Health insurance plans secure the medical and surgical expenses of the insured in the event of an injury/ illness. They may be taken by an individual or a group. It is an essential coverage against rising medical costs and to be able to avail quality healthcare services. Personal Accident Insurance policy on the other hand provides monetary compensation to the policyholder in the event of bodily injuries, disability and even death arising from an accident, violent, visible and external event.
Mediclaim Policy provides cover for healthcare expenses incurred by insured in a hospital due to a medical emergency, such as illness or accidents. This policy provides coverage to individuals and their covered family members against expenses such as hospital room/ICU charges, diagnostic charges, medicine and other medical expenses.
The key features and benefits of a mediclaim policy are:
Suitable for any person between the age of ninety one days to sixty five years
Offers the power to either opt for self or for the entire circle of relatives (spouse, children, parents)
Covers pre-existing medical conditions after a waiting period of 2- four years
Get higher cover at low-priced premium rates
Offers the benefit of a high sum insured of as much as Rs. 50 lakhs or even more
Can be ported to another distinctive insurer at the time of renewal
Gives you and your family a complete health cover, proving to be an effective protection option
Includes cashless hospitalization to ensure that you don't have any out-of-pocket medical expenses
Easy online buying method from the comfort of your home
Enables you to avail tax deductions on premiums paid underneath Section 80D of the Income Tax Act, 1961
Can be renewed annually. Some insurers provide longer duration policies with renewals due each 2 or 3 years
Benefits covered by a mediclaim may vary depending on the insurance company. These are the common benefits covered by mediclaim policies:
Hospital expenses: Expenses incurred due to hospitalization like medicines, oxygen, blood, OT charges, medical tests and diagnosis, chemotherapy, radiotherapy, organ transplantation, etc.
Hospital accommodation expenses: Expenditures towards ICUs are either addressed through cashless hospitalisation feature or are reimbursed by the company.
Day-care hospitalization: Expenditures towards tech-driven medical treatments that do not involve 24-hour hospitalization.
Charges for medical experts: The fees for medical professionals involved during hospitalization like doctor, nurse, etc. are also provided by mediclaim policies.
Hospital lodging expenses: Expenditures towards ICUs are both addressed via cashless hospitalisation feature or are reimbursed via the insurer
War or any act of war, invasion, an act of foreign enemy, warlike operations
Biological/Chemical/Radioactive/Nuclear fallout
Self-inflicted injuries
Maternity and pregnancy treatments
Breach of law/criminal activity
Participation in military operations
Participation in extreme sports
Substance Abuse/Alcohol/Narcotics
Treatment of Obesity
Cosmetic Surgery
Dental Treatment
STDs/HIV/AIDS
Infertility treatments
Age is a major factor that determines the premium, the older you are the premium cost will be higher because you are more prone to illnesses.
No of Members Included in the floater policy affect the premium
Previous medical history and lifestyle factors are major factors that determine the premium. If no prior medical history exists, premium will automatically be lower.
Claim free years can also be a factor in determining the cost of the premium as it might benefit you with a certain percentage of discount which will reduce your premium.
In mediclaim you can make two types of claims- Cashless and Reimbursement
In this type of health insurance claim, the insurer settles all the hospitalization bills with the hospital directly, provided he is hospitalised at a network hospital. The procedure to avail cashless claim for a health insurance policy is:
In this type of health insurance claim process, the policyholder pays for the hospitalization expenses upfront and requests for reimbursement by the insurance provider later. This can be availed at network and non-network hospitals. The insured has to submit the following documents to the insurance provider in order to avail the claim:
Duly filled and signed Claim form
Insurance Card or Policy Copy
Medical Certificate signed by the doctor
Pathological reports like X-ray reports
Hospital discharge card
Original Bills and receipts
Original Pharmacy bills
Investigation report, if any
FIR / MLC Copy (in case of an accidental claim)
NEFT Details to credit Claim Settlement
Duly Filled CKYC Form if Claimed amount is above Rs 1L.
The following documents are generally required for purchasing a health insurance policy:
The insurer will mention it in their policy buying procedure if any other document is required.
