Health insurance faq's
- 1.Why do I need health insurance?
-
|
Health insurance will shield you and your family against any financial unforeseen
event arising due to a medical crisis. |
- 2.What is a Health Card?
-
|
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. |
- 3.Who is eligible for health card?
-
|
Policyholders are eligible for health card. |
- 4.What are the benefits of a health card?
-
|
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. |
- 5.Is there any validity of the Health card?
-
|
The health cards need to be renewed or re-issued during the policy tenure. |
- 6.What is a TPA?
-
|
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. |
- 7.What is Pre-existing disease?
-
|
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. |
- 8.Pre existing diseases are covered or not?
-
|
Pre-existing diseases are covered subject to waiting period as mentioned in your policy. |
- 9.Which family members can get covered in one policy?
-
- Spouse
- 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
- Dependent Parents upto 70 years of age. |
- 10.What do I do in case of a claim?
-
|
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. |
- 11.What is a Network Hospitals?
-
|
These are the hospitals that form part of the TPA's network to provide cashless service to you
upon presentation of health-card. |
- 12.What is a Non-network Hospitals?
-
|
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. |
- 13.Where can I get network hospital list?
-
|
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. |
- 14.What is a cashless service?
-
|
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. |
- 15.What is Pre-authorization?
-
It is a hospital request to TPA to confirm the pay ability of your illness.
In case of planned hospitalization:
Please contact your TPA helpline-Which is mentioned on the Health Identity Card. Obtain
approval from the TPA.
In case of emergency hospitalization:
Family to contact TPA help-line as mentioned in the policy. |
- 16.How long does it take to get an approval from TPA?
-
|
TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant
documents are submitted. |
- 17.What are the documents required for filing a claim?
-
Duly completed claim form
Original bills, receipts and discharge certificate/card from the hospital.
Original bills from chemists supported by proper prescription.
Information and evidences from the attending Medical
Practitioner/Hospital/Chemist/Laboratory as required. |
- 18.Within how many days should I submit the claim?
-
|
The claim must be filed within 30 days from the date of discharge from the Hospital or
completion of treatment. |
- 19.How much time does it take to settle the bills?
-
|
Normally, the bills are settled within 7 working days of receiving the relevant documents. |
- 20.In the event of no claims during the first year, what if I want to discontinue my policy?
-
|
Once you stop paying the premiums, the policy would be discontinued. |
- 21.Are cosmetic treatments or medical attention for cosmetic purposes covered?
-
|
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. |
- 22.Is there any tax benefit that one can avail of while purchasing Health Insurance?
-
|
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. |
- 23.Can I buy more than one Health Insurance policy?
-
|
Yes, you can have more than one Health Insurance policy. In case of a claim, each company will
pay ratable proportion of the loss. |
- 24.What is the maximum number of claims allowed over a year?
-
|
Any number of claims is allowed during the policy period. However the sum insured is the
maximum limit under the policy. |
- 25.Can I avail this policy if I am not an Indian National but living in India?
-
|
Yes, foreigners living in India can be covered under a health insurance policy. However, the
coverage would be restricted to India. |
- 26.Who will receive the claim amount under health insurance if the policyholder dies during the
time of treatment?
-
|
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. |
- 27.Is Mediclaim the same as health insurance?
- 28.What is the difference between Health Insurance & Critical Illness policies or Critical Illness
Riders in insurance?
-
|
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. |
- 29.What happens when I cancel the policy?
-
|
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. |
Registered Address : A-201, Crystal Plaza, 2nd Floor, Opp. Infinity Mall,
Oshiwara Link Road, Andheri (West), Mumbai - 400 058.Tel : +022-40679000, Fax :
022-40679099
Insurance is the subject matter of solicitation. IRDA Registration Number - 134
© Copyright 2009 Universal Sompo General Insurance Co. Ltd.
