How to claim health insurance :

Making a claim on your health insurance is easy
if you have the paperwork in place. Here's how to go about it.

Reimbursement Claims :

Intimate the TPA or insurer before hospitalisation. In case of an emergency, inform within 24 hours of admission.

Retain all prescriptions, bills and payment receipts of medicines and ancillary expenses.

Make sure the bills and receipts have the correct name and dates.

Take the discharge card while leaving the hospital.

Keep photocopies of all prescriptions, bills and the discharge card.

If treatment is to be continued at home, make sure this is prescribed by the doctor at the time of discharge.

Fill the claims form and submit along with original bills, discharge card and other documents.

While submitting the claims form physically, take a stamped receipt. If sending by post, use courier, speed post or registered post.

Cashless Claims: Emergency Hospitalisation

Show the identity card issued by the TPA or insurer at the hospital at the time of admission.

Inform the TPA or insurer within 24 hours of admission. You can call or send an e-mail. Make sure you get a claim intimation number.

Fill the authorisation form and submit it to the TPA or insurer. They will then send the authorisation letter to the hospital.

Some hospitals may ask for a 15-20% deposit depending on the TPA. This is refunded after deducting expenses not covered by the policy.

At the time of discharge, get photocopies of prescriptions, discharge card, bills and other documents.

Cashless Claims: Planned Hospitalisation

If hospitalisation is planned, intimate the TPA or insurer after fixing the schedule with the doctor. Do this 3-4 days before being hospitalised.

Note down your claim intimation number after you have informed the TPA or insurer about the hospitalisation.

Fill pre-authorisation form with details of the treatment needed and estimated cost. This form is provided with the policy document. It can also be downloaded.

After examining the details, the TPA or insurer will issue an authorisation letter for cashless treatment.

At the time of discharge, get photocopies of prescriptions, discharge card, bills and other documents. The hospital will give the originals to the TPA or insurer directly.

Pre- & Post-Hospitalisation Claims

After discharge, pre- and post-hospitalisation claims have to be filed separately.

If no further treatment is required after hospitalisation, these claims can be submitted along with the hospitalisation claim.

Insurance companies reimburse expenses incurred 30 days prior to and 60 days after the hospitalisation.

Domiciliary expenses include doctors' fee, tests, nursing and medicines for up to 60 days after discharge.

Fill up the claim form and submit it along with the original bills and receipts to the TPA or the insurance company.

Retain photocopies of documents for your own reference.

Documents needed for claim submission

A copy of your health insurance policy.

TPA card.

The pre-authorisation claim form provided by the TPA or insurer.

Claim form along with the patient's and the doctor's signatures.

Discharge card.

Letter from the doctor who recommended hospitalisation.

All prescriptions for medicines and line of treatment.

Medical bills.

Hospital bills with invoice number, break-up of treatment expenses and proof of payment.

Medical reports, X-rays, blood test reports (signed by the doctor).

Hospital registration certificate.

Smart idea: Get the documents scanned and store them in digital format for ease of access.

Tips to avoid claim rejection

Check whether the hospital is on the insurance company's network.

In case you have more than one health cover, mention that in the claim form.

All bills (medicines, diagnostics and surgeries) must be accompanied by prescriptions.

In case of an emergency hospitalisation, make sure the doctor specifically prescribes admission.

Unless your policy covers daycare procedures, hospitalisation is covered only if the patient is admitted for at least 24 hours.
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Source : ET

Key Features and Benefits of a Health Insurance Policy :

What is Health Insurance?

