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Health Insurance Guide
What is health insurance?
How does health insurance work?
What are the different kinds of health insurance?o Individual mediclaim policy
o Floater Policy
o Critical illness policy
o Overseas mediclaim policy
o Student medical insurance
o Ta saver
So! what kind of covera"e can I "et?
o #ccidental death $enefit
o Permanent and total disa$ility cover
o % opinion rider
o Children&s education allowance How much does health insurance cost?
o The no of people to $e covered
o #mount of covera"e needed
o #"e of the oldest family mem$er who is proposed to $e covered
o Can I "et ta $enefits with health insurance?
#re there any alternatives to health insurance?
o Critical illness $enefit
o Hospital cash $enefit
Thin"s to watch out for
What is Health Insurance ?
Health Insurance also known as'ediclaim in Indiaprovides you the cover a"ainst the
medical care costs arisin" from disease or accidental in(uries) Health insurance is a
crucial financial product that every individual must have irrespective of their a"e) Itallows you to focus on "ettin" the $est treatment without $otherin" a$out the financial
costs of the same)
*ependin" on the terms of the health insurance policyit covers all or part of the medical
costs of treatin" the disease or in(ury includin" doctor&s consultation char"es! medicine
and nursin" costs) Treatment can $e sou"ht in any reco"ni+ed nursin" home or hospitalacross India) This policy however usually does not cover routine medical epenses like
outpatient care! and daily medicines)
Health insurance in Indiacan $e $ou"ht $oth as an individual or a family or as a "roup),roup Health Insuranceis $ou"ht $y either an employer or an association for its
mem$ers) In this article we will $e coverin" onlyhealth insurance for individuals)
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How does health insurance work ?
Topurchase health insurance!you need to pay an annual fee to the company for this
covera"e known as -premium) .ou choose the amount of covera"e that you want! $ypayin" a hi"h or low premium) The hi"her the premium the more the covera"e) /ets say!
you choose a covera"e of 0s 122!222 for the year) If durin" the course of the year!you
incur some medical costs due to disease or in(ury 3 the insurance company will reim$urseyou up to the maimum of 0s) 122!222) This 0s) 122!222 can $e used in one time or
throu"h multiple claims in one year) 4
This payout $y the insurance company can $e claimed in two ways 5
6) #fter the char"es have $een paid $y your upfront) Claimed as a reim$ursementwhere in you $ear the costs first and then file a claim to the insurance company
and it7s paid $ack to you)8) Cashless settlement 3 where if the treatment is sou"ht in a hospital which is
associated with the insurance provider! the insurance company pays the hospital
directly)
What are the Different Kinds of Health Insurance?
Individual Mediclaim Policy
This is the plain vanilla mediclaimor health insurance policy for an individual protectin"this person from the epenses incurred due to disease or in(ury)
Floater Policy
# floater health insurance policy covers your entire family under one policy with onesum insured and one premium) It covers all the epenses as covered under mediclaim
only the cover is now etended to the family instead of one person) This cover can $e
used $y any mem$er of the family any num$er of times) The advanta"e of this policy isthat saves money $y spreadin" the cover across family mem$ers)
Critical Illness Policy
Insurance companies define certain specified illness or diseases as -critical4) If you have
a critical illness policy!then the insurance company will pay you a lump sum payment if
you are dia"nosed with a critical illness as defined $y the insurance company)
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Some of the diseases9conditions which are usually deemed critical are Cancer !Heart
#ttack! :idney Failure! 'a(or Or"an Transplant! Stroke!Paralysis and Heart ;alve
0eplacement Sur"ery)
nlike other "eneral insurance policies! these policies come with multiple options in
terms of sum assured and term of the policy) For eample ICICI /om$ard provides
critical cover for 1 years for a 0s) 68!22!222 covera"e) These policies are also availa$lewith disa$ility covera"eto ensure that you are also covered for loss of incomedurin" that
critical period)
verseas Mediclaim Policy
#n Overseas 'ediclaim Insurancepolicy provides cover for medical epenses incurred
a$road for treatment of illness and diseases contracted or in(ury sustained durin" the
insured period of overseas travel) #nyone who is travelin" a$road for $usiness orpleasure or for educational purposes should have this policy)
!tudent Medical Insurance
Student 'edical insurancecovers the cost of health care while studyin" a$road) It is an
essential reuirement of many forei"n universities for its overseas students) Students are
"enerally advised to $uy it in India as it is su$stantially cheaper than $uyin" it a$road)
"a# !aver
This is a new class of insurance launched to take full advanta"e of the income ta $enefitunder section @2 * of the Income Ta #ct 6AB6) The premium is fied at 0s 61!222 forall plans) For Senior Citi+ens a"ed B1 and a$ove! the premium is 0s) 82!222 This plans
includes reim$ursement of OP* epenses upto 0s) 62!222) This includes dia"nostics
tests! dental treatment and related epenses) This insurance is suita$le for people who arelookin" to cover all their medical epenses in a ta free manner)
!o what kind of covera$e can I $et ?
