Eligibility and Coverage

Eligibility
• The customer can buy the policy for any family member(s) i.e. spouse, children and / or parents
• Any person between 18-80 years of age is eligible for insurance
• The Proposer needs to be aged above 18 years

What is covered?

Accidental Death*: In case of death of the insured due to an accident within the policy period, the nominee (mentioned in the policy) is compensated with the Sum Insured.

Permanent Total Disablement (PTD)*: Individual Personal Protect pays compensation against the permanent and total loss of limbs, sight etc.

Accidental Hospitalisation Expenses Reimbursement*: Medical expenses incurred in case of Hospitalisation (minimum of 24 hrs), due to injury, within 7 days from the date of accident

Accidental Hospital Daily Allowance: Per day allowance paid to Insured person each day during Hospitalisation after the Insured event, not exceeding 30 days of Hospitalisation, deductible of 1 day

Note: If any such injury as mentioned above shall result in the inability to remain gainfully employed, then the Capital Sum Insured payable will be 100%.

* Within 12 months from date of accident

What is not covered

The Company shall not be liable under this policy for:
• Compensation / Claim under both Cover 1 and Cover 2 as mentioned above.
• Claims arising from sickness/illness

Death, injury or disablement of Insured Person as a result of
• From intentional self-injury, suicide or attempted suicide
• Whilst under the influence of intoxicating liquor or drugs
• Whilst engaging in aviation or ballooning, or whilst mounting into, or dismounting from or travelling in any balloon or aircraft other than as a passenger (fare-paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world
• Directly or indirectly caused by venereal disease or insanity
• Arising or resulting from the Insured committing any breach of the law with criminal intent
• War, invasion, act of foreign enemy, hostilities (whether war be declared or not) civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrests, restraints and detainment of all kinds
• Nuclear weapon induced treatment
• Child birth or pregnancy or in consequence thereof

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• Individual Cover for each member of the family
• Flexible Sum Insured
• Flexible Deductibles
• Long term cover from 1 year to 3 years.
• Entry Age: 5 years to 65 years and Renewable up to 70 years
• No sub-limits on room rent, hospitalisation expenses, diagnostic tests/ doctors fees, etc.
• No Co-payment
• Free Health Check-up for any one insured member upon policy renewal
• Income Tax benefit under section 80D.
• Access to ICICILombardHealthcare Value-added Services
• Buy in instalments without any extra charges
• Tax Benefits are subject to tax laws

** EMI facility available only for ICICI Bank, Citibank, HDFC Bank up to 6 months and Credit Card customers at the sole discretion of the Banks.

Eligibility and Coverage

Eligibility

• The enrolment age (of senior most member) can be between 5 to 65 years of age.
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be aged above 18 years
• No health check-up up to the age of 45 years (age as on last birthday).
• Individual(s) proposed for Insurance whose age is 56 years &above have to undergo medical tests at ICICI Lombard GIC Ltd designated diagnostic centers
• The policy is renewable till the age of 70 years
• Income Tax benefits u/s Section 80D of the Income Tax Act, 1961 can only be availed for policies bought for self, spouse, dependent children or parents.

What is covered

The Company will indemnify, subject always to the Limit of Indemnity, the Insured against:

• Any illness contracted within 30 days of the inception date of the Policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals
• Hospitalization Expenses (without sub limits) covering all your
• Bed Charges/ Room Rent
• Drs/ Surgeons Fees
• Medicines and surgical suppliest
• Diagnostic Tests (Blood and radiological)
• Pre-existing diseases after 4th consecutive renewal of the Health care plus policy with the company

The Coverage provided under Health Care Plus policy is independent of any other Group/ Individual/ Floater policy held by the insured.

What is not covered?