Health Insurance, also known as medical insurance is a form of insurance which covers the expenses incurred on medical treatment and hospitalisation. It covers the individual and family against any financial constraints arising from medical emergencies. In case of sudden hospitalisation, illness or accident, health insurance takes care of the expenses on medicines, oxygen, ambulance, blood, hospital room, various medical tests and almost all other costs involved. Thus, by insuring one’s health, he ensures that if he pays an amount of health insurance premium every year depending on the person’s age, then till a certain limit of medical expenses, he/ she would be covered by the insurance company and will not have to spend it from his own pocket.
Basically, since medical expenses are increasing every year, it becomes difficult for someone to suddenly pay about Rs. 2,00,000 to Rs. 3,00,000 towards medical emergencies. Since medical emergencies cannot be postponed or neglected, this unforeseen expense becomes inevitable if health insurance has not been availed. Thus by paying a nominal amount of premium of say Rs. 1,200 per annum, a 35 year old man can get covered till Rs. 1,00,000 of medical expenses per annum. Thus, a sudden expense of Rs. 1,00,000 may seem very high for the individual; however a nominal amount of Rs. 1,200 per annum, i.e. Rs. 100 per month may seem to be a very reasonable cost. This amount however, has to be paid every year; otherwise the cover ceases to exist.

Key Features and Benefits of a Health Insurance Policy

Over and above the basic benefit of health insurance (also called mediclaim) i.e. covering the unforeseen medical expenses, there are few other features and benefits in most of the products offered in the market. Some of them are listed below:

Family Floater Policies: Most health insurance plans give the flexibility of covering up to 4 members of the family under the same plan with a slightly higher premium than an individual health insurance policy. It gives the flexibility of choosing say 4 or 5 lakhs of cover for the entire family. If one member in the family is hospitalized and uses about Rs. 2 lakhs for his treatment, then the rest 3 lakhs can be availed by others. It is very unlikely that more than 1 or 2 members would require hospitalisation in the same year. Hence the family floater serves the purpose whoever in the family falls ill.

Hospitalisation Cash Benefits: This benefit entitles the customer to cash benefits for every completed day of hospitalisation, which helps him to take care of the increased financial burden incurred at the time of hospitalisation, such as loss of earnings away from work and other expenses.

Cashless facility: There is a network of hospitals tied up with each insurance company which accepts the insured’s medical identity card (issued by the insurance company) for providing cashless facility to the insured. Hence either part or entire expenses are covered by the policy and the individual doesn’t need to spend from his pocket.

Pre-hospitalisation and Post-hospitalisation benefits Some mediclaim policies provide for up to 60 to 90 days of pre-hospitalisation and post-hospitalisation benefits, i.e. the cost of medical tests, medicines, scans, etc. This is usually provided under maternity benefits and treatments which do not require hospitalisation.

Ambulance Charges In most cases the ambulance charges are taken up by the policy and the policy holder usually doesn’t have to bear the burden of the same.

Health check up Some health insurance policies have a facility of free health check-up for the well being of the individual if there is no claim made for certain number of years.

Cover for Pre-existing Diseases Some health insurance policies have a facility of covering pre-existing diseases after 3 or 4 years of continuously renewing the policy, i.e. if someone has diabetes, then after completion of 3 or 4 years of continuous renewal with the same insurer (depending on the plan offered and his age), any hospitalisation due to diabetes will also be covered.

No-Claim Bonus Some health insurance policies provide a no-claim bonus. If there has been no claim in the previous year, i.e. if the person covered has not availed any hospitalisation benefit, then a bonus is declared; either by reducing the premium or by increasing the sum assured by a certain percentage of the existing premium.

Tax Benefits of taking a Health Insurance Policy Under Section 80D of the Income Tax Act, income tax benefit is provided to the customer for the premium amount till a maximum of Rs. 15,000 for regular and Rs. 20,000 for senior citizen respectively.
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Source : myinsuranceclub

Understanding health insurance :

The term health insurance is a type of insurance which grants you cover against ever rising medical care costs or expenses, beginning from diseases to grave accidental injuries. Health insurance is a critical monetary product that is a must for every individual irrespective of his or her age, sex or religious specification. It aids you in obtaining the first class treatment without muddling your head much over the financial costs involved.

Benefits of health insurance

Our lives cannot be predicted; hence health insurance helps to make it secure and protected from handling mammoth financial hammering. It not only helps you in dealing with severe emergencies effectively, but it also beneficial in dealing with disability and custodial needs.

Health insurance as a concept is new in India; however it is catching up speedily. Its responsiveness has been massive in the last couple of years. This is due to the response to the series of qualms, worries and suspicions people have observed in current times such as terror attacks and so on.

