Health Insurance

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Clarify All Doubts Related To Health Insurance

A health insurance policy is an agreement between an insurance company and a policy holder. In this agreement, the policy provider offers financial assistance for medical expenses to the policy holder in return of a premium. The policy holder can get reimbursement for medical treatments, hospital bills, surgical bills, etc or choose the cashless claim feature. The cashless claim feature allows the policy holder to avail treatment on a network hospital without worrying about the payments. The insurance company and the network hospital have an association through which they settle the bills of the policyholders.

You can compare multiple health insurance plans online. Buying medical insurance online helps you to choose the one which best fits your requirements.

Why is Health Insurance Important?

A health emergency will not knock on your door before entering your life. Especially with physical fitness featuring low on our priority list, diseases are becoming more common. Medical treatments especially in private hospitals can lead to inflated bills. And if you find yourself in such a situation, it can completely drain your savings if you don’t plan ahead. A health insurance plan will offer you a cushion in times of medical emergencies. It provides you and your family with financial assistance that will cover you and your family’s urgent medical needs. Apart from this, buying a health insurance policy can also offer you tax benefits under Section 80D of the Income Tax Act. 1961.

Different Types of Health Insurance Plans in India

The several types of offline and online health insurance plans in India are:

  • Individual Health Insurance Plans
  • Family Health Insurance Plans
  • Senior Citizen Health Insurance Plans
  • Personal Accident Insurance Cover
  • Group Health Insurance Plan
  • Maternity Health Insurance Plan

Two types of health insurance policies that have been introduced recently are

Individual Health Insurance Plans

Individual health insurance plans offer financial cover against medical expenses for an individual. The insured alone gets all the benefits of the plan. It is best for individuals whose family members are already insured or who is at a higher health risk. An Individual health insurance is for a single person and cannot float within the family. This type of medical insurance plan covers hospitalisations, surgeries, room rent, physician’s fee and tests. However, the insured has to pay a certain amount as co-payment for some healthcare services. There are no restrictions on the maximum age for the renewal of the policy.

Family Health Insurance Plans

A Family Health Insurance Plan or a Family Floater health Insurance plan is a single sum of money offered to the entire family as coverage. The sum is divided amongst the family members equally in case multiple members fall sick. A single premium is to be paid in a year to avail this insurance. A single claim or multiple claims can be made within a year under this plan. It is more cost-effective than taking individual health insurance plans for each member of the family. However, addition of senior citizen members into this plan may increase the yearly premium.

Key Benefits of Health Insurance Policy in India

When the medical bills pile up, your savings drain quickly out of your pocket. A regular health check-up may also cost you more than you can afford. This doesn’t mean that you cannot have access to the best treatments available for you and your family. A health insurance policy comes to your aid is such a scenario. It covers your medical expenses so that you can lead a long and healthy life. Here are some key benefits of an online health insurance:

  1. Medical Check-Up Facility
  2. You should get a full health check-up once a year to nip any oncoming diseases in a month. Most of us ignore this fact because we don’t have the resources. A health insurance plan offers you the facility of regular health check-ups. These check-ups can be inclusive or you can have it as an add-on with your medical insurance plan.

  3. Ambulance Fee
  4. The transportation fee for the patient from their home to the hospital can be costly. Most health insurance plans offer coverage of the ambulance fee up to a certain amount. This way, the patient and the family can only focus on the treatment and forget about the frill charges.

  5. Coverage of Pre and Post-Hospitalization Expenses
  6. If the insurance covers the disease or illness, they will provide the pre and post-hospitalization expenses. This means that if there are any medical bills that arise prior to hospitalization, they will be covered. If you need medical care at home after your stay at the hospital, the health insurance will cover that too.

  7. Cashless Medical Treatment
  8. If you get treatment from one of the network hospitals of the insurance company you can avail the Cashless Claim facility. This facility allows you do get treatment without paying for it. The network hospital and the insurance company will settle your bills amongst themselves. The list of network hospitals is available on the website of company.