This is the sum insured of the policy you take which should be calculated keeping your existing lifestyle, family members, medical history, income, city of residence and age in mind.
Critical Illness Insurance is a type of health insurance plan wherein the insured receives a lump sum amount equal to the sum insured on acquiring a serious ailment like cancer, heart attack, stroke etc. The lump sum payment can cover the hospitalisation and treatment expenses, recuperation expense and any other debt as well. The insured receives the entire sum insured irrespective of the hospitalisation costs.
The key features of critical illness insurance are:
Provides cover ranging from a minimum of Rs. 1 lakh
30 day grace period is applicable
Sum assured is paid as lump sum
Medical screening is required if the policyholder is above the age of 45 years
Day care procedures (less than 24 hours) are covered
Pre-existing diseases are not covered
Cashless facility is available
The key benefits of critical illness insurance are:
Coverage is provided for up to 36 life threatening diseases
Convenient, fast, hassle-free claims process
The sum assured provided is in the form of lump sum payment which can be used as an income replacement
100% benefit payout upon diagnosis of terminal illness
Provides accidental death benefit
Protection against disability
The premium paid towards a critical health insurance plan is eligible for tax deductions under Section 80D of the Income Tax Act, 1961.
The following are normally covered Critical Illnesses with various Insurance Companies:
Heart Attack (Myocardial Infarction)
Coronary Artery Bypass Surgery
Stroke
Cancer
Kidney Failure
Major Organ Transplantation
Multiple Sclerosis
Paralysis
SInce the coverage could differ from policy to policy and hence it is crucial to compare the illnesses covered before buying the policy.
Pre Existing Conditions
Illness or Injury diagnosed within the first 90 days of the inception of the Policy
War or any act of war, invasion, an act of foreign enemy, warlike operations
Biological/Chemical/Radioactive/Nuclear fallout
Self-inflicted injuries
Aggravated pregnancy or childbirth
Breach of law/criminal activity
Participation in military operations
Participation in extreme sports
Substance Abuse/Alcohol/Narcotics
Cosmetic Surgery
STDs/HIV/AIDS
Age: A person’s age plays an important role in determining the premium amount. Younger you are, the cheaper your policy will be.
Health Status: High blood pressure, overweight or other medical conditions that can lead to future health problems will lead to higher premiums.
The following documents should be submitted by the insured to initiate the claims process:
Duly filled and signed claim form
Medical Certificate confirming the diagnosis of Critical Illness
A medical certificate, investigation test report, etc. from an attending Medical Practitioner authorising that the claim does not relate to any Pre-existing conditions or any Illness or Injury which was diagnosed within the first 90days of the inception of the Policy.
Discharge Card/ Death Summary from the hospital, if applicable
First Consultation letter and subsequent prescriptions
Specific documents listed under the respective critical illness
Know your client doc (KYC)
In the case critical illness arises due to an accident, FIR copy would be required.
Other medical or Pharmacy Bills along with the required prescriptions
No pre policy medical check up is required for individuals upto 45 years.
Personal Accident Insurance policy provides monetary compensation to the policyholder in the event of bodily injuries, disability and even death arising from an accident, violent, visible and external event.
Education Benefit
Employment Benefit
Ambulance Benefit
Cumulative Benefit
Compensation for clothing damaged in an accident
Expenses for the carriage of the dead body
Modification allowance
Family transportation
Self-injury
Suicide
Venereal disease
Insanity
Influence of intoxicating liquor or drugs
War and nuclear risks
This policy provides complete cover in the event of death or disablement of the insured due to accidents occurring anywhere in the world. The following documents are required to make a claim:
Claim form
Death Certificate
FIR/MLC/Police Final report/Railway Guard Memo (In case of a Railway accident)
Post Mortem Report/Viscera Report/Certificate from treating doctor giving proximate cause of Death.
If Medical expenses are to be claimed - Medical bills and cash memos, Doctor’s Prescriptions, and hospital Discharge summary
AML Documents (address and id proof) and KYC form
ID Proof of the Nominee & Deceased.
Pays 10 % of Sum Insured upto 50,000(for dependent parents), if an accident results in broken bones.
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