Exclusions valid for the first 30 Days

• Any expense incurred prior/ post Hospitalization
• Pre-existing Diseases covered only after 4 consecutive renewals with the company
• Expenses incurred on treatment of following diseases within the first 2 years from the commencement of the Policy, will not be payable:
• Cataract
• Benign Prostatic Hyperplasia
• Benign tumors
• Arthritis and related disorders
• Stones Kidney and Gall bladder
• Ulcer- Gastric, Peptic, Duodenal
• D&C and hysterectomy unless for Malignancy
• Tonsillitis, sinusitis and related surgeries
• ernia and Hydrocele
• Medical charges incurred within 30 days of inception date of the policy except thosethat are incurred as a result of bodily injury caused by an accident. This exclusion does not apply for subsequent renewals with the Company without a break.

Permanent Exclusions

• Any Physical, Medical or mental condition or treatment or service which is specifically excluded in the Policy in Part I of the Schedule under Special Conditions
• Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations, issue of medical certificates and examinations as to suitability for employment or travel
• Internal congenital illness
• Suicide or self-inflicted injury
• Alcohol or Drug Abuse
• Illness or Injury whilst performing duties as a serving member of a military or police force
• Treatment relating to birth defects and external congenital illnesses
• All dental treatment unless due to accident
• Treatment traceable to Pregnancy and Childbirth, abortion and its consequences, tests and treatment relating to infertility and invitro fertilization. This will not apply to Ectopic Pregnancy proved by diagnostic means and is certified to be life threatening by the Medical Practitioner
• Birth control procedures and hormone replacement therapy
• Prosthesis, corrective devices and medical appliances which are not required intra-operatively or for the illness for which the Insured was hospitalized
• Treatment of mental illness, stress, psychiatric or psychological disorders, Aesthetic treatment, Cosmetic surgery and Plastic surgery unless necessitated due to accidentor as a part of any illness
• Circumcision unless necessary for treatment of a diseases or necessitated due to an accident
• Vaccination and inoculation of any kind
• Any Sexually transmitted diseases. Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrome (ARCS) and all diseases caused by and/ or related to the HIV
• The performance of hazardous sports of any kind
• Treatment by a family member and self-medication or any treatment that is not scientifically recognized
• Flying other than as a passenger on a scheduled regular carrier
• Any criminal act
• War invasion, act of foreign enemies, hostilities (whether declared or not), civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, riot, strike, lockout, military or popular uprising, civil commotion martial law, loot, sack and pillage
• Nuclear weapons, materials ionizing radiation or contamination by radioactivity from
  any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
• Experimental and unproven treatment, diagnostic tests and treatment not consistent with or incidental to the diagnosis and treatment of any illness or injury for which hospitalization is required
• Costs of donor screening or treatment including surgery to remove organs from a donor in case of transplant surgery
• Non-allopathic treatment
• Treatment taken at home or received outside the country
• Treatment taken from persons not registered as Medical Practitioners under respective medical councils
• Vitamins and Tonics, Treatment of obesity, general debility, convalescence, run-down condition and rest cure

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Key Benefits

• Comprehensive cover and pure benefit policy offering lump-sum amount equivalent to sum insured just on first diagnosis / undergoing of any of 9 Major Medical Illnesses &Procedures, Accidental Death /Permanent Total Disablement (PTD) due to accident
• No health check-up required for policy issuance
• No survival period
• Benefit paid immediately on first diagnosis of the covered Major Medical Illnesses and Procedure
• Choose between a cover of Rs 3 Lakh, Rs 6 Lakh or Rs 12 Lakh sum insured and policy duration between 1 year, 3 years or 5 years
• Avail of tax benefit under section 80D of Income Tax Act on the premium applicable for Major Medical Illnesses &Procedures cover*
• Only a proposal form and medical declaration from needs to be filled for policy issuance
• Claim settled within 21 days of receipt of all required documents
• Tax benefits are subject to tax laws

Eligibility and Coverage

Eligibility

• The enrolment age (of senior most member) can be between 5 to 65 years of age.
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be aged above 18 years
• No health check-up up to the age of 45 years (age as on last birthday).
• Individual(s) proposed for Insurance whose age is 56 years &above have to undergo medical tests at ICICI Lombard GIC Ltd designated diagnostic centers
• The policy is renewable till the age of 70 years
• Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be availed for policies bought for self, spouse, dependent children or parents.