  9. Tax Benefits of Health Insurance Plans
  10. Health insurance plans offer you tax benefits under the Section 80D of the Income Tax Act. You get a tax rebate, the amount depending upon the premium and certain factors. If you are below 60 years, you can get a rebate of up to Rs.25000 in a year. If over 60 years, this amount can go up to Rs. 50000. If you are paying insurance premium for your parents, you get rebate up to Rs. 55000.
    *tax benefits are subject to changes in tax laws

  11. Third Party Administrators
  12. Third Party Administrators or TPAs assist both the insurer and the insured. They help the insurers against fake claims or overhead costs. TPAs help the insured to avail secure and swift services. These TPAs handle claims, reimbursements, premium collection, etc. on behalf of the insurance company.

  13. Pre-Existing Disease Cover
  14. After an incubation period (generally 2-4 years) insurance plans begin to cover pre-existing diseases. Pre-existing diseases are illnesses that the policyholder had before buying the policy. These may include diabetes, hypertension, etc. You can claim for these illnesses once the incubation period is over. But these diseases should be mentioned in the policy.

  15. Room Rent Sub-limits in Your Health Insurance Plan
  16. Most insurance policies reduce their liability by putting sub-limits on certain services. One of which is room rent sub limit. The health insurance policy will offer you a maximum coverage up to the sum assured, but they may limit their expenses. For example, there may be a cap of Rs 6000 on room rent, or they may not offer to cover a suite. If your hospital room charges are 10,000, the insurance will give you 6000 and the rest 4000 will be borne by you. The charges mostly depend upon the type of room you require, for example, a private room, semi-private room, suite, etc.

Does a Health Insurance Policy Cover Coronavirus (COVID-19)?

If you have an existing health insurance policy, a coronavirus claim will be handled by the insurance company expeditiously. It will go through a thorough review by the claim review committee and decided if it will be accepted. If you want to buy a health insurance policy online, most of them now offer insurance against coronavirus. Certain insurance companies have also rolled out medical policies centred around COVID-19. The IRDAI has also launched two new policies for Coronavirus – Corona Kavach Policy and Corona Rakshak Policy.

Health Insurance Plan Inclusions & Exclusions

Most insurance policies are customizable and you can choose which one suits your requirements. However, there are certain common inclusions and exclusions which you can choose from. They are:

Inclusions

  • Hospitalization expenses
  • In case of organ transplant, donor expenses up to a certain amount
  • Overnight hospitalizations in cases of serious injuries
  • Pre-existing diseases after a set incubation period
  • Pre and post hospitalization expenses
  • Ambulances charges up to a certain amount
  • Room rent up to a sub limit
  • Free health check-ups
  • Maternity and new-born expenses
  • Day care treatments
  • Treatment from home or domiciliary hospitalization

Exclusions

  • No expenses incurred during the waiting period (30 days), unless it is an accidental emergency
  • Pre-existing diseases are not covered in the incubation period. (Usually 2-4 years)
  • Illness and injuries caused by war or nuclear activities
  • Suicide attempt
  • Cosmetic/Obesity/Aesthetic surgeries
  • Replacement of hormones or sex-change operations
  • Dental or Eye Surgeries
  • Non-allopathic treatment
  • Certain treatments or diagnostic tests
  • Treatment abroad by under-qualified professionals

It is best to compare health insurance plans online to choose the one which offers maximum coverage.

How to Compare Health Insurance Plans at Paybima?

You need to fill up a form which asks for your basic details depending upon the insurance type you’re looking for.

  • The form will lead you to a host of policy options customised according to your needs. The list quotes the premium and the basic details of every policy.
  • You can click on each policy to view their detailed information.
  • On the page with the list, you can select the policies you want to compare by checking the ‘Compare Product’ box. You can select up to 4 products at a time and click compare.

This will lead you to a comprehensive table which lists all the benefits of your shortlisted policies. You can take your time and choose the best one for you and your family.

