Frequently Asked Questions

Health insurance covers you against unforeseen health expenses. Even if you are healthy and haven't had the need to see a doctor in a while it is essential that you get yourself covered for future emergencies. Also, health insurance policy premiums at the time of subscription may be higher if you subscribe at a later age.While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren’t too costly like routine doctor’s visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury. Please do understand your policy and its inclusions and exclusions and make the right decision.

In case the primary insured expires post hospitalization then the claimable health expenses would be reimbursed. If the primary insured is also the eldest member in the family, then for the succeeding years after the death of the primary insured the premium would be calculated on the basis of the age of the next eldest member. For this to happen, the family should fill up the change of request form provided by the insurer. Please note that in case there were only two members covered under the policy then the family floater plan would be converted to an individual plan.

When choosing a health insurance policy there are a few things which you should be ready with are: The number of members and relations to be covered- Because this will be the basis of buying a policy. Type of coverage – Individual, Family floater or group. Sum insured or coverage amount – Ensure that you consider future expenses too. Room rent – Check for the capping amount or criteria defined if applicable. Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also, check if the plan has a copay feature. Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital. Policy wording – Most important thing to check before buying a policy. In case you are not sure about the certain term or conditions you can always contact the insurer for clarification. Add-ons: Check for the add-ons that are available and choose the ones that you are definitely likely to use in the following year.

Yes, you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause you can cancel the policy and get a refund. Stamp duty, expenses on medical check-ups and proportionate risk premium (the number of days that the insurance company was at risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer to the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded. Note: For the refund to happen there should be no claim during the policy period.

There are four important types of exclusions in a Mediclaim policy they are: Time-related exclusions: e.g. Waiting period- general, specific ailments and pre-existing Non-medical expenses: e.g. Registration charges Illegal reasons: e.g. drugs, alcohol abuse, self-inflicted injuries Out-of-scope: e.g. Unproven medical procedures, HIV, adventure sports, etc.

Yes, your health insurance policy is very much applicable even if the hospitalization is less than 24 hours. This is known as Day Care Treatment. Here, 24 hours hospitalization is not required and you do have a scope of coverage too. Day Care refers to any treatment or surgical procedure that is performed under general or local anaesthesia in a medical clinic/hospital or a day care centre requiring hospitalization for a period of fewer than 24 hours because of technological advancement. However, remember that OPD (out-patient department) are not a part of the Day Care treatments.

There can be 2 possible cases: Case 1: You are hospitalized just before the policy expiry date & have intimated the insurance company before the policy lapses (where the policy lapses while you are still in hospital), the company will pay the benefit as per the plan chosen Case 2: If your health insurance lapses and you are hospitalized during the grace period, on intimation during the grace period about the hospitalization, the company will pay the coverage as per the plan, and its terms and conditions.

It is strongly advised to take a private policy due to 2 reasons: If you change your job, you might not necessarily get health insurance from your new employer & you will be exposed to health costs in the transition period between jobs. The track record that you have built-in health insurance at your old employer will not transfer to the new company policy. Covering pre-existing diseases might be a problem. In most policies, pre-existing diseases are covered only from the 5th year onwards.

Yes, there is a tax benefit available under Section 80D of the Income Tax act 1961. Every taxpayer can avail of an annual deduction of Rs. 15,000 from taxable income for the payment of health insurance premiums for self and dependents. For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show proof for payment of the premium. (Section 80D benefit is different from the Rs 1,00,000 exemption under Section 80 C).

A medical checkup is necessary for a new health insurance policy for customers above the age of 40 or 45 years depending on the health insurer’s norms. Medical checkups are usually not needed for the renewal of policies.

A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely settlement.

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from the hospital. The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This is for your convenience. However, prior approval is required from the TPA before the patient is admitted into the hospital. In case of emergency hospitalization, approval can be obtained post-admission. Please note that this facility is available only at the network hospitals of the TPA.

A health insurance policy is reimbursement of medical expenses. Critical illness insurance is a benefit policy. Under a benefit policy upon the occurrence of an event, the insurance company pays the policyholder a lump sum amount. Under a critical illness policy, if the insured is diagnosed with any critical illness as specified in the policy, the insurance company will pay the policyholder a lump sum. Whether the client spends the amount received on the medical treatment or not depends on the client’s own discretion.

While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware of whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses. Note: It is important to disclose any disease you might be suffering from before buying the health insurance policy. Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future.

Most policies offer the benefit of treatment at home: a) When the condition of the patient is such that he cannot be moved to the hospital Or b) When there is no bed available in any of the hospitals and only if it is like the treatment given at the hospital/nursing home which is reimbursable under the policy. This is called “domiciliary hospitalization” and is subject to certain restrictions both in terms of the amount which is reimbursable as well as the disease coverage.