For details, kindly refer to Policy Wordings.

What is coverd

Critical Care offers you a choice of coverage on both the sum insured and the tenure of the policy. You can choose between a cover of Rs 3 Lakh, Rs 6 Lakh or Rs 12 Lakh sum insured and policy duration between 1 year, 3 years or 5 years.

Major Medical Illness &Procedures Cover:

• The Critical Care Insurance shall cover, subsequent to 90 days from
  the policy start date, the following Major Medical Illnesses &Procedures:
• Cancer
• Coronary Artery Bypass Graft Surgery
• Myocardial Infarction (Heart Attack)
• End Stage Renal Failure
• Major Organ Transplant
• Stroke
• Paralysis
• Heart Valve Replacement Surgery
• Multiple Sclerosis
• On first diagnosis of any of the above illnesses / procedures, the insured is entitled to the lump-sum benefit of the entire Sum Insured opted for.

Accidental Death Cover

In case of death of the insured due to an accident within the policy period, the nominee (mentioned in the policy) is compensated with the Sum Insured.

Accidental Permanent Total Disablement (PTD) Cover

Critical Care insures against the permanent and total loss of limbs and sight due to an accident. The compensation (sum insured opted for) is given as a lump-sum benefit in the event of a claim being considered admissible. It is to be noted that the compensation is payable only if the disablement results in inability to remain gainfully employed.

What is not covered

Exclusions applicable to Major Medical Illness and Procedures section:

90 Days Exclusion:
Any illnesses and procedures within 90 days from start date of policy will not be covered. This clause does not apply for subsequent renewal (without a break) of this policy with us.

Treatment of the following diseases:

• Cataract (sub-limit of Rs 20,000 per eye applicable)
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation &Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils and sinuses
• Gastric and duodenal ulcers
• Deviated Nasal Septum

Major Exclusions

The Company shall not be liable under this policy for:

• Pre-Existing illness
• Absence of submission of Doctor’s medical certificate confirming the first diagnosis / undergoing of Illness or Injury or undergoing of medical / surgical procedure
• Any congenital illness or condition
• Any medical procedure or treatment, which is not medically necessary or not performed by a certified Doctor
• Any physical, medical or mental condition, illness, injury or treatment or service which is specifically excluded under the Policy
• Treatment relating to birth defects and external congenital Illnesses
• Birth control procedures and hormone replacement therapy
• Any treatment / surgery for change of sex or any cosmetic surgery or treatment
• Treatment by family member and self-medication or any treatment that is not scientifically recognized

Exclusions applicable to Accidental Death / Permanent Total Disability due to accident

The Company shall not be liable under this policy for:

• Compensation / Claim under more than one of the categories specified in the Policy

Coverage in respect of the same period of disablement of the Insured Person

• Claims arising out of sickness / illness
• Permanent Total Disablement prior to commencement of the policy
• Death, injury or disablement of Insured Person:
  1) From intentional self-injury, suicide or attempted suicide
  2) Whilst under the influence of intoxicating liquor or drugs
  3) Directly or indirectly caused by venereal disease or AIDS
• Directly or indirectly caused by or contributed to or aggravated or prolonged by childbirth or pregnancy or in consequence thereof
• Engagement in dangerous activities
• Mounting into, dismounting from or traveling in any aircraft other than as a fare paying passenger on a scheduled flight
• Mental disorder or psychosomatic dysfunction