Benefits of Comparing Health Insurance Plans Online

It is crucial to compare medical insurance plans online before finalising one. It helps narrow down the best plan which offers the maximum coverage. There are several plans that offer more services on a low premium. So, you can choose the one that suits your requirements and is also affordable. You don’t have to simply accept amongst the couple of choices handed to you by an agent. Comparing health insurance policies gives you the power to choose according to your needs.

  1. Access to Accurate Information
  2. When you compare health insurance plans, get access to all the information you need to purchase a policy. You don’t have to rely on agents and middle-men who offer their (mostly) biased opinions. You can easily log on to a website and read all the services, terms and conditions.

  3. Time Efficient and Convenient
  4. You don’t have to meet agents or set up calls with insurance companies to buy a policy. You can get a comprehensive table which lists all the benefits and shortcomings of every policy when you check online. Post-buy tasks such as paying premiums or renewing policies are also now available at the click of a button.

  5. Pocket-Friendly
  6. Many insurance companies offer a variety of services and coverage on a low premium. You can view them online and choose the one which fits your needs. Comparing health insurance plans online also reduces the cost of purchasing a plan since it eliminates the middle-men. You are not required to pay any sort of commission.

  7. Availability of Provider/Plan Reviews
  8. Not only can you compare health insurance plans, you can also read reviews about the Insurance company or the plan online. If you have shortlisted a few policies, read their reviews before making a final decision. These reviews enable you to make an informed decision.

Factors to Consider before Buying Health Insurance Policy

If you don’t have the experience of buying a health insurance policy, all the information available can be a little confusing. There are several factors that you need to consider before buying a health insurance plan. Such as, the premium, if you want an individual plan or a family floater plan, sum assured, etc. You need to know how to choose a robust plan which covers all your requirements. Here are a few factors which you should keep in mind:

  1. Caps and Sub-limits
  2. All insurance companies want to reduce their liability. To do so, they apply caps and sub-limits on certain services. For example, a room rent sub-limit can be of Rs 5000 per day or ambulance fee can be up to Rs 2000. Any expenses incurred above this limit on either of the services will be borne by you.

  3. Claim settlement Record
  4. Always choose a company with a good claim settlement record. This ensures that your future claims will not be wrongfully rejected. Always look for the insurance company’s claim settlement ratio before making a choice. This saves you from unnecessary harassment in times of need.

  5. Scope of Coverage
  6. Always look for a health insurance policy that offers you the maximum coverage. Don’t simply compare premiums with sum assured. A low premium plan might not cover all your needs. So, when comparing health insurance plans, always shortlist the ones offering you more services with higher sub-limits.

  7. Renewability
  8. When you buy medical insurance online, always check their renewability. The usual plans have a yearly contract which gets renewed when you pay the premium. Many Insurance companies offer a discount on premiums if you pay for two- or three-years’ premium in advance. If there is a break in renewal, you might lose all the accumulated benefit.

  9. Cashless Hospital Network
  10. Every medical Insurance company has a list of network hospitals that offer you cashless claims. Check if the hospitals around you or in your city feature on such list of the insurance company you are planning to choose. This helps you to get treatment without worrying about the payments and reimbursement claims.

  11. Internal Claim Settlement Team
  12. Ensure that the insurance company offering you a medical insurance plan has a claim settlement team. This helps your claim to move swiftly in the process and eliminates any room for mistakes. Most companies hire TPAs to do this work, but that might slow down the process. An internal claims settlement team expedites the claims process.

  13. Health Insurance Portability
  14. Choose a health insurance policy and an insurance company which offers the health insurance portability feature. This means that you can switch from one company to another without losing the benefits accumulated. This feature eliminates the waiting period and is offered by most companies for free.

  15. Top up Health Insurance Plans
  16. A top-up health insurance policy reduces the cost of your deductibles. A deductible is the cost that you bear willingly. For example, your hospital bill is of 5 lacs and you need to pay a deductible of 2 lac. You can use a top-up health insurance plan to further reduce your deductible. This method is proven to be cost-effective for policy holders.

