Mediclaim/Health Insurance

 
Mediclaim Insurance

 Who can take this policy?

This insurance is available to persons between the age of 18 years to 60 years. Children between the age of 3 months to 18 years can be covered provided parents are covered simultaneously. The persons beyond 60 years can continue their insurance provided they are insured under Mediclaim policy with our Company without any break.

What does this policy cover?

The policy covers hospitalisation expenses for the treatment of illness/injury provided hospitalisation is more than 24 hours. Pre-hospitalisation expenses for 30 days and post hospitalisation expenses for 60 days are also payable.

Day-care treatment

The Medical expense towards specific technologically advanced day-care treatments / surgeries where 24 hour hospitalisation is not required.

Ambulance Charges for shifting the insured from residence to hospital are covered up to the limits specified in the policy.

 Ayurvedic/Homeopathic and Unani system

Ayurvedic/Homeopathic and Unani system of medicine are covered to the extent of 25% of Sum Insured provided the treatment is taken in the Government Hospital.

Pre-existing diseases

Pre-existing diseases are covered only after 3 continuous and claim free renewals with Mediclaim Insurance Company.

Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of additional premium.

Exclusions

Diseases contracted within 30 days of insurance

Dental treatment except arising out of accident.

Debility and General Run Down Conditions.

Sexually transmitted diseases and HIV (AIDS)

Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness

Vaccination and Inoculation

Pregnancy and child birth

War, Act of foreign enemy, ionising radiation and nuclear weapon.

Treatment outside India

Naturopathy

Domiciliary Treatment

Experimental or unproven treatment

All external equipments such as contact lenses, cochlear implants etc.

Premium

Premium is based on age of the proposer and geographical area of treatment.

Discount in premium for family cover

Loyalty Discount

Good Health Discount

Cumulative Bonus

Cost of Health Check up

Income Tax Benefit under Section 80D of IT Act.

How to avail claim?

Claims are administered through Third Party Administrators (TPA) whose contact particulars appear on the policy document. Insured can opt for cashless or reimbursement facility for their claims. The proposer has the option to avail TPA services, which is cashless or direct service by Policy issuing Office, which is on reimbursement basis.

 Mediclaim isurance requirement list:-

v  Floater or Individual

v  Top-up & Super Top-up requirement

v  Private or Government

v  Group Insurance or Individual Insurance

v  Smoker & Drinker, Nature of job (Hazardous and non hazardous)   

v  Base Cover & Super Top-up

v  Restoration Benefits

v  Room Rent (Hospital generally settled the claim on the ground of room rent)

v  Sub-limit on Disease

v  Co-pay

v  Pre-existing Disease (18 types PED) & waiting period

v  Disease Pay Capping & Lifestyle Disease

v  Zonal Policy Vs. PAN India

v  Pre & Post Hospitalization (After & before hospitalization expenses)

v  Reasonable & Customary Clause (Difference in area-wise surgery charges).

v  Day Care Procedures

v  Maternity Benefits

v  Cosmetic & Ayush Treatement

v  Free Preventive Health Check-up

v  Cashless Hospitals Network

v  Ambulance Charges Limit

v  Claim Ratio (Incurred & Settled) & Brand of Company in Mediclaim.

v  Personal Accidental Risk Cover

Fequently ask Questions (FAQ) in Mediclaim Insurance.

 Ø  All Claim is link from Room Rent (like Doctors Fee/Consultation Charges, surgery charges etc.)

Ø  Disease Pay Capping.

Ø  Co-Pay (how much client pay from his pocket despite mediclaim insurance).

Ø  Zone Vs. PAN India (Premium different always in zonalwise and if any one person comes from tier-3 city to tier-I city he bound to pay 20% mediclaim charges). 

Ø  Reasonable & Customary Clause Act (like in one area hospital one hospital charge any surgery of Rs. 1,50,000/- but the same time other hospital in the same area take charge of that surgery of Rs. 1,00,000/- then mediclaim company pay Rs. 1 lakh and not 1.5 Lakh.

Ø  Group Insurance (if any one have group insurance and want to switch or resign from the job he should try to take individual mediclaim from the group insurance company so that his/her continuity insurance subsist.

Ø  Top-up Vs. Super Top-up (always prefer Super Top-up mediclaim policies).

Ø  Base Policy and Super Top-up policy always should be from the same company so that increase claim settled easily in one insurance company.

Ø  Pre & Post Hospitalization (min. 30 to 90 and maximum 60 to 180 days) Therapies, Ayush treatment and medicines should be covered in pre & post hospitalization).

Ø   Waiting Period for Pre-existing Disease (PED) like Hypertension (BP), Sugar etc. 18 types PED as per IRDA. In PED cover in mediclaim period upto 3 to 4 year (if client wants to pay extra PED can be waived off).

Ø  No Claim Bonus benefits Mediclaim company normally increase the cover from 5% to 100% depend on policy type).

Ø  Free Health Check-up

Ø  Maternity Benefits

Documents are required in Mediclaim Insurance:

ü  Passport Size Photograph of all persons.

ü  Age Proof (School/Birth Certificate/Aadhaar Card) any one for all persons

ü  Aadhaar Card & Pan Card Photocopy (Self Attested) of Proposer.

ü  Address Proof(any one): Passport, Voter's/Election Card, Aadhar card, Utility Bills (like Telephone Bill, Ration Card, Postpaid Mobile Bill, Credit Card Bill), Rental Agreement, Bank passbook, Driving License (Self Attested)

ü  One payment cheque or can also pay online through link option. 

For More Details: Pooja Manoj Gupta, visit www.giia26.com
Email: pmgiia26.com Mobile 8882286639