.ou can $uy health insurance covera"e$oth as an individual as well as for the family) Itcan also $e $ou"ht $y companies for their employees as a -"roup4) #s mentioned a$ove!
here we will $e concentratin" only on health covera"e for individuals and families)
>sually! health insurance covera"e is availa$le to individuals a$ove the a"e of months
to a maimum a"e of B1 years) .ou can choose to cover your family in one floater policyor throu"h multiple individual policies dependin" on your needs and the costs involved)
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While decidin" on your covera"e! you may come across a term called -rider4)# rider is a
certain add on which "ives you additional $enefits) .ou will have to pay for the rider $ut
usually the incremental costs are minimal) .ou cannot purchase a rider without firsthavin" a health insurance policy) Some of the riders commonly availa$le with health
insurance policies are 5
a% &ccidental Death 'enefit
In case of death of the policy holder due to an accident within the policy period! the
nominee
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Whether you are plannin" to cover (ust yourself! you and your spouse or include your
children as well)
(% "he amount of covera$e needed
Insurance is usually availa$le from 0s 12!222 to 0s 122!222 in multiples of 0s 81222 or0s 12!222 dependin" on the insurer) .ou can choose the covera"e that you needdependin" on your $ud"et and your anticipated needs)
c% &$e of the oldest family mem(er who is *ro*osed to (e covered
The premium is determined $y the relative health of the person who is seekin" insurance3 insurance keeps $ecomin" epensive as you "row older) #s older people are considered
to $e more vulnera$le to illness)
d% Can I $et any "a# 'enefits with Health Insurance?
#s per Section @2*! of the Income Ta #ct any amount of health insurance premium
paid up to 0s) 61!222) Would $e allowed as deduction from the total income for incometa calculation purposes)
# hi"her amount of up to 0s 82!222 is permitted for senior citi+ens)
&re there any alternatives to health insurance ?