Health Insurance Eligibility Criteria

A health insurance policy is extremely beneficial for individuals as well as families. These policies secure you against high medical bills across a network of hospitals. There are two basic types of insurance policies

  • Individual Health Insurance Plan
  • Family Floater Health Medical Insurance Plan

The essential eligibility criteria for both the plans are:

  • Adults should be between 18 to 65 years of age (There are separate plans for 70 and above)
  • Children should be between 90 days to 18 years of age
  • The policy can be renewed for your entire lifespan and is subject to medical clearance.

Health Insurance Claim Procedures

You can file for a claim if the illness, injury or accident is covered by your health insurance policy. Here are the two ways to make claims:

  • Reimbursement claim: If you incur any medical expenses, you can pay the amount to the hospital or the clinic. Once done, you can submit all the documents including medical bills and prescriptions to the insurance company. The company will review your claim and release the reimbursement amount if approved.
  • Cashless Claim: You can avail this facility if you get a treatment in a network hospital of the insurance company. Network hospitals have an association with the insurance company where they settle your bills amongst themselves.

Documents Required for Health Insurance Claim Reimbursement

If you make a reimbursement health insurance claim for your medical expenses, you need to submit the following documents:

  • Discharge card issued by the hospital
  • Signed/Stamped In-patient hospitalization bills
  • Prescriptions and medical store bills
  • Duly filled and signed claim form
  • Investigation report
  • Doctor’s consultation bills
  • Copies of Insurance policies and copy of an ID proof
  • Doctor prescribed consumables and disposables
  • Any other document asked by the TPA/Insurance company
A health insurance or a mediclaim policy is an insurance contract which covers the medical expensesincurred by an individual in case of hospitalisation. The policy covers the financial implications incurred at the time of medical contingencies and pays either the actual medical expensesincurred or a lump sum benefit depending on the plan’s coverage features
A Health Insurance policy is not a financial priority anymore, it has become a necessity in today’s age due to the continuous rise in healthcare risks and prices inflation. Any unplanned hospitalisation would lead to numerous expenses such as medicinal treatment or surgery costs, diagnostics test charges, pharmacy, doctor’s visits, room rents,ambulance transportation charges etc. These costs can easily cripple a family’s financial health in a flash.But with the right health insurance cover, you can protect yourself and your family from these medical expenses without causing much dent in your savings. Do not let the massive costs oftreatment become a hindrance inseeking the right care for a loved one. Get a health insurance for your family now.
Following are some of the key coverages and benefits you get when you buy a health insurance policy:

1. Cost of hospitalization:All the hospitalization expenses incurred due to illness oraccident injuries

2. Pre and posthospitalization expenses: Expenses incurred during a certain number of days before and after hospitalization as long as they are related to the illness/injury

3. Day care procedures: Surgeries and treatments that do not require 24- hour hospitalisation,due to technological advancements, are also covered

4. Ambulance cover: Transportation of the patient to hospital

5. Income Tax benefit: Save upto Rs 75,000 on tax (25,000 for self and family & additional 50,000 if senior citizen parents included) under section 80(D) of Income Tax Act

6. Organ donor expense: Medical expenses of organ donor during an organ transplant.

7. No Claim Bonus: Bonus given to the insured during renewal in case of no claims are filed in the previous policy year. The bonus can be in the form of an increase in the sum insured.

