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Common Myths about Health Insurance
Let's debunk some common myths about health insurance:
Fact – The fact is that buying health insurance at a young age can allow individuals to avail of a plan at an affordable premium price. When you are young, you are fit and healthy and the chances of getting admitted to a hospital are less. This makes premiums affordable.
Fact – As per IRDAI reports, Indian insurance companies settled over 95 % to 97% of insurance claims during the year 2020-21. Also, many health insurance companies in India have a CSR of 95% and above.
Fact – Smokers can avail of a health insurance policy. However, since smoking may be the cause of several respiratory diseases, health insurance companies may charge a high premium as compared to non-smokers.
Fact – The fact is several health insurance policies cover conditions like diabetes or cancer. However, if these diseases are pre-existing ones, the insured might have to go through the PED waiting period.
Why do you need Health Insurance?
Buying a health insurance policy for self or family is important as medical care is costly. Check out these videos to help you understand the need for Health Insurance plans
Health Insurance for Unexpected Surprises | Paybima
Insure your Family from Paybima| Family Health Insurance
Health Insurance Add-Ons
Maternity Cover
Maternity Health insurance is an add-on coverage that an insured can avail of by paying an extra cost to get coverage against expenses related to childbirth, hospitalization, medicines, etc.
Critical Illness
The critical illness add-on provides coverage against several life-threatening diseases that require multiple hospital visits and long periods of hospitalization.
Personal Accident
A personal accident add-on is a rider that can be availed of by health insurance policyholders to get compensation against injuries, death, or disability.
Hospital Cash
This health insurance add-on offers fixed hospital daily cash to the insured and his family if the individual is hospitalized for a long duration.
Room Rent
To avail of the facility of hospital room rent without any capping, a health insurance policyholder can avail of a room rent add-on.
Simple Steps and Assistance for Buying a Health Insurance Plan
At Mahindra Paybima, buying an insurance plan is easy and you can opt for an advisor’s help anytime.
Simple and Easy-to-follow Steps
Comparison of Top Plans for Free
Help from Certified Advisors Anytime
Honest Advise. No Force Selling
How to Select the Best Health Insurance in India
Choosing the best health insurance policy is as important as choosing any type of insurance. With the rising cost of medical expenses, a health insurance policy will ease your mind about any future health conditions that may arise. Whether you are choosing for yourself or your loved ones, there are certain factors that one needs to consider. Here’s a guide on how to choose the best health insurance policy in India
Type of Plan
Always opt for the best health insurance in India that allows maximum coverage benefits to fulfill your healthcare requirements.
Sum insured
Sum insured is an important consideration to ensure that you get adequate coverage to reap the benefits of your best health insurance plan whenever required.
Coverage
Check the inclusions of the best health insurance policy in India to protect you against a range of diseases and medical conditions.
Lifetime Renewability
Always go for policies offering lifetime renewability to stay covered for your entire life under a comprehensive and best health insurance plan
Budget Friendly
Buying a health insurance plan that suits your pocket is also crucial so that you can continue it without any financial crunch.
Add-on Covers
The best health insurance plans in India allow the insured to add or remove riders/add-on covers as required.
Sub-limits
Checking the sub-limits under the best health insurance policies in India is important for expenses like room rent, ICU room rent, disease-specific limits, etc.
PED Waiting period
Most Health Insurance policies come with a pre-existing waiting period which needs to be checked if you have an immediate coverage requirement.
Network Hospitals
Always go for the best health insurance companies that provide an extensive list of network hospitals.
Pre-Medical Tests
Medical screening may or may not be a part of a health insurance policy. It is vital to check if medical screening is compulsory under your health plan.
How to Minimise Health Insurance Premium
Age
If the age of the insured is more, the premium charged is higher because they are more susceptible to diseases. Starting early gets you started on a lower premium.
History of diseases
A healthy person has to pay a lesser premium as compared to a person with a history of diseases.
Policy tenure
Long-term policies give a lower amount of premium as compared to short-term ones.
Premium paying frequency
Many insurance companies offer a discount on annual payments, whereas monthly payments can be a little more expensive.
Policy with the desired base plan
They might have to pay a lower premium for a base plan that fulfils their necessities without any additional riders.
Consumption of harmful substances
Bad habits like smoking, drinking, chewing tobacco, etc. could incur the insured a hefty price for premium as there are chances of dangerous illnesses.
Location
Geographic locations in India are classified into different zones that vary in elements such as climate, pollution, and quality of medical facilities. As a result, the premium for insurance is likely to be higher in Tier 1 cities compared to Tier 2 and Tier 3 cities.
Health Insurance Claim Procedures
Steps for Cashless/Reimbursement Claims
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Step 1
Visit the Paybima store near you and connect with your relationship manager or call the toll-free number 1800 267 6767. We will assist you with the steps for raising the claim. -
Step 2
Verify the type of claim: Cashless or reimbursement. -
Step 3
Inform the TPA or the insurance company as per the timeframe for cashless or reimbursement respectively. -
Step 4
Inform the TPA or the insurance company as per the timeframe for cashless or reimbursement respectively.