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Key Benefits

• Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental
  treatment, medical bills, ambulance charges, etc.
• Avail Cashless Claim facility at over 4,000+ network hospitals acrossIndia(Tip – Simply use your Health ID card at any of our 4,000+ network hospitals and avail cashless service, a boon for those times when you need finance the most.)
• No sub-limits on room rent, doctor fees, and hospital charges or for any disease (Tip – Sub-limit means any limit or restriction put on the Sum Insured available for any treatment/ service/ disease/ covered under the policy. For example, a health policy may have sub-limits of 1% of Sum Insured on the Room rent on a per day basis, or a sub limit of 25% of Sum Insured on Doctor’s fees. Sub-limits can be applied on the entire treatment of one illness, like Heart diseases may have a sub-limit of Rs. 50,000, i.e, a maximum of Rs. 50,000 can be claimed for the heart disease treatment)
• No co-payments for any disease or any Hospitalisation expenses (Tip – Co-payment means a certain percentage of every claim amount which has to be borne by the insured person. For example a health policy may have co-pay of 20% on hospitalisation expenses taken in a non network hospital then he will have to bear 20% of such claim amount out of his own pocket.)
• Now get an Additional Sum Insured for every claim free year
• Pre-existing illness covered after two years, subject to continuous renewal of the
  policy with the Company
• Avail Tax Benefit under Section 80 D of the Indian Income Tax Act, 1961
• Maternity expenses can be covered under OPD expenses of this plan up to the
  OPD sum insured
• Insurance against Terrorist activities
• A maximum of 2 adults can be covered under a single policy
• Buy Online and pay in EMIs without any extra charges.

Eligibility and Coverage

Eligibility

• The enrolment age (of senior most member) can be between 5 to 65 years of age.
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be aged above 18 years
• No health check-up up to the age of 45 years (age as on last birthday).
• Individual(s) proposed for Insurance whose age is 56 years & above have to >undergo medical tests at ICICI Lombard GIC Ltd designated diagnostic centers
• The policy is renewable till the age of 70 years
• Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be availed for policies bought for self, spouse, dependent children or parents.

What is covered?

• Medical expenses incurred as an inpatient during hospitalisation for more than 24
  hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic
  tests, etc.
• Medical expenses incurred 30 days prior and 60 days post hospitalisation
• Pre-existing diseases can be covered after two continuous years of coverage with
  the Company*
• Covers against hospitalisation# in case of Swine Flu / H1N1 influenza

* Conditions Apply
# If it’s not a pre-existing illness

The following technologically advanced treatments that do not need 24-hour hospitalisation but are covered under this policy are:

• Cataract (limited to 20,000 per eye)
• Lithotripsy (Kidney Stone Removal)
• Tonsillectomy
• Eye Surgery
• Dialysis
• Dilatation & Curettage
• Chemotherapy
• Radiotherapy
• Coronary Angiography
• Cardiac Catheterisation

Outpatient Department (OPD)
Cover Room, Boarding Expenses as charged by the Hospital Nursing Expenses Expenses related to Dental Treatment Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids, Dental treatment charges, Ambulance charges

Note: The OPD claims can be made only on a reimbursement basis. You can lodge a claim only once during the Period of Insurance, i.e. 90 days after commencement of policy and 30 days after expiry of the Period of Insurance.

What is not covered

Exclusions for Hospitalisation Benefit Cover

Exclusions valid for the first 30 Days:

Any illness contracted within 30 days of the inception date of the policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals of this policy.

Exclusions valid for the first 2 Years:

Treatment of the following diseases:

• Cataract (limited to Rs 20,000 per eye)
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast
  lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils and sinuses
• Gastric and duodenal ulcers
• Deviated Nasal Septum

Note: The OPD claims can be made only on a reimbursement basis. You can lodge a claim only once during the Period of Insurance, i.e. 90 days after commencement of policy and 30 days after expiry of the Period of Insurance.

Pre-existing Disease Exclusion:

Any illness / disease / injury pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the Company for 2 consecutive years.

Permanent Exclusions:

• Non-allopathic treatment, pregnancy and childbirth related diseases, cosmetic,
  aesthetic and obesity related treatment.
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor,
  intoxicating substances or drugs as well as intentional self injury.
• War, riots, strike, nuclear weapon induced treatment.

Exclusions for OPD (Outpatient Department Expenses):

• Suicide or self-inflicted injury
• Alcohol or drug abuse
• War, riots, nuclear related hospitalisation
• Non-allopathic treatment, experimental and unproven treatment
• Expenses arising from treatment of HIV/ AIDS or related disease, use or misuse
  of alcohol and other intoxicating substances and intentional self-injury.