8. Cashless treatment: Can be availed when hospitalised in one of the network hospitals of insurance company

9. Sum insured recharge: Sum insured gets replenished on exhaustion of entire health cover

10. Alternative treatments (AYUSH Benefit): Alternate therapies like Ayurveda, Unaani, Siddha and Homeopathyget covered

11. Free health check-ups: Free health check-up facility given to the insured members upto pre -defined limit in policy.

12. Domiciliary hospitalization (Health homecare): Treatments availed at home on doctor’s recommendation

13. Convalescence Benefit: Lumpsum amount given to the insured person as a recovery benefit in case of a long duration of hospitalisation

It is important to realize that inclusions will vary from one provider to the next and from plan to plan.
Some of the exclusions under a health insurance policy are as follows:

1. Expenses due to pre-existing disease incurred during waiting period

2. Expenses occurred during the waiting period for the disease/ailments having mandatory waiting period

3. Cosmetic and Dental surgery expenses

4. Sexually transmitted diseases

5. Self-inflicted injuriesor adventure sports

6. Injuries caused due to war

Detailed list of exclusions can be found in the policy wordings of the respective health insurance product.
There are two types of health insurance plans available today. They are as follows:

1. Individual health insurance plan: This type of plan suits for individuals who chose to buy a policy for covering one individual.

2. Family health insurance plan: This type of plan provides coverage for the entire family which can include spouse, parents and children. The sum insured can be shared among all the family members or each family member can have an individual sum insured.

Choosing the right health insurance plan is the most important step while purchasing a policy. Following are some of the factors that should be kept in mind while looking for a health insurance:

1. Sum insured: Determining the right coverage is the first step when opting to buy a health insurance. Individuals residing in metro cities may go for higher sum insured. If looking for family health insurance plans, sum insured above 10 lacs can be considered so as to cover multiple claims in a year from different members without exhaustion

2. Sub-limits: Policies that do not have sub-limits on room rents i.e. no higher limit on the rent charges are always recommended.

3. Co-payment: Policies that have co-payment option have lesser annual premiums because the insured individual pays a fraction of the hospital expenses and the rest is borne by the insurance company. Though the premiums are discounted but the co-payment amount could be a significant amount in case of high value claims.

4. Waiting period: Some insurers have shorter waiting periods for pre-existing ailments. Specific covers like maternity benefits are covered after 3 years under policies of few insurance companies. The shorter the waiting period, the better for the insured person.

5. Cashless hospital network: Insurance companies have tie-ups with hospitals across the country. One should always look for the insurer who has more number of hospitals under their cashless service.

There are numerous health insurance plans available in the market. Each plan has its own inclusions and exclusions list, benefits and features, cashless hospital network, sub limits, waiting periods for certain illnesses etc. Hence it becomes imperative to compare these plans first and then choose the one which suits your requirements the most. PayBima helps you choose the right plan by showing a detailed comparison of all the health insurance policies available based on the data provided and hence assists you in making an informed choice.
You can compare and buy health insurance online in a few easy steps. Visit PayBima website and select health insurance. Then you will be asked to enter few basic details like age, sum insured amount, area of residence, number of members to be insured etc. Based on the details submitted, quotes from various health insurance companies will be displayed. You can select multiple plans and compare the benefits and coverages provided along with the premium. After you have decided on a particular policy that fulfils your requirements, you can select the plan and proceed to the proposal form stage. You have to provide accurate and correct information in the proposal form. After the form is filled, you can review all thedetails shared till now in the summary page. After reviewing, you can proceed to make the payment online through various modes like credit/debit cards, internet banking, wallets etc. Post successful payment, health insurance policy will be generated and emailed to you instantly.
Pre-existing disease is a disease or a condition existing in a person before he purchases the policy. The individual buying a health insurance policy should declare all such known diseases in the proposal form. The insurance company may verify medical test reports and agree to cover such pre-existing diseases after a certain waiting period.
Yes, but after a certain waiting period as specified in the policy wordings. The waiting period can range from 2 to 4 years depending on the underwriting policy of the insurer. Also, the insured member should declare his medical history accurately in order to claim any expense arising out of the treatment for such diseases, else the claim might get rejected.
  • There is a 30-day waiting period that follows the inception of the policy when you buy health insurance online. Any disease, injury or sickness that arises in these 30 days are not covered by the policy.
  • Any pre-existing diseases, which are conditions existing in a person before he purchases the policy, are not included in the policy cover.
  • Other diseases that health insurance plansdo not cover are HIV or AIDS, pregnancy or childbirth complications, aesthetic, cosmetic or obesity treatments, alcohol or substance intoxication, treatment for war, riots, strike, nuclear weapon injuries

You can compare various health insurance plans to know which covers your requirements.