In brief, a health insurance is a contract signed between an individual and an insurance company.

One must note in advance, the amount and type of health care expenses that will be covered under a health plan. Based on the terms and condition of a health insurance policy, it covers major and at times all part of medical expenses which includes medications, nursing expenses and doctor's consultation charges. Treatment can be obtained from any authorized hospital or medical organization across India.

Health insurance in India can be purchased in two available formats: individual and group plans. In an individual policy, he or she is himself or herself the owner of the policy, whereas in group policy, the guarantor or the sponsor purchases the policy and the beneficiaries covered under it are labeled as its members. 

The need of health or medical insurance

Looking at the sky mounting expenses now a day's, health insurance is a must. A simple appointment with your doctor is capable of shelling big bucks from your pocket, it is then that health insurance comes in handy.

Convoluted medical treatment expenses combined along with modern sedentary lifestyle patterns could binge into your savings which for all obvious reasons is meant for your future. For peaceful, secure and healthy lives of you and your family, it is always advisable to buy a well suited health insurance plan. Right from the food we consume to the air we inhale to our daily stressful activities, having a right health insurance plan is imperative.

At some time or the other, we all have met people who wonder that if they buy a Health insurance policy, it is certain for them to get ill. However, let us face the fact. We all need a health insurance plan in order to cover a small appendix operation cost which is more than Rs. 25,000, when compared to the year 2000, when it was close to just about Rs. 10,000. The cost of any sort of treatment is likely to shoot, without giving a prior notice to general public in advance.

Benefits of a health insurance plan

The benefits of a health insurance policy are multi fold. It not only aids you in getting a suitable treatment keeping your pocket under watch, but it also covers the signs of financial instabilities in the event of long, delayed illnesses.

Benefits of a health insurance policy depend on two factors: the coverage it provides and the policy you choose. 

Let's explore some of the basic advantages that major health policies provide.

1.    It aids in rendering a safe future by paying a fraction as your medical care costs, which is called as the premium. Depending upon the kind of policy you have opted for, it at times can cover the whole chunk of your medical costs.
2.    It helps in dealing with huge amount of monetary losses and danger of financial breakdown in the cases of costly medications and post-illness care.
3.    It unquestionably gives you a sense of security.
4.    Depending upon the type of widely available policy that you opt for, it aids in covering pre-hospitalization to post-hospitalization bills, for the period of 30 days and 60 days respectively.
5.    It helps in providing a financial security to the family members.
6.    It also takes care of custodial bills and disability.
7.    One can also benefit from the tax benefits on the premium paid under section 80D of the Income Tax Act.
8.    Depending upon the type of policy you claim for, one can also avail discounts on insurance premium which is available on family packages.
9.    The premiums are considerably available at much cheaper costs for younger people.
10.    Domiciliary hospitalization can also be covered.

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Source : prajnacapital

Health Insurance after retirement :

It's never late to get a cover for your non-income years

Most health insurance plans expired at the age of 60 and no insurer was ready to issue a fresh policy to a retiree. Not anymore. Insurance companies have devised innovative plans for senior citizens and have extended the age limit for renewing health policies to 100 years. So whether you are young or old, there is no reason why you can't shield yourself against scorching hospital bills in your non-income years. Here are the different options in the market along with an analysis of their pros and cons.

Special Plans For Late Starters
According to a survey by Celent, a financial research and consultancy firm, 52% of those who have a health cover get it from their employers. Obviously, the policies lapse with their jobs. If you are one of those who didn't supplement that cover with a separate plan, a huge chunk of your nest egg could be exhausted by a couple of expensive medical treatments. The solution — pick up one of the special plans with a minimum entry age of 60 years. Senior citizens are at a higher risk of health problems. So we thought it fit to cover them under a separate health plan which would address their requirements. Which has designed the Red Carpet plan exclusively for people over 60. Bajaj Allianz, New India Assurance, United India, Oriental Insurance and National Insurance also offer such plans.

