Health Insurance Plan provides adequate insurance coverage to the Insured, for expenses related to medically necessitated hospitalization for a minimum duration of consecutive 24 hours due to an Illness, Disease or an Accidental Injury.
The basic criteria for the policy to trigger is Hospitalization for minimum of 24 hours and administered with an active line of treatment which is advised by a Medical Practitioner.
The only exception to the above is the Day Care Procedures which are covered (Only Listed Treatments) due to the medical advancements even if the hospitalization is only for a few hours.
If the Insured is admitted in a hospital for a minimum period of 24 consecutive hours, only then the Health Insurance Plan gets triggered and all medical treatment expenses like Doctors’ fees, Professional charges and Other medical charges etc are covered up to sum insured as per subject to sub limit and other condition applicable in the policy.
DAY CARE PROCEDURES
The Medical Expenses incurred for Surgeries/ Procedures that do not require a minimum of 24 hours of hospitalization due to medical advancement are covered under the Day Care Treatments.
PRE & POST HOSPITALIZATION EXPENSES
Doctor Consultations,Diagnostics tests and prescribed Medication expenses incurred prior to hospitalization(30 days)and post discharge (90 days) for similar line of illness,emergency and accident as per the policy and plan selected.
HOSPITAL ROOM RENT
Hospital Room Rent/Accommodation Expenses means the amount charged by a hospital for the occupancy of a Bed/Room/ on per day (24 hrs basis) and shall include associated medical expenses and nursing charges .
The Room Rent eligibility depends on the Plan selected:
- Most common are 1% of the sum insured
- Room type -Single Private Room/sharing Room
- With no Capping.
**we would recommend for plans with Single Private Room options or with no Capping .
INITIAL WAITING PERIOD
The Initial waiting period is the minimum waiting before we can raise any claim on the policy. Usually its 30 days for any illness or disease and accidental injury is covered from DAY 1.
PRE-EXISTING DISEASES (PED) WAITING PERIOD
If before the inception of the policy, the insured has any Pre-Existing Disease or Condition then there will be a waiting period of 2,3 or 4 years for the particular Disease or Condition depending on the type of plan selected.
SPECIFIC DISEASES WAITING PERIOD
Any Claim arising from the listed illness or surgical procedures will not be covered in the first 2 or 4 years depending upon the plan selected.
Some of the similarly listed illness under various companies are:
- Fissure / Fistula in anus
- Hemorrhoids / Piles
- Pilonidal Sinus
- Gastric and Duodenal Ulcers
- All types of Hernia & Hydrocele
- Hysterectomy for menorrhagia or Fibromyoma or prolapse of uterus unless necessitated by malignancy
- Internal tumours
- skin tumours
- cysts, nodules
- polyps including breast lumps (each of any kind) unless malignant
- Kidney Stone / Ureteric Stone / Lithotripsy / Gall Bladder Stone etc.
The cashless policy is a type of insurance policy where policyholders can be hospitalized, get the relevant treatment and be discharged without having to pay anything from their pockets because it is one of network hospitals the company have being tied up with.
Only the expenses related to the listed treatment given by the insurance providers are being covered with cashless facility.
LIFE LONG RENEWABILITY
The renewing of the policy can be done life long ,it is an added advantage that has been proved useful in various situation, It enables the insured to enjoy extended coverage in cost effective rates.
It requires the payment on a yearly basis, thus allowing the insured to continue with the policy of his/her choice.
NO CLAIM BONUS (NCB)
No claim bonus comes Into picture only when the claim is not made by the insured during the policy period.
The No Claim Bonus offered on a health insurance policy is usually in the form of a cumulative bonus.
The rate at which the sum insured is increased each year varies from 10% - 60% up to the extent of 150%.
When the claim is made it decreases by 10%- 60% in the same progression as it increased with out affecting the sub limits applicable to the policy.
OPD(OUT PATIENT TREATMENT)
An outpatient is someone who visits hospitals for a specific type of illness and doesn’t stay back at the hospital for more than 24 hours , due to technological advancements.
In Max Bupa for 1 Cr of sum insured Rs.40,000 will be covered.
In ICICI for 50 lakh of Sum Insured Rs.20000 will be covered .