What is “any one illness”?
‘Anyone illness’ is an ongoing illness, including its relapse within a specific period, usually 45 days, from the last consultation at the hospital where treatment is being availed, as indicated in the policy terms.
health insurance questions
What if the claim amount exceeds the sum assured?
Depending on the policy terms, if the claim is related to hospitalization, if it exceeds authorized limit, the network hospital can intimate the TPA for an enhancement of limit. After verification of eligibility, this is…
What if I am unhappy with the claim amount?
Most insurance providers have a grievance redressal system. If you are unhappy with your claim you can file a written complaint with the insurer. If necessary, this can be escalated to the IRDA Grievance Cells…
What happens when the insured is in an accident that results in death?
If the accident results in death, the beneficiaries/nominees get 100% sum insured. Some insurance companies also offer an education bonus for dependent children.
What does a health insurance policy offer?
Health insurance coveroffers protection against health risks. For the policy period and to the extent of the sum insured, it covers inpatient treatment, hospitalization expenses for an illness or accident, room rent, boarding expenses, nursing,…
What are the inclusions and exclusions in a health policy?
A majority of health insurance policies cover daycare treatment for less than 24 hours hospitalization where technologically advanced methods do not require it, hospitalization with a cashless facility in networked hospitals and reimbursement in the…
Under what circumstances can I make a claim?
A claim can be made in the event of planned and emergency hospitalization, both at a network and non-network hospitals, reimbursement of medical expenses allowed in your policy terms and pre / post-hospitalization expenses or…
To whom should the claim be submitted?
Medical expense claims must be submitted with the requisite documents to the TPA of the health insurance company as per the procedure outlined in your policy document.
Suppose I have accumulated cumulative bonuses for three years and have to make a claim in the fourth year, what will happen?
While basic sum insured stays the same and will not be reduced, the cumulative bonus will be reduced by a certain percentage of sum insured when you next renew your health insurance policy.
Suppose I don’t want cashless facility am I allowed to receive reimbursement?
Yes. Health insurance policies let you opt for the cashless facility as well as reimbursement of claimed medical expenses based on the terms of your policy. If your treatment is in a network hospital, go…