   To sign up for these policies, you have to first undergo a battery of tests including echocardiogram, ultrasonography and cholesterol check-ups. Insurers reimburse only a part of this expense, that too, only if your application is accepted. These plans cover hospitalisation charges for something as minor as fever to critical illnesses. However, carelessness has its cost. The later you sign up, the higher is the premium. For instance, at the age of 35, a 3-lakh cover costs only 4,430 a year. But if you are 60 years old, the annual premium is nearly 14,000. This is why Bedi, who opted for one of these plans, pays close to a hefty 31,000 as annual premium. However, she is unfazed by the high premium — it is a small price for her peace of mind. There are other things that should concern her though. For one, the limited cover of these plans. Most do not offer more than 3 lakh annual cover. This is hardly enough in an era when a knee fracture can put you back by 1.5 lakh and a heart surgery skims off about 3 lakh from your savings. Some plans, like Bajaj Allianz's Silver Health, offer the option of a 5-lakh cover, but they come with various riders. For instance, Silver Health does not allow claims exceeding 15 lakh in five years. As older people face multiple health problems, their medical expenses are high. Therefore, they need more, not less cover. This discrimination between young and old people is unfair. There is a waiting period of two years before these policies cover common ailments of old age such as cataract, hernia, piles, gall bladder stone removal, sinustis, gout and rheumatism. Joint replacement surgery is covered only after four years. You must read the fine print carefully to detect other exclusive riders. For instance, the Varistha Mediclaim policy by National Insurance has a waiting period of 90 days for critical illnesses as well.

   In the case of pre-existing diseases, insurers conduct extensive tests to ensure that the condition is controlled by treatment. Only when they are convinced do they provide cover, which becomes effective two years after buying the policy. This seems to be unreasonable, but compared to other plans where pre-existing diseases are not covered for the first four years, it is not a bad deal. But the biggest sore point is that the special plans come with a high co-payment limit. This means you will have to shell out up to 30% of the hospitalization charges (Star Health's Red Carpet Policy) even if they are within the limit of your cover. Let's assume that you have racked up a bill of 1 lakh, which is half of your 2-lakh policy. Don't think you won't pay a penny from your pocket; you may have to cough up much as 30,000 if the insurer's liability is limited to 70% of the total cost.

   Insurance firms claim this provision ensures that patients spend wisely. This clause imparts a sense of ownership. Every insured person feels the need to at least check the hospital bills. You may not agree, especially as these plans seem to be loaded with other qualifiers. However, you look at the larger benefits. In old age, medical expenses are a certainty. Therefore, such plans are a boon for people who did not insure themselves earlier. Just make sure you compare all the options available and choose the plan that requires minimum medical tests and offers the highest cover.

Options For The Early Birds
So retirement is still some years away but you want to be prepared for the runaway medical costs after you hang your boots. By a conservative estimate of 10% annual inflation, a 2 lakh surgery will cost about 8.35 lakh after 15 years. Clearly, it is never too early to start preparing for these expenses. The good news is that some insurers have extended the age limit of renewing a policy to 80 years. Therefore, you can choose from plans such as Bajaj Allianz's Health Guard (80 yrs), National Insurance's Mediclaim (80 yrs) and ICICI Lombard's Health Advantage (70 yrs) that take care of your needs well into the twilight years. You can also opt for top-up plans after retirement to boost the cover of your base plan. Max Bupa has raised the bar for the industry by allowing people to enter its Heartbeat Plans at any age. "As the majority of health care costs are incurred during the later years of one's life, we have not put any cap on the entry age of this plan.

The Best Combo
If only these plans were active even after retirement. However, you can still enjoy their benefits through your child's group insurance policy. To include dependent parents within the health plan, companies charge a small premium from their employees. But the benefits far outweigh the extra cost. To begin with, there is no restriction of age or cover. Neither are medical tests mandatory. Also unlike any other plan, pre-existing diseases are covered from day one. It's a win-win situation for everybody. The only catch is that these plans are flexible. Most of what you get depends on what the employer manages to negotiate with the insurer. It is possible that the employee is covered for a larger amount than his parent.