For more details, kindly refer to the Policy Wordings.

Tax Benefits

Section 80D: Save Tax and Insure your Health

Besides the investments of 1 Lakh under Section 80C, there are other options for saving tax

Section 80D:
Investments made towards medical insurance premium paid qualifies for deduction under section 80D from your income up to a defined limit.

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Key Benefits

• Comprehensive coverage for your family with floater benefit
• Cashless claims facility at over 4,000+ network hospitals acrossIndia
• Continue to enjoy quality service even during claim settlements with – ICICI Lombard Health Care – our own in-house health claim processing and wellness team
• No sub-limits on room rent, doctor fees, and hospital charges or for any disease (except Cataract where Rs 20,000 per eye is applicable).
• No co-payments for any disease or any hospitalisation expenses
• Now get a Free health check-up coupon for any one insured family member, valid for the policy period
• Called a Convalescence benefit, the insured, once during the policy period, is eligible for a benefit amount of 10,000 if hospitalised for any bodily injury or illness as covered under the policy, for a period of 10 consecutive days, or more.
• The insured will be eligible for a daily cash of 1000 per day for a max. of 7 days, in case the insured is hospitalised for any injury or illness as covered under the policy, for a minimum of 5 consecutive days.

Eligibility and Coverage

Eligibility

• The customer can buy the policy for any family member(s) children and / or parents
• The senior most person to be insured should be between 5 to 60 years of age
• The Proposer needs to be aged above 18 years
• To cover children aged between 91 days to 5 years, the policy must also cover at least 1 adult under the same policy
• Children under less than 91 days old cannot be covered
• Individual(s) proposed for Insurance whose age is 46 years & above have to undergo medical tests at ICICI Lombard designated diagnostic centers
• The policy cover is renewable till the age of 70 years
• Income Tax benefits u/s 80D can only be availed for policies bought for Self, Spouse, Children or Parents
• Floater benefit under the policy is available up to the age of 60 years. All floater policies thereafter will be renewed under individual plan up to the age of 70 years

For details, kindly refer to Policy Wordings.

What is covered?

• Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor/ surgeon’s fee, medicines bills, etc
• Medical expenses incurred 30 days prior and 60 days post hospitalisation
• Day Care expenses incurred on named advanced technological surgeries and procedures requiring less than 24 hours of hospitalisation. (Including Dialysis, Radiotherapy and Chemotherapy)
• Pre-existing diseases can be covered after four continuous years of coverage with the Company
• This policy also covers you for hospitalisation in case of Swine Flu / H1N1 influenza
• Conditions Apply

What is not covered?

Exclusions valid for the first 30 Days

• Any illness contracted within 30 days of the inception date of the Policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals

Exclusions valid for the first 2 Years

• Treatment of the following diseases/illness/ailments:
• Cataract
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and duodenal ulcers

If the Policy is renewed with us for two consecutive years, the above diseases / illness / ailments will be covered from the third year. If these are pre-existing diseases at the time of inception of the policy, the same will be covered after the fourth year onwards, subject to continuous renewal of the policy with us.

Permanent exclusions

• Any illness/ disease/ injury/ pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the Company for 4 consecutive years
• Non-allopathic treatment, pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury
• War, riots, strike, nuclear weapon, induced treatment

For details, kindly refer to Policy Wordings.

Tax Benefits:

Section 80D: Save Tax and Insure your Health

Besides the investments of 1 Lakh under Section 80C, there are other options for saving tax

Section 80D:
Investments made towards medical insurance premium paid qualifies for deduction under section 80D from your income up to a defined limit.

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Health insurance companies use to outsource their solution requirements agency called third-party administrators (TPA). This was done to reduce costs and time and help insurance companies focus on their heart of business.

The economy and praised the speed of operations in which they would bring did not happen. Now, after several years of unsatisfactory experience with these agencies, insurance companies are back to do these things on their own. Go to the house is the name of the game now.