Critical Illness Insurance is a policy that pays out a lump sum amount upto the Sum Insured upon diagnosis of a critical illness covered under the policy.

Critical Illness Insurance provides you and your family, the additional financial security on the diagnosis of a critical illness. The policy provides a lump sum amount which could be used for: Costs of the care and treatment Recuperation aids Debts pay off Any lost income due to a decreasing ability to earn Fund for a change in lifestyle.

Under a benefit policy on the happening of an insured event, the insurance company pays the policyholder a lump sum amount.

The company will pay the Sum Insured as a lump sum on the first diagnosis of any one of the following Critical Illnesses, provided that the Insured Person survives a period of 30 days from the date of the first diagnosis. The following Critical Illnesses are covered under our plan:- Heart Attack (Myocardial Infarction) Coronary Artery Bypass Surgery Stroke Cancer Kidney Failure Major Organ Transplantation Multiple Sclerosis Paralysis

The Insured shall arrange for submission of the following documents required for processing of the claim within 45 days from the date of Intimation. Duly Completed Claim Form Original Discharge Summary. Consultation Note/ Relevant treatment papers. All relevant medical reports along with supporting invoices and doctors requisition advising the same. Original and Final hospitalization bills with a detailed breakup. Pharmacy Bills along with prescriptions. Any other documents as may be required by the Company. On receipt of claim documents, claims will be processed in accordance with the terms and conditions of the Policy.

Personal Accident Insurance protects your finances by providing a lump sum compensation in the unfortunate event of a fatal accident or one that disables you permanently. The compensation shields you and your loved ones from a financial crunch. This insurance also covers accidental hospitalization costs.

Accidents can happen to anyone. Motor accidents, rail accidents, natural calamities, the list is endless. These can sound scary. But, getting intimidated is not the solution, being financially prepared is. Opting for Personal Accident Insurance helps you to meet expenses in case a crisis arises.

Accident policies offer worldwide coverage. Your claim will be paid even if you meet with an accident overseas. Contact OneAssure partner to help you understand terms of each policy before buying.

Life insurance offers a death benefit to your nominee in case you pass away. Health insurance provides compensation and/or reimbursement of hospitalization and other medical expenses. A Personal Accident Insurance policy, on the other hand, insures against the financial risk that could arise due to accidental permanent total disability or accidental death of an earning family member. In short, the policy is essential as it strengthens your financial portfolio securing the future of dependent family members against unforeseen events.

Yes. Health insurance policies have optional covers that you get by paying an additional premium. An Accidental Hospitalization Cover provides reimbursement for medical expenses related to hospitalization and a Daily Cash Cover provides you with a cash allowance for each day of hospitalization.

No. For example, the premium for a basic policy of Rs. 5 lakh (duration 1 year) is approximately Rs. 610*. It is but a small price for ensuring your family's financial security!

Yes. All you need to do is mention the name of your nominee in the policy document. The sum insured will be paid to your nominee by the insurance company.

Travel insurance in India provides coverage for medical expenses incurred overseas for any treatment received as an inpatient or outpatient. All plans also cover trip-related exigencies like trip delays, trip interruptions, trip cancellations and related problems that may arise during your trip. Some plans also provide services such as travel-related advice, Medically required Evacuation to your home in India or a hospital overseas for continued medical treatment. Other assistance services include providing emergency cash or help in the event of the loss or theft of your money, valuables or travel documents.

No, there is no such requirement to get a medical test for travel insurance. Some companies might ask for medical tests for travellers more than seventy years for higher coverage. Coverage often to fifteen thousand dollars is provided without medical tests.

You can reach out to us at +91 63643 34343 and we’d be happy to help. You can also contact OneAssure partners for claims assistance. Rest assured that you will be provided with timely support. In addition, your policy document would also have the details to get in touch with you insurer directly.

Yes, some insurers are offering travel insurance for travellers aged 71 to 85. Yes, senior citizen travellers who are aged 71 to 85 years are also eligible to buy a Bajaj Allianz travel insurance policy for 6 months with $50,000 coverage.

It is a benefit that allows an insured to reinstate the entire sum insured in the policy year when it gets exhausted due to incurred claims. Most of the health plans these days offer the ‘restoration benefit'. It is just like a ‘magical backup’ to recharge your exhausted sum insured. In case the entire cover is exhausted, it gets replenished automatically for the next hospitalization that occurs within the policy year. In a situation when the sum insured is completely exhausted, sum insured restoration proves to be of great help not only to family floater policies but individual health insurance policies, equally.