   Another way of covering a dependent parent's medical expenses is through a family floater policy. Unfortunately, these plans do not offer the same benefits as group plans. For instance, there is a cap on the entry age of the family members and pre-existing diseases may not be covered. But remember, in health insurance, something is always better than nothing at all.

Health Check

High Cost Of Medical Tests

1. Insurance firms reimburse only a part of the expense of tests, which are mandatory for getting a policy
2. Most health plans for senior citizens offer cover up to Rs 3/year
3. This is inadequate as there could be multiple medical problems in old age

Limited Cover
Cover for pre-existing diseases starts two years after buying the policy. If chances of claims are high, the cover may be denied

Exclusion
Cover for common ailments like cataract, hernia, piles, gall bladder stone removal, sinustis, gout and rheumatism starts two years after buying the policy

Co-Payment
Insurers do not pay the entire amount of the claim. The patient has to shell out up to 30% of the total medical bill

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Source : prajnacapital

Create healthcare corpus :

With the Union Budget introducing service tax on hospitals and health check-ups, your medical bills are likely to get higher

More and more people, now, realise the need for medical insurance. They have either experienced sudden, unmanageable medical expenses or have known someone in a similar situation. There are still many who rely on employer provided cover or family floater. 

With soaring medical costs, an individual health policy with adequate cover is necessary.

Cost

A recent survey by global consultancy firm, Towers Watson, has indicated a steady rise of 15-25 per cent in health cover premiums. Unlike life insurance, there is no ways to assess the need for medical cover.
Looking at the high medical costs, we suggest a minimum of `5lakh cover per adult and `3lakh per child.
Most companies these days cover upto `10 lakh. The differential between a `5lakh cover and a `10 lakh one is not much.
For instance, 42-year old Nandan, his wife, Neelam (38) and two kids, aged nine and seven years, are fit. A `5lakh cover for the adults and `3lakh for each kid would see a premium of `22,500 a year.
If Nandan covers his wife and himself for `10 lakh each and his kids for `5lakh each, the premium will be `31,000 per annum. They need to pay `8,500 more, to double the cover. A good option, as medical emergency can arise anytime. 

Budget Spoiler 

This Budget, the Finance Minister has brought medical treatment under the service tax net. All nongovernment hospitals with 25 or more beds, central air conditioning, partially or fully will be charged service tax. And this is most likely to get reflected in patients' bill. There is, however, an abatement of 50 per cent, which means 5.15 per cent will be levied instead of 10.30 per cent. Also, all diagnostic tests will have to pay 5.15 per cent service tax. Obviously, this is a negative step. This may push up healthcare related expenses for all of us.
Increased costs due to service tax, will automatically reduces the insurance cover to the extent of the tax. 

Portability 

This move by the Insurance regulatory and Development Authority (IRDA), allows a consumer to move from one health insurer to another and carry over benefits like waiting periods for pre-existing diseases. This will ensure policyholders cannot be held captive and better quality services. This will be effective from July 1, 2011. 

Policy Constraints 

Employer-provided health cover is good for its coverage of pre-existing illnesses and child birth, related expenses immediately, cover for parents (on a co-payment basis, in many cases), and importantly, at negligible cost until you want extra cover. For that you need to pay a residual premium.
The limitation here is, it is valid only as long as the job. These are rarely portable. Not all companies may provide health cover. The cover also needs to be sufficient.
Many opt for family floater plans, as they are cheaper. There is no limit to which the sum assured can be used by one family member. The problem arises if more than one person fall ill together. That time, if one person has higher bills, the other member suffers due to lower cover under the same policy. 
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Source : prajnacapital

Top 10 Health insurance queries :

Q.1. How is the agent helpful in settling claims in future?

Ans. Yes your agent will be helpful but he is getting 100% of his income from the insurance company and he may be getting .001 % of his income from you. If he has to make a choice, he will favour Insurance Company. You are the best person to decide whether directly from the company or through an agent. Theoretically he is supposed to help you in claim settlement but time will tell when the claim is to be lodged. Be positive and buy it through agent but better buy through an Insurance Brokerage Firm as it offers wider choice.

Q.2. What are the minimum and maximum policy durations?