Health cards did not arrive in time, the delay in question without cash, delays in payment of debts, some of the most common complaints that the insured against any claims by TPA, experts say in the insurance sector.

For the Future Generali, customer complaints have gone to 80 % after moving to the demands of internal models in November 2010.

“Customer service is the point of touching the most sensitive to any insurance company. It is an essential activity for the company, which ideally should not be outsourced. There is also much more accountability with its own units of settlement of the claim because they offer end to end solutions to health insurance, “said TA Ramalingam, head-underwriting, Bajaj Allianz General Insurance.

Direct Connect, an important

I agree with Mr. Sanjay Datta, head-Client Services, Health and Motor, ICICI Lombard General Insurance, “It’s important for us to have direct contact with our customers.”

Insurance companies also say that the claims could be resolved more quickly if you did.

Time claims fell by 50-70 % (as applicable) to ICICI Lombard because it has changed the process in-house in 2008.

“Now, decisions are made directly to us, and also the resolution of disputes is much faster than dealing with customers and directly to hospitals,” said Shreeraj Deshpande, Director, Health Insurance, Future Generali Insurance.

“In-house claims settlement is faster, because there is no link in the client and the insurance company. Benchmark in the sector is about 6-8 hours to accept the request without cash, while the approval of our team -supports will house only 40 minutes, because we process the image, adds Mr. Ramalingam.

Administrative expenses
Claims, the house can lead to an increase in administrative costs than the insurance companies must commit to a solid foundation for the work to link with hospitals, and maintains a 24×7 call center, among other things. However, in the long term, experts believe that it would help to lower insurance premiums.

Source: thehindubusinessline

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The wait is over finally. The Insurance Regulatory and Development Authority (Irda) has issued the final guidelines on health insurance portability, clearing the decks for their implementation from October 1. This means, from October you can switch from one health insurer to another without losing any benefits you have earned on your existing health cover.

THE PLUS POINTS
Till now, policyholders were reluctant to switch to a new health insurer mainly because the transfer of the waiting period credit for pre-existing diseases (PED) was generally not allowed. Typically, pre-existing diseases are covered only after one to four years of the policy being in force, depending on the company and the illness.

This is referred to as waiting period in insurance industry parlance. Portability will allow policyholders dissatisfied with their insurer’s services – be it with premiums or claim settlement – to migrate to another insurer who will not insist on them biding their time for four more years to get the PED cover. For instance, if you decide to shift to another insurer after completing three policy years, and the existing policy undertakes to cover PED after four years, you will have to wait for just one more year to be eligible for PED cover under the new policy. “Health insurance portability will help policyholders as they will gain from a wider choice. It will also benefit the insurance industry in the long run,” says Sanjay Datta, head, customer service, health and motor , ICICI Lombard.

“The penalty of the portability proposal being deemed accepted in case the insurance company does not respond within the timeline will make the process very efficient,” says Mahavir Chopra, head, e-business , Medimanage. The most interesting aspect of the guidelines, perhaps, is that they allow a switch from group mediclaim to individual or family floater policies, and let the policyholder to retain the waiting period credit. Since many families depend solely on their employers’ group policies, such transfers will help them have a policy of their own without having to wait for the four-year period for coverage of pre-existing diseases to come to an end.

WILL IT REALLY HELP?
While the insurance regulator’s diktats are to be welcomed, portability cannot be assumed to be the panacea for all the grievances of policyholders. “Portability of a health insurance policy is attractive only on paper,” says consumer activist Jehangir Gai. “As long as a policy is profitable, every insurance company is good to the insured (when there is no claim, there cannot be any dispute).” He points out that only after a claim arises do insurance companies get worried about the policy becoming onerous with repeated subsequent claims. It is then that the insurer becomes troublesome and, consequently, the insured becomes unhappy with his/her existing insurer and considers a migration to another insurance company.