'any life insurance companies have started offerin" riders with their life insurancepolicies which are specifically "ive you health related $enefits) Some of these riders are
outlined $elow5
a% Critical Illness 'enefit
# health insurance policy is a reim$ursement of the medical epenses whereas the
Critical Illness rider as provided $y most life insurance companies are $enefit policies)
>nder a $enefit policy on happenin" of an event! the insurance company pays thepolicyholder a lump sum amount re"ardless of the epenses incurred) Whether the client
spends the amount received on the medical treatment or not rests on his or her owndiscretion) The catch lies in the structurin" of the payouts and the $ase policy&s statusafter claimin" the $onus) 'any plans reduce the sum assured or cancel the other riders
after payout of the critical illness rider)
(% Hos*ital Cash 'enefit
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>nlike health insurance which "ives a comprehensive cover! Hospital Cash Genefit
usually reim$urses only room char"es! and does not cover all hospital epenses) # 'a(or
Sur"ical Illness rider provided $y ICICI Pru "ives a lumpsum of up to 12 per cent of theS#! dependin" on the de"ree of the ailment) This $enefit can $e received any num$er of
times provided it does not eceed the maimum amount eli"i$le and the illness has not
$een treated earlier) There is also no cashless settlement in the $enefits provided $y a /ifeInsurance provider)
"hin$s to watch out for-
Health insurance will not cover all the costs that you mi"ht incur for medical relatedreasons) Gut it will still "o a lon" way in savin" your money)
%ven after $uyin" health insurance it is essential that you set aside some part of your
savin"s for health related epenses as the product inherently has some limitations thatone should $e aware of when plannin" for the future)
.o covera$e for routine medical e#*enses/ checku*s or medicines0
# minimum of a day&s hospitali+ation is needed to claim health insurance) If you incur an
epense that does not result in hospitali+ation
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is afflicted $y any of these medical pro$lems! he will have to pay for the epenses on his
own) %penditure on pre"nancy and related ailments are not covered under individual
health insurance policies)
.eed Protection a$ainst loss of income
/astly! health insurance only covers the epenses that you mi"ht incur for treatment $ut it
does not protect any loss of income due to in(ury or disease) It should ideally $e
complemented $y disa$ility insurance for total protection of your family)
Health Insurance Glossary
&$ent
#n a"ent is appointed $y the insurer to conduct $usiness on $ehalf of the insurance
company) #n a"ent must hold a license issued $y the I0*#)
Claim
The process of applyin" to the insurer for reim$ursement of the epenses incurred for
treatment is called -filin" a claim4) >sually! this process is handled $y a service providerto the health insurance company)This service provider is called a -Third Party
#dministrator4
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# Critical Illness is a serious possi$ly terminal disease! which is strictly defined $y the
insurer) Conditions such as cancer! multiple sclerosis! ma(or or"an transplants are deemed
as -Critical Illness4) 'ostcritical illness policiesprovide for the payment of a lump sum$enefit if the policyholder is dia"nosed as sufferin" from one of a num$er of specified
terminal conditions)
Cumulative 'onus
%ach claim free year ensures that you "et a $enefit known as -cumulative4$onus 3 it is
similar to -no claim discount4
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Good Faith
,ood Faith is a minimum standard to "et into a contractual arran"ement) It reuires $oth
the $uyer and seller in a transaction to act honestly toward each other and to not mislead
or refrain from providin" critical information to the other party) In the contet of health
insurance in India! it reuires you to disclose all relevant personal information likeprevious disease history to the insurer $efore $uyin" insurance)
Grou* Insurance
# firm or an association may $uy a policy to insure mem$ers of a "roup) For eample a
Company may take a policy to cover a lar"e "roup of its employees)
Insurance
Insurance is a contract in which an individual or entity! pays the insurance company in
return for the insurance company $earin" the risk of loss a"ainst specified conditions)The individual receives reim$ursement a"ainst losses from an insurance company) The
company pools the clients& risks to make payments more afforda$le for the insured)
I+D&
I0*# stands for -Insurance 0e"ulatory and *evelopment #uthority4) It was esta$lished
in 6AAA under an act of Parliament to promote and re"ulate the insurance industry in
India includin" all its constituents like Insurance Companies! #"ents and Grokers)
Moral Ha2ard