A detailed description of ‘steps for cashless’ or ‘reimbursement claim’ is given below:
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Cashless Procedure for Planned
Admission -
Cashless Procedure for Emergency
Admission -
Reimbursement Claim
Steps
1. Choose a hospital: For a cashless claim the Insured or a family member has to choose a hospital from the network as mentioned in the policy document/insurer’s website
2. Inform the TPA: The insured or a family member has to visit the TPA counter of the hospital 2-5 days prior to the admission date.
3. Document submission: At the counter, submit the health ID card, policy copy, Aadhar card copy and diagnosis reports/advise note of the treating doctor.
4. Document inspection: The insurer/TPA will inspect all the documents and issue an initial authorisation letter to the hospital. The hospital may ask for a nominal refundable security deposit as per their management
Approval of cashless claim:
At the time of discharge, the insurance company will give final authorisation against the hospital bills, which excludes non-consumables, instruments, and various charges as per IRDAI guidelines.
Rejection/disapproval of cashless claim:
Even if the cashless claim gets denied during the cashless claim process, the insured can submit the claim for reimbursement. The respective TPA verifies the claim based on policy terms and conditions and inspects documents submitted and gives their final decision.
Steps
1. Choose a hospital: For a cashless claim the insured or a family member has to choose a hospital from the network hospitals as mentioned in the policy document.
2. Inform the TPA: The insured or a family member has to visit the TPA counter of the hospital (within 24 hrs) after admission along with the health ID card, photo ID proof & policy copy.
3. Document submission: At the counter, submit the health ID card, policy copy, Aadhar card copy, and diagnosis reports/advice notes of the treating doctor.
4. Document inspection: The insurer/TPA will inspect all the documents and issue an initial authorisation letter to the hospital. The hospital may ask for a nominal refundable security deposit as per their management
Approval of cashless claim:
At the time of discharge, the insurance company will give final authorisation against the hospital bills, which excludes non-consumables, instruments, and various charges as per IRDAI guidelines
Rejection/disapproval of cashless claim:
Even if the cashless claim gets denied due to the non- availability of documents, the insured can submit his claim for reimbursement. The respective TPA verifies the claim based on policy terms & conditions and documents submitted and gives their final decision.
Even if the cashless claim doesn't get through in time during discharge or if the insured needs to be admitted to a non-network hospital, you can file for a reimbursement claim.
Inform about the hospitalisation
Inform your insurance company/TPA through the toll-free number or connect with Paybima store, within 48 hours of admission.
Download the reimbursement claim form
The claim form is available on the insurer’s website/TPA,
Submit the following documents
- Claim Form - Filled and signed by the insured - Part A
- Claim Form - Filled and signed by the hospital - Part B
- Original discharge summary/discharge card
- Original payment receipts (advance receipts & final bill payment receipts)
- Original bills for doctors' consultations and doctor's consultation notes
- Bills and receipts for all investigations (MRI, Xray, Pathology, etc.)
- Original pharmacy bills
- Doctor’s prescriptions
- Copy of in-patient records
- Copy of age proof (driving license/ PAN card/Aadhar card/passport)
- Personalised cancelled cheque (name printed) of the proposer or bank passbook copy
- Prescriptions and hospital bills 30 days pre- and 60 days post-hospitalisation. In such cases, the expenses for post-hospitalisation can be claimed after 60 days.
- Attested hospital registration certificate
- ** Depending on the specific case, additional documents may be asked
Inspection of documents
The insurance company/TPA will inspect to see all the documents submitted are in order, settle the reimbursement amount via electronic transfer within 10 to 15 working days.
How to Get Maximum Claim?
To get the most out of the premium you have paid for your health insurance policy,
here are some of the factors you need to know.
Avoid vagueness
Make sure you fill out your application properly with accurate information. Never withhold any essential details, including your medical history and lifestyle associated factors like drinking and smoking. Any ambiguity may cause delays in claim settlement in the future.
Get familiar with your plan
Knowing your policy inside out will help you understand its features, clauses, inclusions, exclusions, and more.
Understand the claim process
To ensure seamless settlement of your claims, you must understand the process, the documents required, and all other associated requirements.
Timely intimation
Especially in times of cashless claims, one must inform their insurer within 24 hours so that you can claim your benefit during hospitalisation.
Keep documents handy
All your documents, including your health card, bills and receipts from the hospitals, prescriptions and memos for medicine costs, claim form and requirements checklist of the insurer, etc., should be kept handy when claiming a settlement.
Guaranteed Claim Support
Schedule a Callback
We will guide you from start till end in your ‘claim’ journey. Start your claim process with us to get our support.
Health Insurance - How to Avoid Rejections
Waiting period
If the insured claims for an ailment that is not covered during the policy’s waiting period.
Uncovered illness
A claim can also be rejected if the disease or treatment is not covered or permanently excluded from the policy.
Fraudulent claim
If the insurer finds out during the verification process that the claim is fraudulent, the claim will be rejected.
Documents for Claiming Health Insurance
For a seamless claim process, make sure to keep these documents handy.
Policy Copy/Health card provided by the insurer.
A claim form duly filled
A medical form duly signed by the doctor who is treating the insured.
The original copy of the complete discharge summary that’s received from the hospital.
Original copies of all receipts and bills from the hospital.
Prescription of medicine as well as the cash memos received from chemists or the hospital.
A copy of the investigation report.
In case of an accident, a copy of the FIR/MLC or Medico Legal Certificate is also needed.
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