“This is the time when portability is required. But the catch is that portability is not a matter of right. It is up to the new company to accept or reject a proposal. Which insurance company will want to take on the liability of an onerous policy? None. So, a person can submit his proposal for portability and the insurance company would reject the proposal ,” reasons Gai. Then, there are other issues, too. Many feel that insurance companies will reject outright the proposals of senior citizens, who are seen as a highrisk category, thus defeating the whole purpose of portability. Besides, for those who have accumulated a no-claim bonus, portability could turn out to be a lossmaking proposition. As per the Irda circular, the no-claim bonus can be carried forward to the new policy, but the premium charged will be for the enhanced sum assured .

This means that the policyholder will have to pay a higher premium if he/she wants the new sum assured to be equal to the previous sum assured plus the noclaim bonus. Therefore, in case of a switch, the policyholder will stand to lose out on discounted premium that he/she would have obtained, since no-claim bonus component would not have attracted any premium with the existing insurer.

Arvind Laddha, MD & CEO, Vantage Insurance Brokers, points out another aspect that could go against policyholders when they migrate from group to individual plan. “It also appears that when an insured ports from a group to an individual cover, he will get credit only for the period he has been insured with the current group insurer . This seems like a compromise for the insured, especially if he has had no claims with the previous insurer,” he says. Such policyholders should also remember that they can port only to the individual policy offered by the same insurer first. After a year, they will earn rights equal to all other policyholders and can then choose any other insurer.

NOT ALL BLACK AND WHITE
Confusion prevails over the definition of pre-existing illnesses in certain cases. Say a policyholder has undergone treatment for a disease and his/her insurer has settled the claim. If he/she decides to migrate, will the new company deny cover for the disease for which a claim has been made? “This is a grey area that needs clarity. If the new insurer does not offer cover without a waiting period for ailments suffered during the continuous running of the old policy, then senior citizens and others with chronic ailments would not be able to enjoy portability in the true spirit,” says Chopra.

“If the new insurer is aware of the fact that the policyholder was suffering from a pre-existing condition and decides to accept the proposal, in practical terms, it will be difficult to reject a claim on the grounds of pre-existing diseases,” says Subrahmanyam B, head, health insurance vertical , Bharti-Axa General Insurance . However, Gai says the new insurer will have to extend cover to these illnesses, too. “This is in view of the provisions of clause 2. If a disease is already listed as pre-existing in the existing policy , then the new insurer will also treat it as pre-existing .”

“Under the definition of PED, the waiting period is across any insurer. Therefore, if the new company accepts the risk, the time-bound PED would apply and PED would be covered,” says Antony Jacob, CEO, Apollo Munich. While measures taken by Irda are commendable, health policyholders will have to wait for some more time before they have complete freedom of choice. But, at least it is a desirable beginning.

Source: [ET]

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Refusal to pay premiums without getting anything in return is the only reason why insurance cum investment are popular in the market despite the availability of cheaper alternatives, such as coverage term.

Like term insurance, health coverage as well, not finding many buyers, as many mistakenly believe that buying health coverage while maintaining some sense of perfect health. In addition, coverage of health premiums with a rare person to exhaust the Rs 15,000 you can claim deductions for health insurance under Section 80D of the Act on Income Tax. Again, is against such policies. That’s why some health insurers have been designing products that applicants for such assurances happy.

Health ‘plus’
These include health coverage in units of account and the OPD (outpatient department) of products that will expand coverage to treatments that do not require 24 hours of hospitalization or not included under “care” procedures. Companies like ICICI Lombard, Apollo Munich and Max Bupa provides cover OPD.

Unit-linked health plans seemed to address another source of consternation among the insured – “shopping” is a policy that does not produce “returns”. OPD continues to cover the hearing, dental and maternity costs, constraints, which are the key exclusion criteria based on the standard mediclaim compensation for individuals. These plans will also appeal to people who want to maximize the tax benefits for health insurance premiums.

Pursuant to standard policies, 30, we choose a sum insured RS 3 lakh would pay an annual premium of about Rs 3000, well below the PAC Rs 15,000 eligible for tax relief. “With costs going north OPD steeplyand most insurances do not cover the cost of DPO, covers this type have been incredibly helpful to the individual. Completeness is the proposed policies. Mallets with the advantage of economies of taxes, such policies have become very popular among customers, “said Sanjay Datta, director, customer service – health and motor, ICICI Lombard.