'oral Ha+ard is a term used in insurance to descri$e the phenomena where the customermay seek an undue advanta"e! as a result of $uyin" insurance or where the customer has
not acted in "ood faith and has provided misleadin" information to the insurance
company)
.etwork Hos*ital
etwork Hospitals are hospitals and nursin" homes which are associated with the -Third
Party #dministrator4
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verseas Medical Policy3MP%
#n overseas mediclaim policyis issued to persons who undertake trips a$road for
$usiness or pleasure or for educational purposes) The policy terms are similar to plain
vanilla mediclaim policywith no pre Deistin" disease covera"e and similar eclusions as
well) The only difference $ein" that it is applica$le in the country of travel and not India)
Personal &ccident Policy
Personal #ccident Policies are issued as fied $enefit policies where$y specified sumsare paid on the occurrence of specified events) These events could $e death or disa$ility)
This payout is not related to the epenses incurred) For %ample5 Shyam has a personal
accident policy) He meets with an accident and is permanently disa$led) He wouldautomatically "et 622J of the sum insured and this would $e in no way linked to the
epenses he has incurred in treatment of the same)
Policy
# policy is a stamped document which is evidence of the contract of insurance $etween
the insurer and the insured) The policy encapsulates the $enefits and features of the
policy)
Pre 4 e#istin$ Disease
# pre D eistin" disease is any ailment or disease that a person is already sufferin" from atthe time of purchasin" health insurance)
Premium
Premium is the amount paid $y the insured
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Health insurance policies are usually annual contracts)#t the end of the policy period! the
policy has to $e renewed $y the insurers) Gut renewin" a contract of insurance is at the
discretion of the insurer) There should $e continuous renewal of the policies) If there is a$reak in insurance! the insured would lose the $enefits of insurance in the event of any
contin"ency)
+eim(ursement
>nder a Health Insurance policy! the cost of various hospital char"es
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6) What is the maimum num$er of claims allowed over a year?
6@) What are the documents reuired for $uyin" a health insurance?
6A) Can I avail this policy if I am not an Indian ational $ut livin" in India?82) What are eclusions in a health insurance policy ?
86) What are the factors which determine the premium paya$le for health insurance ?
88) Who will receive the claim amount under health insurance if the policyholder diesdurin" the time of treatment ?
8) Is mediclaim the same as health insurance ?
8K) What is the difference $etween Health Insurance M Critical Illness policies orCritical Illness 0iders in insurance?
81) How does the insurance company decide whether a disease was a preDeistin" one
or not?
8B) What happens when I cancel the policy?8) Can I seek treatment at home and $e reim$ursed for it under health insurance?
8@) What do you mean $y covera"e amount ? Is there is a minimum or maimum
limit?
670 I am youn$ and healthy0 Do I really need health insurance?
.es) .ou will need insurance) %ven if you&re youn"! healthy and haven&t had to see a
doctor in years! you will need covera"e a"ainst unepected events like accidents or an
emer"ency) While your health insurance covera"emay9may not
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690 My em*loyer *rovides me with health insurance covera$e0 Is it
advisa(le to take another *olicy on my own?
It is stron"ly advised to have health insurance on your own as well $ecause of reasons ofcontinuity) Firstly! if you chan"e your (o$! you mi"ht not necessarily "et health insurance
from your new employer) In any case you will $e eposed to health costs in the transitionperiod $etween (o$s)
Secondly! the track record that you have $uilt in health insurance at your old employer
will not transfer to the new company policy) Coverin" pre eistin" diseases mi"ht $e a
pro$lem) In most policies preDeistin" diseases are covered only from the 1th yearonwards)
Therefore to avoid the a$ove pro$lems! it is advisa$le to take a private policy in addition
to your company provided "roup health insurance policy)
Top
6:0 &re Maternity;Pre$nancy related e#*enses covered under Health
Insurance *lans?
o) 'aternity9Pre"nancy related epenses are not covered in aHealth Insurance plan)
However! employer provided "roup insurance plans often cover maternity related
epenses)
Top
6
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6=0 Is a medical checku* necessary (efore (uyin$ a *olicy?
# medical checkup is necessary for anew health insurance policyfor customers a$ove
the a"e of K2 or K1 years dependin" on the health insurer&s norms) 'edical checkups are
usually not needed for renewal of policies)
Top
6>0 What are the minimum and ma#imum *olicy durations?