Ans. Minimum is 1 year. Some companies offer 2 years duration also.

Q.3. Can I buy more that one Health Insurance policy?

Ans. Yes, you can buy more than one insurance policy but the claim should not be duplicated to two insurance companies. Under normal circumstances the claim amount will be shared by both insurance companies in the ratio of the sum insured. Let us say Company 'A' insured you for Rs. 2 lakhs and Company 'B' insured you for Rs. 3 lakhs, then the claim will be shared in the ratio of 2:3. In case you have gone in for a normal policy of Rs. 2 lakhs from Company A and Top-Up policy of Rs 3 lakhs from United, then in that case first Rs. 2 lakhs will paid by Company A and the claim above Rs. 2 lakhs will be paid by United. Top up Policy costs less than normal policy of Insurance Company. For right advice it is always better to consult an Insurance Brokerage Firm.

Q.4. Can I buy health insurance policy even if I am not an Indian National but am living in India?

Ans. Yes, if you are a student studying in India or you are working on a valid Visa then you can get the policy. But if you are a tourist coming to India for a short duration say 3 weeks then it will not be worthwhile to buy health insurance as 30 days cooling off period will take away the benefits, you are looking for.

Those who are coming for Medical Tourism can not buy the policy and avail the benefit i.e. claim.

Q.5. Who will receive the claim amount under health insurance if the policyholder dies during treatment?

Ans. Nominee will receive the amount if the policyholder dies during treatment.

Q.6. Can I seek treatment at home and be reimbursed for it under health insurance?

Ans. It can be possible in exceptional cases only when there is an epidemic and no beds are available in hospitals. This is called domiciliary treatment in insurance language/terminology.

Q.7. I might be laid off soon. Should I see my doctor before I lose my insurance?

Ans. No purpose will be served by seeing your doctor. You should consult an insurance brokerage firm and buy a health insurance policy which should be in place 30 days before your last day in your company. This protects your interests as on the day you leave the present employer –on the same day cooling off period of your new policy will be over.

Q.8. I am unable to work due to Disability. What are my options for health coverage?

Ans. It depends on the disability. We suggest that you should buy a health insurance policy. Suppose you are disabled due to poor eyesight, you may not be able to work but you may fall ill and need hospitalization. Insurance company will put eye disease /ailment as pre existing disease and it may not be payable –but there can be hundreds of other ailment and accidental happenings, which get covered.

Q.9. Who is a Third Party Administrator?

Ans. TPA is an abbreviation for Third Party Administrator. These companies are BPO's of insurance companies and are responsible for coordinating all aspects of claims pertaining to health insurance policies.

These companies are licensed by IRDA (Insurance Regulatory & Development Authority) and are having
•    Telecom facility generally with phone number starting with 1600 (toll free no.)
•    Computer network having details of all policies holders.
•    Medical specialists, for assessing need for hospitalization treatment being given in the hospital and for passing of the claim bills.

The role of TPA is to coordinate with hospitals with respect to treatment and also
to pass the bills on behalf of the insurance companies. The actual payment is made by the insurance company. As far as the legal contract is concerned, it is between the insurance company and the person insured.

The individual insured will get an ID card issued by the TPA. This ID card is useful and may be needed at the time of hospitalization.

Q.10. Are naturopathy and homeopathy treatments covered under a health policy?

Ans. In all policies naturopathy is not covered. However Homeopathy is now being covered by some insurance companies, provided treatment is taken in a Homeopathic Hospital, which is empanelled with the insurance company. Star Health permits use of Homeopathic medicines during post hospitalization period.

We foresee more and more Insurance companies will start covering naturopathy and homeopathy treatments in future.

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Source : prajnacapital

Why buy Health Insurance?

Why buy Health Insurance?

• Health Insurance gives you and your family protection against accidents, sudden illness and medical emergencies. • Cover your spouse, children (over 90 days) and dependent parents (up to 60 years) for all medical expenses 30 days prior to hospitalization and 60 days post hospitalization. • Get cashless hospitalization facility, no need to run around to collect cash prior to admission in case of an emergency. • Income Tax benefit under section 80D of the IT Act