Then there are other systems, such as Bajaj Allianz insurance health card, provided to policyholders. “Even if the insured does not make claims for health policy in a given year, can use the discounts on OPD consultations, pathology tests, eye care centers and dental clinics,” says TA Ramalingam, head of underwriting, Bajaj Allianz.

OPD how policies work?
The basic mechanism is similar to the normal compensation plans based health care. The costs of hospitalization are paid when the pre-and post-hospitalization expenses, and those relating to day-care treatments for serious diseases.

Similarly, existing medical conditions are covered after a waiting period of 2-4 years, depending on the policy. The most significant difference, as mentioned, is within range of conditions / treatments outside the standard of dental health, pregnancy-related expenses, diagnostic tests, pharmacy bills, etc.

Click here to apply health insurance mumbai

In the production of necessary bills related to treatment or consultations, the insurance company will reimburse the amount spent by you, subject to sub-limits.

Source: [ET]

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Source: [ET]

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These policies can now breathe easy as some insurance companies have begun to include alternative forms of treatment under its coverage, especially Ayurveda. “Ayurveda is the most common alternative system, we designed a product to cover Ayurvedic treatments in the hospital,” said SS Gopalarathnam, MD, Cholamandalam MS General Insurance.

While some insurers do offer policies in their group, others have begun to offer individual applicants for health insurance. PSU insurerNew India Assurance and independent health insurance provider Star Health and Allied Insurance are other insurers began to cover the Ayurvedic treatments tutoring policies.ICICI Lombard General Insurance covers it under the government, and the future Generali insurance it offers to commercial insurance buyers.

“Our policies, as such, do not cover any other line of treatment outside of allopathy. However, the political group, we offer tailor made packages for companies to cover the topic of Ayurvedic treatment under certain conditions,” says Shreeraj Deshpande, future director of the insurer Generali. Few insurance policies cover treatment Unani

How do I do with alternative medicine health insurance rise? SS Gopalarathnam, Managing Director, Cholamandalam MS General Insurance “, in the course of the discussions focus groups with customers and agents, we found that chronic diseases such as spondilytis, arthritis and epilepsy, many people prefer alternative treatment such as streams Ayurveda, Siddha and Homeopathy, etc. “

Although coverage was expanded, there are curbs on the amount and situations where it may be necessary. New India Assurance is extending coverage to those treated with systems of Ayurvedic, Homeopathic and Unani medicine. “Such claims will be covered only to the extent that 25% of insurance. They also need to have benefited from treatment in a public hospital to be eligible to claim,” said Segar Sampath kumar, Assistant General Manager, New India Assurance.

Similarly, Health Star also covers non-allopathic treatment, except in naturopathy, health insurance costs its Unique “, up to 25% of the insurance policy or fixed a maximum of Rs 25 000 Fri presence of a year.” Chola line single book provides health insurance coverage for hospital treatment in Ayurveda before, during and after hospitalization. The contractor can be treated with any government registered ayurvedic hospitals across the country and require hospitalization if more than 24 hours.

Naturopathic treatments are excluded in all policies, while covering some unani and homeopathic. This is because other forms of treatment have no standard treatment protocols and costs will vary so it is difficult to calculate the actuarial cost to cover.

Even in Ayurveda, the selection procedures are covered so that people do not abuse policy for a process of rejuvenation of the base.

“We do not cover the Unani system of medicine. According to Ayurveda, mean hospitalization Panchkarma (five actions) to clean the whole body by eliminating accumulated toxins are covered by case basis,” says Deshpande. It is important to note that no one cover to cover alternative treatments. You’ll have to buy a standard health insurance from these insurance companies and others choose to start offering coverage Nonallopathic.

Before going for an alternative and make a claim, to see if treatment is indicated in the document of insurance.

Source: [ET]

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