No, there is a waiting period of 30 days from the day of inception of the policy. Any treatment of illness undergone during this period is not covered in the policy except for injuries from accidents.
Before an individual is hospitalized, there are preliminary expenses which are incurred on doctor’s consultations for diagnosing the illness, medical tests for finding out the reason for illness, medicines, etc. These expenses are called pre-hospitalisation expenses. Similarly there might be treatment costs incurred after the individual is discharged from the hospital. These are called post hospitalisation expense. Both pre and post hospitalisation charges upto a certain number of days are covered in most health insurance plans, provided the hospitalisation expenses claim is covered by the insurer.
If the sum insured is exhausted in the treatment of a member, no further claims would be paid by the health insurance policy in that policy year. If another claim occurs within the same policy year, it would be denied. But from the next policy year, the full sum insured would be available for subsequent claims. In case Sum Insured Recharge benefit is opted while purchasing the policy, then the sum insured will get replenished upon exhaustion in the same policy year however it can only be availed for a different treatment.
A health insurance portability is a provision given by IRDA that allows the insured to switch their health insurance policy to a different insurer while retaining all the accumulated benefits from the old insurer like waiting period, no claim bonus, etc. In order to avail this facility, the policyholder will have to intimate the new insurer where he/she wishes to port at least 45 days prior to the policy renewal date.
The premium in a health insurance policy is the amount of money which you pay to the insurance company to buy the health coverage. The premium depends on a number of factors that the proposer declare at the time of buying insurance.
The premium for health insurance is calculated based on a number of factors. Some of them are listed below:

1. Age: One of the most important factor that decides your health insurance premium. The older you get, the more you have to pay for insurance as the probability of getting illis high.

2. Number of members to be covered: Depending on the number of members you want to include in your policy, the premium is calculated. For a family of four including children, the premium will be high whereas for insuring an individual, premium would be low.

3. Pre-existing ailments: Premium will be high for individuals who have a history of illness e.g. diabetes, hypertension etc.

4. Location of residence: Depending on the place you live, the premiums vary. Cost of treatments in metro and tier-1 cities are high, hence premium is high for individuals residing in such locations. Whereas tier 2 and tier 3 cities will have lesser premium for the same individual.

5. BMI: Your body mass index also plays a role in deciding your health insurance premium. Individuals with high BMI will have to pay more for insurance cover as they are assumed to be more prone to serious ailments. If you have a BMI in healthy range, the premium would be lesser.

