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padding-top: 4px;" vspace="10" /></a> </div></div> <div id="band"> <img src="image/career.jpg" width="728" height="173" /></div> <div id="content"> <h2 class="heading"> Health insurance faq's</h2> <div id="content_text2"> <ul class="qmmc" id="qm0"> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">1.</span>Why do I need health insurance? </a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table2"> <tr> <td> Health insurance will shield you and your family against any financial unforeseen event arising due to a medical crisis.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">2.</span>What is a Health Card? </a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table1"> <tr> <td> It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">3.</span>Who is eligible for health card?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table6"> <tr> <td> Policyholders are eligible for health card.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">4.</span>What are the benefits of a health card?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table7"> <tr> <td> A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">5.</span>Is there any validity of the Health card?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table8"> <tr> <td> The health cards need to be renewed or re-issued during the policy tenure.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">6.</span>What is a TPA?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table9"> <tr> <td> Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">7.</span>What is Pre-existing disease?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table10"> <tr> <td> Any condition, ailment, injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and/ or received medical advice / treatments within stipulated months as mentioned in your policy prior to your first policy with us.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">8.</span>Pre existing diseases are covered or not?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table11"> <tr> <td> Pre-existing diseases are covered subject to waiting period as mentioned in your policy.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">9.</span>Which family members can get covered in one policy?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table12"> <tr> <td> - Spouse<br /> - Dependent Children means all unmarried children, stepchildren or legally adopted children who are above 91 days and under 23 years of age and are financially dependent on Insured <br />- Dependent Parents upto 70 years of age.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">10.</span>What do I do in case of a claim?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table13"> <tr> <td> In case of a planned hospitalization or emergency services, use your Health ID Card at any of network hospitals and avail cashless service. In case the hospital is not listed in the network of hospital, then pay the cash and submit the claim to TPA for reimbursement with relevant documents and bills.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">11.</span>What is a Network Hospitals?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table14"> <tr> <td> These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">12.</span>What is a Non-network Hospitals?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table15"> <tr> <td> Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">13.</span>Where can I get network hospital list?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table16"> <tr> <td> List is provided to you along with your health card which is issued by TPA. This list is subject to change and updated list is available on TPA website.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">14.</span>What is a cashless service?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table17"> <tr> <td> When you approach a hospital which is listed in the provider list of our network and disclose the health-card, hospital will pursue TPA for pre-authorization. Once the authorization is issued by TPA, you do not have to pay any money towards the covered services provided by the hospital. This is called as a cashless service.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">15.</span>What is Pre-authorization?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table18"> <tr> <td> It is a hospital request to TPA to confirm the pay ability of your illness.<br /> In case of planned hospitalization:<br /> Please contact your TPA helpline-Which is mentioned on the Health Identity Card. Obtain approval from the TPA.<br /> In case of emergency hospitalization:<br /> Family to contact TPA help-line as mentioned in the policy.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">16.</span>How long does it take to get an approval from TPA?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table19"> <tr> <td> TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant documents are submitted.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">17.</span>What are the documents required for filing a claim?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table20"> <tr> <td> Duly completed claim form<br /> Original bills, receipts and discharge certificate/card from the hospital.<br /> Original bills from chemists supported by proper prescription.<br /> Information and evidences from the attending Medical<br /> Practitioner/Hospital/Chemist/Laboratory as required.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">18.</span>Within how many days should I submit the claim?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table21"> <tr> <td> The claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">19.