Health insurance policies are "eneral insurance policies usually issued for a period of 6
year only) However! some companies also issue a two year policy) #t the end of your
insurance period you must renew your policy)
Top
60 What is covera$e amount ?
Covera"e amount is the maimum amount paya$le in the event of a claim) It is also
known as -sum insured4 and -sum assured4) The premium of the policy is dependent on
the covera"e amount chosen $y you)
Top
6@0 My wife and children are residin$ at Mysore while I am here in
'an$alore0 Can I cover all of us in one *olicy?
.es! you can cover the entire family under one policy) .our health insurance policy is in
force across India) .ou must check whether there are any network hospital near to your
as well as your family&s place of residence) .ou must check if your insurer has a networkhospital close to you or where the rest of your family resides) etwork Hospitals are the
hospitals that have tied up with the TP#
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67A0 &re naturo*athy and homeo*athy treatments covered under a health
*olicy ?
aturopathy and Homeopathy treatments are not covered under a standard health policy)
The covera"e is availa$le only for allopathic treatments in reco"ni+ed hospitals and
nursin" homes)
Top
6770 Does health insurance cover dia$nostic char$es like B4 ray/ M+I orultrasound ?
Health Insurance covers all dia"nostic test like LD ray! '0I! $lood tests etc as lon" they
are associated with the patients stay in the hospital for at least one ni"ht) #ny dia"nostic
tests which have $een prescri$ed in the OP* are "enerally not covered)
Top
6780 Who is a "hird Party &dministrator ?
# Third Party #dministrator
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epenses at the time of dischar"e from hospital) The settlement is done directly $y the
ThirdDParty #dministrator
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#pril! you make a claim of 0s 8 lakh) The covera"e availa$le to you for the 'ay to
*ecem$er will $e the $alance of 0s) lakh)
Top
67>0 What is the ma#imum num(er of claims allowed over a year?
#ny num$er of claims is allowed durin" the policy period) However the sum insured is
the maimum limit under the policy)
Top
670 What are the documents re5uired for (uyin$ a health insurance?
o documents are reuired for purchasin" health insurance) #s of now! you do not evenneed any P# Card or I* proof) *ependin" on the norms of the insurer and the
TP#).ou mi"ht need to furnish documents like I* proof at the time of su$mittin" a
claim)
Top
67@0 Can I avail this *olicy if I am not an Indian .ational (ut livin$ in
India?
.es! forei"ners livin" in India can $e covered under a health insurance policy) However!
the covera"e would $e restricted to India)
Top
68A0 What are e#clusions in a health insurance *olicy ?
%very health insurance policy has a set of eclusions)
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6) Permanent eclusions like #I*S!cosmetic sur"ery and dental sur"ery which the
policy will not cover at all)
8) Temporary eclusions like cataract M sinusitis which are not covered in the firstyear of the policy $ut are covered in su$seuent years)
) Conditions arisin" from diseases eistin" $efore the purchase of the policy are not
covered) These -preeistin"4 diseases are covered usually after K years of thepolicy $ein" in force dependin" on the policy terms M conditions)
Top
6870 What are the factors which determine the *remium *aya(le for
health insurance ?
>nder health insurance! the a"e and the amount of cover are the factors that decide thepremium) >sually! youn"er people are considered more healthy and thus pay lower
annual premium) Older! people pay a hi"her health insurance premiumas their risk of
health pro$lems or illness is hi"her)
Top
6880 Who will receive the claim amount under health insurance if the*olicyholder dies durin$ the time of treatment ?
In cashless mediclaim settlement!it is settled directly with the network hospital) In cases
where this is no cashless settlement! the claim amount is paid to the nominee of the
policyholder)
In case there is no nominee made under the policy! then the insurance company will insistupon a succession certificate from a court of law for dis$ursin" the claim amount)
#lternatively! the insurers can deposit the claim amount in the court for dis$ursement to
the net le"al heirs of the deceased)
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6890 Is mediclaim the same as health insurance ?
