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Clarify All Doubts Related To Individual/Family Health Insurance

A health insurance policy is an agreement between an insurance company and a policyholder. In this agreement, the policy provider offers financial assistance for medical expenses to the policyholder in return for a premium. The policyholder can get reimbursement for medical treatments, hospital bills, surgical bills, etc. or choose the cashless claim feature. The cashless claim feature allows the policyholder to avail treatment on a network hospital without worrying about the payments. The insurance company and the network hospital have an association through which they settle the bills of the policyholders.

Health Insurance

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Plan Type

Multi - Individual

No. of Adults & Children

4 Adults, 2 Children

Proposer's Age & Gender

Female, 45 years

Benefits of Buying Health Insurance Policy

When the medical bills pile up, your savings drain quickly out of your pocket. A regular health check-up may also cost you more than you can afford. This doesn’t mean that you cannot have access to the best treatments available for you and your family. A health insurance policy comes to your aid in such a scenario. It covers your medical expenses so that you can lead a long and healthy life. Here are some key benefits you should look out for while buying online health insurance:

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  • Annual Health

  • Robotic

  • Ambulance

  • Hospitalization
    More or Less than 24 hrs

  • Post-Hospitalization

Types Of Health Insurance Plans

There are 2 types of health insurance plans:

An indemnity health insurance policy would pay for the hospitalisation expenses that are incurred when treatment is taken. In simple words, it is the actual hospitalisation expense that is covered up to your plan’s sum insured limit. This kind of health insurance is the most common and is opted for a basic or comprehensive health plan for families, individuals and senior citizens. Such plans cover in-patient treatment expenses, doctor’s fee, ICU charges, surgery, room rent, medicines, pre and post-hospitalisation expenses etc. In addition, most health insurance companies offer cashless treatment under indemnity based health insurance plans.
In a fixed benefit health plan, a fixed sum is paid as a cover for certain predetermined illnesses or conditions. The pay-out is done in the form of a lump sum, irrespective of the actual medical expenses. Such policies are considered helpful if you are looking for accidental covers or protection against specific critical illnesses.

Inclusions & Exclusions In Health Insurance Plans

  • In-Patient Hospitalization expenses
  • In the case of organ transplant, donor expenses up to a certain amount
  • Overnight hospitalizations in cases of serious injuries
  • Pre-existing diseases after a set incubation period (Usually 2-4 years)
  • Pre and post hospitalization expenses for the same illness and for a specified number of days
  • Ambulance charge up to a certain amount, and for a specific number of hospitalisations
  • Room rent up to a sub-limit
  • Free health check-ups
  • Maternity and newborn expenses are not covered unless opted as an add-on
  • Most daycare treatments are covered
  • Doctor-prescribed home treatment or domiciliary hospitalization
  • No coverage for expenses incurred during the waiting period (30 days) unless it is an accidental emergency
  • Pre-existing diseases are not covered in the incubation period. (Usually 2-4 years)
  • Illness and injuries caused by war or nuclear activities
  • Suicide attempt or self-inflicted injuries
  • Cosmetic/Obesity/Aesthetic surgeries
  • Replacement of hormones or sex-change operations
  • Dental or Eye Surgeries, unless covered under the plan
  • Non-allopathic and experimental line of treatment
  • Certain treatments or diagnostic tests, listed in the policy document
  • Treatment abroad or beyond geographic limitations as specified in the policy
  • Doctor-prescribed home treatment or domiciliary hospitalization

Clarify All Doubts Related To Multi Individual Health Insurance

  • In case of multiple policies taken by an Insured Person during a period from one or more Insurers to indemnify treatment costs, the  Insured Person shall have the right to require a settlement of his/her claim in terms of any of his/her policies.
  • In all such cases the Insurer chosen by the Insured Person shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.
  • Insured Person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy/policies, even if the sum insured is not exhausted. Then the Insurer shall independently settle the claim subject to the terms and condition of this policy.
  • If the amount to be claimed exceeds the sum insured under a single policy, the Insured Person shall have the right to choose Insurer from whom he/she wants to claim the balance amount.
  • Where an Insured Person has policies from more than one Insurer to cover the same risk on indemnity basis, the Insured Person shall only be indemnified the treatment costs in accordance with the terms and conditions of the chosen policy.
  • In case no claim is made in a particular policy year, no claim bonus would be credited automatically to the subsequent policy year even in case of multi year policies (with 2 or 3 year policy tenure)