remain relevant through innovation.
2) Nine teaching cases on topics such as using board room simulation games to teach strategic management, innovative classroom pedagogies, becoming a socially responsible business school, molding conscious leaders, teaching ethics, and harnessing creativity.
3) Information on the journal, editorial board, and submission guidelines.
Building impact with Quality (BSIS Report) - BIMTECH, Greater NoidaBIMTECH Greater Noida
The document discusses BIMTECH's impact assessment process using the Business School Impact System (BSIS). Some key points:
- BIMTECH underwent the BSIS process to evaluate its impact on stakeholders like students, alumni, recruiters, and the local community in Delhi NCR.
- The BSIS assessment found BIMTECH has a significant financial impact on the local economy, estimated at over 2 billion rupees annually from direct, indirect, and induced impacts.
- BIMTECH also makes an educational impact by attracting students from outside the region and retaining many students from Delhi NCR. About 40% of graduates enter the local job market.
- The school supports business development through initiatives
Designing Innovative and Evolving Curriculum in Mission Centric waysBIMTECH Greater Noida
Designing Innovative and Evolving Curriculum in Mission Centric Ways
A framework to design curriculum that helps a business school to evolve continuously and remain relevant to the ever-changing needs of students, business and society; to maintain the curriculum current and relevant; enables to evolve continuously in tandem with a dynamic environment; helps in meeting the changing expectations of students, recruiters, businesses, society and all stakeholders and, finally, communicates the distinctive feature of the programme.
Education Promotion Society for India (EPSI) & Indian Management Conclave (IM...BIMTECH Greater Noida
This document discusses factors needed for India to achieve its goal of becoming a $5 trillion economy by 2024. It notes that India's economy would need to grow at an average of 11.5% annually to reach this target. Robust growth in higher education focused on skills development will be critical to support India's transition to a services-led economy. The document outlines projections that India will need 1200 universities and 50 million students enrolled by 2025, up from the current 950 universities and 36.6 million students, in order to sustain the targeted growth in gross enrollment ratio to 35% by 2025. Strengthening accreditation standards and curriculum to develop talent ready for Industry 4.0 will also be important for India
Draft National Education Policy - A Game-changer for Management EducationBIMTECH Greater Noida
Draft National Education Policy - A Game-changer for Management Education presented by Dr. H. Chaturvedi, Director - BIMTECH presented during 10th Indian Management Conclave
Expansion of modern retail in tier 2 and tier 3 cities challenges & opportu...BIMTECH Greater Noida
This document discusses the expansion of modern retail in tier 2 and tier 3 cities in India, along with the associated challenges and opportunities. It notes that per capita incomes are rising in these cities, which have lower living costs than tier 1 cities. Surveys found that residents spend an average of Rs. 1500 per shopping trip at modern retailers and spend 71 minutes shopping. However, modern retailers face strong competition from traditional retailers and issues with talent retention, infrastructure, and shrinkage. Opportunities for modern retailers include the large amount of real estate investment in tier 2/3 cities, their high urbanization rates, and the potential for personalized offers, experiential shopping, and gamified training programs.
MODERN RETAIL V/S KIRANAS : WHO WILL LOSE THE BATTLE FOR CUSTOMER BASE?BIMTECH Greater Noida
MODERN RETAIL V/S KIRANAS : WHO WILL LOSE THE BATTLE FOR CUSTOMER BASE? by NIKHIL SHARMA, SWATI SINGH and NIMISHA SOMANI students of BIMTECH, Greater Noida
Introduction to Emerging Technology in Management by Prof. SS DubeyBIMTECH Greater Noida
This document introduces an emerging technology in management course taught by Professor Sanjiva Shankar Dubey. The objectives of the course are to understand emerging technologies and their impact on business, understand how technologies change business processes, and apply technologies to redesign business models. The course will focus on technologies like social media, cloud computing, mobile apps, AI, big data, IoT, and more. Students will complete projects using tools like ChatFuel, IBM Bluemix, and more. Professor Dubey's areas of expertise and list of authored books are also provided.
Employee benefits are non-wage compensation provided to employees in addition to their normal wages or salaries. They are growing in cost and complexity, now commonly accounting for a fourth or more of employee compensation expenses. Employers provide benefits to improve staff retention and attraction, motivate employees, foster good morale, and improve employee health and welfare, among other reasons. Benefits include mandatory programs like provident funds and voluntary benefits like life insurance. Trends in benefits include rising healthcare costs driving innovative solutions and more defined contribution retirement plans. Issues shaping benefits design include improving perceived value, controlling costs, communicating benefits, and engaging and satisfying employees within regulatory compliance.
Ten Principles of Economics and Concept of Demand and Supply by Prof. K K Kri...BIMTECH Greater Noida
Ten Principles of Economics and Concept of Demand and Supply by Prof. K K Krishnan, Area Head – Insurance and Business Management (PGDM-IBM), BIMTECH, Greater Noida
Interesting PPT on the topic Waste Recycling and Circular Economy by Prof. K. R. Chari, Faculty and Dean – Student Welfare and Support Services, Birla Institute of Management Technology (BIMTECH), Greater Noida, Uttar Pradesh, India
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Elevate Your Nonprofit's Online Presence_ A Guide to Effective SEO Strategies...TechSoup
Whether you're new to SEO or looking to refine your existing strategies, this webinar will provide you with actionable insights and practical tips to elevate your nonprofit's online presence.
2. Current Regulatory Requirement
A progressive employer is expected to provide health
facilities to the employees.
There are some mandatory provisions such as workmen
compensation / ESI but they have limited coverage.