.es! it is the same)
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68:0 What is the difference (etween Health Insurance Critical Illness*olicies or Critical Illness +iders in insurance?
# Health Insurance policy is a reim$ursement of the medical epenses)
# critical illness insuranceis a $enefit policy) >nder a $enefit policy upon the occurrenceof an event! the insurance company pays the policyholder a lump sum amount) >nder a
Critical Illness policy!if the insured is dia"nosed with any critical illness as specified in
the policy) The insurance company will pay the policyholder a lumpsum) Whether theclient spends the amount received on the medical treatment or not depends on the client&s
own discretion)
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68>0 Can I seek treatment at home and (e reim(ursed for it under health
insurance?
'ost policies offer the $enefit of treatment at home5
a= When the condition of the patient is such that he cannot $e moved to the hospital or
$= When there is no $ed availa$le in any of the hospitals and only if it is like thetreatment "iven at the hospital 9 nursin" home which is reim$ursa$le under the policy)
This is called -domiciliary hospitali+ation4 and is su$(ect to certain restrictions $oth in
terms of the amount which is reim$ursa$le as well as the disease covera"e)
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680 What do you mean (y covera$e amount ? Is there is a minimum or
ma#imum limit ?
Covera"e amount is the etent to which the insurance company will reim$urse you for
the medical epenses incurred $y you) >sually! mediclaim policies start with a lowcovera"e amount of 0s 81!222 and "o to a maimum of 0s 1!22!222)
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II0 'uyers Checklist
For $uyin" a health insurance policy you do not need any documents apart from the
cheue or $ank draft that you need to pay your premium with) However $uyers a"edmore than K1 years! mi"ht need to under"o a medical checkup and certain dia"nostic tests
like $lood tests) #t the time of makin" a claim! your health insurer mi"ht reuire you to
show your I* proof !medical documents and $ills)
III0 Where to 'uy
.ou can$uy health insuranceeither directly from any "eneral insurance provider or from
authori+ed intermediaries like insurance a"ents or insurance $rokers) Please check thatthese intermediaries are I0*# certified and are a$le to understand your uniue needs and
answer your ueries)
IE0 6uestions ou Must &sk What ou .eed to
Consider 'efore 'uyin$
Guyin" an individual health insurance policyis more than (ust lookin" at the premium
amount).ou will need to consider many factors $efore purchasin" your health insurancepolicy)
Check whether the insurer facilitates cashless settlement of claims
.ou mi"ht have a preference for a specific doctor or hospital where you mi"ht have $een
seekin" treatment in the past or have a preeistin" relationship )This doctor or hospital
should ideally $e a part of the insurer&s network of hospitals for cashless settlement ofepenses)
Its essential to know the ailments that will not $e covered in the initial years of the policy
and what preDeistin" conditions that would affect covera"e) #s you will $e open to theserisks in the initial years of the policy) #lso of importance are the permanent eclusionslike #I*S! cosmetic sur"ery and dental sur"ery that are currently not $ein" covered
under an individual health insurance ormediclaim policy)Its important to check with the
health insurer a$out the covera"e $efore "oin" in for an epensive treatment)
Check all the details of the epenses that will $e reim$ursed e)") dia"nostic and
medication costs mi"ht not $e covered under all health insurance policies)
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*ue to risin" costs of health care many insurers have enforced su$Dlimits for various
kinds of epenses) So! check whether there is a maimum amount each plan will pay for
a specific epense and if there are any su$ limits on specific kinds of epenses)
Check whether epenses arisin" for treatment due to war! riots or a terrorist attack are
covered
E0 !electin$ the 'est Health Insurance Product for
ourself
#s you mi"ht $e indisposed when you need to utili+e your health insurance! select a
policy that you and your family mem$ers will find easy to use) #fter all! you or your
family should not $e runnin" around to take care of paperwork when your immediate
priority is to "et medical care) When selectin" a health plan! check the followin" features5
Check if cashless hospitali+ationis included) What is the num$er of hospitals where this
facility can $e availed ? Where are these hospitals located ?