You can pay premium online through one of the various modes of payment offered by insurance companies. Once you have shortlisted a health insurance plan and filled the proposal form, you will be redirected to the payment page of the insurance company. You can then choose to pay through credit or debit cards, net banking, wallets or UPI. Some insurance companies also provide EMI facility on select credit cards.
Premium up to Rs.75,000(Rs. 25,000 for self and family & additional Rs. 50,000 if senior citizen parents included) can be claimed for income tax deduction under Section 80(D) of the Income Tax Act.
Yes, you would be required to pay premium again. However you can avail the benefit of No Claim Bonus if it is being offered by your insurance company. Through this benefit, you sum insured amount may get enhanced further by a fixed amount for every claim free year.
Yes you can cancel your health insurance and get your premiums refunded. Every health insurance policy has a freelook up period of certain number of days. If you are not satisfied by terms of the health insurance policy purchased, you may apply for cancellation. In such cases the insurance company will refund your premium amount after some deductions made for processing costs incurred by them. In case of cancellation after freelook period a pro-rated amount will be deducted.
A claim is defined as the demand made on the insurance company to compensate for the financial losses suffered by the policyholder when the insured event occurs. A health insurance claim occurs when the insured suffers a medical contingency and demands compensation formedical costs which are covered under the policy.
Cashless claim settlement is a processwhere the insurance company takes care of the medical bills itself without you having to pay for the medical cost yourself. A cashless claim is allowed only when you get admitted to a hospital which is tied-up with the insurance company. In such cases, the insurance company settles your medical bills directly with the hospital and you don’t have to bear the financial burden of your medical emergency.
In a cashless health insurance policy your medical costs are handled directly by the insurance company. They are paid by the insurance company to the hospital and you can avail treatments without having to bear the financial burden. As such, a cashless health insurance policy provides you financial relief in medical emergencies. Moreover, since your medical bills are met by the insurance company, you don’t have to draw on your savings to pay for hospitalisation. You can also avail quality healthcare when you know that the subsequent costs would be borne by the insurance company and not you.
Claim assistance is the help offered at the time of a health insurance claim. Insurance companies have a dedicated claim assistance team to help their policyholders with their health insurance claims. They guide the policyholders with the required steps to be followed in order to get their claims settled. PayBima also provides claim assistance services to its customers. In case of a claim under your health insurance policy you can contact PayBima at our toll-free number 1800 267 67 6 or drop us an email at paybima.care@mahindra.com. Our claim experts will help you get your health insurance claims settled at the earliest.

There are two procedures for claims:

  1. Planned: If a member of the family covered knows of a forthcoming hospitalization, they need to call on the helpline number mentioned on the Health Identity Card. The next step is to upload the required documents such as doctor’s certificates, medical bills, etc. The service provider of the online health insurance plan or TPA should approve your claim.
  2. Urgent: If there is a sudden sickness or injury, the patient needs to be immediately admitted to the hospital where they avail treatment. Friends or family then contact the service provider or TPA to make a claim.

Cashless claim facility can only be availed at network hospitals in the medical insurance plan. For non-network hospitals, claims can be availed in form of reimbursement upon submission of relevant bills.

The essential documents required for filing a Reimbursement Claim are:

  • A filled-out claim form
  • Original bills and receipts of the hospital
  • Discharge certificate from the hospital
  • Pharmacy bills with prescriptions
  • Investigation reports from the pathological laboratories including a note from the surgeon prescribing the tests
  • Surgeon’s bills along with a report on the nature of the treatment
No, you are not allowed to claim twice for a single payment even there are two separate service providers offering you medical policy.
Cashless hospitalization allows a member of the medical health insurance policy to get admitted to a hospital and undergo their treatment without worrying about the payments. The hospital will have a procedure to settle the payment directly with the medical insurance policyprovider. However, this facility is only available in network-hospitals. For non-network hospitals, standard procedures for insurance claims will apply.
The members of the policy can pay for the expenses incurred in the treatment themselves and then later claim for the reimbursement of those expenses from the policy provider. This is called a Reimbursement Claim.
A Pre-authorization is issued by the insurance company or the service provider of the health insurance policy. It states the value of medical treatment and cover provided by the company that a member can claim under the health insurance policy. A member can obtain a pre-authorization by filling out a Pre-authorization form for the company.
  • Network Hospitals: A hospital that is in association with the insurance company is known as the network hospital. This is done primarily to enable a Cashless Claim process. A Cashless Claim process is where the hospital settles the payment for the treatment of a member directly with the insurance company. The network hospitals list can vary from one company to another. This can be viewed on the website of the service provider or TPA when buying medical insurance online.
  • Non-Network Hospitals: These are the hospitals that do not have an association with the insurance company, hence, they do not offer Cashless Claims. If a member undergoes treatment in these hospitals, they may either file for a reimbursement claim or contact the service provider in case of an emergency.
A network hospital offers you the Cashless Claim feature while a non-network hospital does not. But a member can choose either of them for treatment.A member can file for a Reimbursement claim in such a case. However, the non-network hospital should be compliant with hospital facility definition and geographical limits as defined in policy documents. This information is available when comparing health insurance plans.