In some of the countries providing healthcare for employees is a must
In such cases , maternity , dental and optical treatment
and the expenses thereon are normally not given.
There are many ways of extending medical facilities to the
employees.
Medical insurance is one such step.
3. System in place
Depending up on the size / decision of management ,we
find different solutions of health management
The Small and Medium size organizations have the
system of reimbursement of the actual expenses.
Some of them even have the system of medical allowance
on monthly basis.
Few big organizations have their own medical facility set
up and in a way it is self managed
Group Medical insurance is getting accepted as a
wholesome solution .
4. Need for health insurance
For Employers it gives an opportunity to outsource this
non-core activity.
It provides a cover against unexpected health related
expenses – helps in financial planning & cost saving.
For employees – it provides a wider range of medical
facilities.
Depending up on the coverage – specialized treatment
abroad / special care can be arranged.
Control on leakages – Managed by professionals
Provides far wide options for the employees –
Geographical sense
5. Present & Future Ahead
Health Insurance is the fasted growing segment in
insurance business.
Premium income has gone up from Rs. 2221 Cr in 2005-06
to Rs. 13975 Cr. In 2012-13 – CAGR 30%
Commission pay out was Rs. 876 Cr. In 2012-13 – means
bulk of the business is thru direct channel
Incurred Claim ration 96.43 - a bit improvement
Future is promising as there is a growing concern for the
health care
Govt. too is thinking of providing some universal health
care on the line of RSBY
7. Insurance vs. Cost
Management
Unlike other forms of insurance Medical
insurance is more of cost management nature
The frequency of claim and related costs are more
or less similar and consistent over the period.
The pricing is more dependent on the past claims
history than the technical parameters.
The success of Medical Schemes depends much
on the approach of the Management and the co-
ordination of all involved.
8. Market Realities
There is a very cut-throat competition in market
Group Medical is a big bargaining point for clients to
place other lines of business
Companies are looking for the lowest possible rates
irrespective of their claims experience
Normally claim experiences are not favourable
This has resulted into frequent shifting of the
portfolio from one Company to another.
9. Essentials for success
Understanding of the basic needs of the customer
Simple product features with least deviation from the
universal and standard norms.
Having least possible feature having sub-limits.
Regular communication between all concerned
Limiting the number of Service Outlets.
Emphasis on quality delivery which need not be the
costliest.
Optimum pricing
Continuous feedback / corrective measures
10. Important Product Features
Annual Max. Limit (Flexibility)
Provision of Pre-Existing Condition
Wide option of Geographical coverage (Abroad/USA )
Tie –up in other counties
In-patient / Out-patient
Discount for limiting outpatient limit as a % of AML
Wide & attractive options of deductible
Improved Group / favorable loss ratio discount
Gate-keeper / Preventive schemes
11. Standard Exclusions….
Aids/HIV
Infertility, In-vitro fertilization, Surrogacy
Psychiatric, mental retardation, Alzheimer and similar
degenerative diseases
Congenital disease, malformations or malfunctions
Oncology, Kidney dialysis, Hormone replacement, Bone
densitometory, Tumours, Development problems, Physical
aids
Organ donation
Expenses for homecare, sanatoriums, long term care
facilities and similar institutions
Epidemics declared by Government/WHO
12. Standard Exclusions
Regular/Preventive health check ups
Expenses for work related injuries/accident as these are covered
under WC policy – mandatory in Oman
Elective Treatment received outside area of cover
Health Spas/Nature Cure Clinics etc
Plastic and cosmetic surgery and beauty related skin treatment
Vitamins and supplements, medicated shampoos, mouth wash
Any treatment which only offers temporary relief of symptoms
rather than dealing with the underlying medical conditions
Treatment following drugs or substance abuse
Injuries from playing professional sport or from any dangerous
sport and activity
13. Claim Settlement
The enrolled members are provided individual
medical card & that takes care of all expenses at
network clinics with in the permissible limits.
Almost 90-95% of the billing is thru cards only.
For non-network clinics and the facilities having sub-
limits , the customer need to pay the bill him/herself
to the service provider and take reimbursement
subsequently.
14. Medical Cards
The Medical Card contains the following
information & provides the bearer medical
services within the scope of the Medical Policy.
Name of Member
Date of Birth , Unique identity no
Name of the company
Validity period of the card
Broad Coverage details , restrictions
Deductible , if any and
Hotline / Contact no for assistance and
clarifications in case of difficulties.
15. Reimbursement of Cash Claims
Medical expenses incurred at non designated Medical Service
Providers are covered subject to customary costs of network hospital
or as per the policy provisions.
Claims papers are to be submitted to the insurance company on
monthly basis.
The claim must be supported by
# Cash Claim Form duly filled in and signed by the Doctor
# Prescriptions
# Original Bills – clear break up of amounts in case of multi
prescriptions,
# Original diagnostic reports
The bills are scrutinized and payment is made to the Client. The
average turn around time would be around 15 days.
16. Pre - Approvals
All non emergency cases that need
hospitalization for medical or surgical treatment.
Chronic medications for more than 1 month
Medical tests etc. beyond a normal /prescribed
limit
Endoscopies, EEG, ECG
MRI Scans and CT Scans
Facilities having sub-limits
However in case of emergency hospitalization no
such approval is required. Intimation with in 24
hours.
17. Claim Process – Important
aspects
Tie up reputed TPA having high volume of business /
IT infrastructure
Network availability in promised locations
24*7 customer helpline by TPAs
Availability of Ins. Co official for TPA support
Claim processing by experienced professionals
Possibility of Expert / Second opinion
Cost reduction – better discount from providers