'any plans also have in$uilt features of disa$ility insurance and personal accidentinsurance) Check whether these are part of the plan you are choosin")
Check whether the plan has any specific covera"e for critical illness)
In case the medical insurance policyis for dependents like parents! check the maimum
entry a"e and the maimum renewal a"e) .ou do not want to end up selectin" a policy(ust for a year when your actual reuirement is for 1 years)
Check whether special conditions like dia$etes can $e covered under the plan)
EI0 .ow "hat ou wn Health Insurance Whats .e#t
&nnual +enewal
'ost health insurance plansare availa$le only on an annual $asis D timely renewal ofyour health insurance policy is of utmost importance) Nust like car insurance needs to $e
renewed annually! health insurance also needs to $e renewed annually) It is not a one
time $uy $ut an annual epense that you must $ud"et for) #nd like you do not leave yourcar without an insurance cover even for a day 3 you certainly cannot afford to $e without
health insurance for a sin"le day)
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In India as of now! the track records of consumers are not transfera$le across companies
hence its important to choose a suita$le policy the first time around and renew the same
year on year and not switch the insurance provider) #lso every insurer provides discountsor $onuses for customers who have a claim free year) >nderstand these features and take
full advanta"e of them)
+eview your covera$e amount *eriodically
#s time passes your needs will chan"e) Therefore! you must also review the covera"eamount every year keepin" in mind the relative health of the family mem$ers and any
$irth or death in the family)
!ome (est *ractices
>nderstand the process of makin" a claim
Please read the fine print and understand the process of makin" a claim thorou"hly fromyour a"ent or $roker) %nsure that your family mem$ers also understand the same in case
you are the one who is afflicted with any ailment)
:eep all your medical records in one place
%nsure that all your medical records and support documents includin" Health Insurance
cards are kept safely in an easily accessi$le place known to all your family mem$ers)
Guild awareness of network hospitals
%nsure that everyone in the family knows the network hospitals near your home coveredunder the health insurance policy) Storin" their phone num$ers on your mo$ile
emer"ency call list mi"ht $e very helpful for the same)
:eep some cash aside for medical emer"encies
#lways keep some cash aside for medical emer"encies as health insurance mi"ht notcover 622J of the costs) In many cases you mi"ht end up seekin" the costs as
reim$ursements)
Makin$ a claim
.ou must follow the insurer&s norms while makin" a health insurance claim otherwise
you will face delays in processin" of the claim) Please "o throu"h the followin" to avoidcommonly made mistakes5
a% 'e *re*ared with the correct documentation-
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%very insurer specifies the documents to $e su$mitted while makin" a claim they include
providin" the ori"inal documents like
ori"inal final $ill with detailed $reak up of various $illin" heads
ori"inal and complete dischar"e card mentionin" duration of ailment
ori"inal investi"ation reports with correspondin" prescription 9reuest pharmacy $ills alon" with the si"ned claim forms)
(% Makin$ the claim in time-
In order to "et reim$ursement! usually the documents would have to $e su$mitted within
2 days after the patient&s dischar"e) To avoid delays! please su$mit your claim in atimely manner)
c% .orms for cashless settlement are different
When you $uy a cashless medical policy from an insurer! you will $e issued an identitycard with the name of a third party administrator
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Please read all the eclusions and the applica$le epense reim$ursements $efore decidin"
on the course of treatment that you plan to "et reim$ursed throu"h health insurance)
In case your claim is not $ein" accepted or $ein" delayed inordinately you can approachthe ,rievance 0edressal Cell of the Insurance 0e"ulatory and *evelopment #uthority