</span>How much time does it take to settle the bills?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table22"> <tr> <td> Normally, the bills are settled within 7 working days of receiving the relevant documents.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">20.</span>In the event of no claims during the first year, what if I want to discontinue my policy?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table23"> <tr> <td> Once you stop paying the premiums, the policy would be discontinued.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">21.</span>Are cosmetic treatments or medical attention for cosmetic purposes covered?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table24"> <tr> <td> No. Cosmetic or aesthetic treatment of any description (including any complications arising thereof), plastic surgery except those relating to treatment of Injury or Disease is not covered.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">22.</span>Is there any tax benefit that one can avail of while purchasing Health Insurance?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table25"> <tr> <td> Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">23.</span>Can I buy more than one Health Insurance policy?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table26"> <tr> <td> Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay ratable proportion of the loss.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">24.</span>What is the maximum number of claims allowed over a year?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table27"> <tr> <td> Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">25.</span>Can I avail this policy if I am not an Indian National but living in India?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table28"> <tr> <td> Yes, foreigners living in India can be covered under a health insurance policy. However, the coverage would be restricted to India.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">26.</span>Who will receive the claim amount under health insurance if the policyholder dies during the time of treatment?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table29"> <tr> <td> In cashless medical hospitalization it is settled directly with the network hospital. In cases where this is no cashless settlement, the claim amount is paid to the nominee of the policyholder. In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">27.</span>Is Mediclaim the same as health insurance?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table30"> <tr> <td> Yes, it is the same.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">28.</span>What is the difference between Health Insurance & Critical Illness policies or Critical Illness Riders in insurance?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table31"> <tr> <td> A Health Insurance policy is a reimbursement of the medical expenses. Universal Sompo's Aapat Suraksha is a critical illness insurance policy. It's a benefit policy. Under a benefit policy upon the occurrence of an event, the insurance company pays the policyholder a lump sum amount.</td> </tr> </table> </a></li> </ul> </li> <li><a class="style1" href="javascript:void(0)"><span style="padding-left:2px;padding-right:8px;">29.</span>What happens when I cancel the policy?</a> <ul> <li><a href="javascript:void(0)"> <table cellspacing="0" cellpadding="0" id="Table32"> <tr> <td> If you cancel the policy, your cover will cease to exist from the date of cancellation of policy. Additionally, your premium should be refunded to you on short period cancellation rates. You will find these in the policy terms and conditions in the policy document.</td> </tr> </table> </a></li> </ul> </li> </ul> <br /> <br /> <br /> </div> </div> </div> <div id="foooter"> <div id="address_bar" class="address"> <b>Regd & Corp Office :</b> Universal Sompo General Insurance Co Ltd. Unit No 401, 4th Floor,Sangam Complex, 127, <br />Andheri Kurla Road,Andheri (E), Mumbai- 400059. Tel : 022-29211800, Fax : 022-29211844 <br /> <b>Insurance is the subject matter of solicitation. IRDA Registration Number - 134 Control Number -ENG/WBHP/056/25Nov2010</b> <br /> <a href="Privacy Policyindex.html">Privacy Policy</a>| <a href="DisclaimerIndex.html">Disclaimer</a> </div> <script type="text/javascript"> var gaJsHost = (("https:" == document.location.protocol) ? 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Car">Motor Pvt. Car</option> <option value="Individual Health">Individual Health</option> <option value="Fire &amp; Allied Perils">Fire &amp; Allied Perils</option> <option value="Aapat Suraksha">Aapat Suraksha</option> <option value="Householders">Householders</option> <option value="Office Package Policies">Office Package Policies</option> <option value="Farmers&rsquo; Package">Farmers&rsquo; Package</option> <option value="Cattle Policy">Cattle Policy</option> <option value="Others">Others</option> </select></td> </tr></table> </div> </td> <td></td> </tr> <tr> <td class="texttable" style="width: 88px"> </td> <td style="width: 193px"> </td> </tr> <tr> <td class="texttable" style="width: 88px"> </td> <td style="width: 193px"> *<em> required fields</em></td> </tr> </table> <hr /> <div style="float:right;padding-bottom:0px;padding-right:44px;"><input id="Button1" title="Submit" type="button" value="Submit" class="button" onclick="checkNewpop()"; /></div> <table width="100%" border="0" cellpadding="0" cellspacing="0" id="Table3" style="display: none;"> <tr> <td class="formtext"> <span class="style1">We will get in touch with you shortly.</span></td> </tr> </table> </div> </div> </form> <!--- pop up window--> </body> </html>