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Introduction
 
Ques. I have an impression that the health insurance sector is not regulated in India. If you have a policy and take a claim then next time the insurance companies denies the extension of the policy or minimum they do is to charge very hefty premium. In that case what is the fun in taking medical insurance?
Ans. IRDA is doing a wonderful job in regulating insurance industry of this country. You might have had bad experience with a company. Generally it does not happen. But if you lodge claims in 2 successive years- then you will face difficulty.
Ques. What are the benefits of floater plan?
Ans. Family floater policy is giving you better rates. If you have a normal policy then every member is eligible for sum mentioned against his name. In family floater sum is for the family so any one/ some/ all family members can lodge claim.
Ques. What should I keep in mind before obtaining services from TPA?
Ans. Keep policy number/ ID Card No. handy. Prescription of doctor advising hospitalization, who will conduct procedure/ surgery in hospital, what is the treatment to be given, what is estimated cost, Expected date of admission into hospital and for no of days you will be in hospital. TPA will ask these questions and will ask you to submit/ fax these documents.
Ques. What happens in the event of an injury or illness that demands immediate medical attention?
Ans. Life is important. Injured/ patient should be taken to doctor/ nearest nursing home/ hospital and emergency treatment should be provided. At appropriate time if necessary the patient can be moved to an empanelled hospital in consultation with the insurance company/TPA.
Ques. How do I purchase the insurance? When does the insurance take effect?
Ans. You can purchase health insurance from Insurance Company or through insurance intermediary–i.e. agent/ advisor/ Insurance Brokerage Firm. It is better to buy through Insurance intermediary as you get support in the event of lodging claim.
Ques. Should I purchase a combined policy for my parents or separate individual policies as both my parents are visiting me?
Ans. Yes – it is better to have combined policy. You can also include their names in family floater policy. You will same money.
Ques. What ate the Documents Required by TPA for giving approval for cashless settlement?
Ans.
  1. Name of patient, policy no, Insurance Company.
  2. Prescription of Doctor advising admission to hospital/ Details needed are.
  3. (a)- Disease to be cured

    (b)- Treatment/ surgery suggested

    (c)- Who will treat/ perform surgery/ date of admission into which hospital

    (d)- Expected duration (no of days) in hospital

    (e)- Estimated cost for Treatmen

    These documents will be needed by TPA and can be.

    1. Person
    2. Fax
    3. Email
  4. Medical officer of TPA will see the docs, talk to Hospital/ doctors if required and give on to hospital to treat the patient.
  5. Collect authorization from TPA to show to hospital so that their do not ask for payment.
Health Plan For Diabetic Senior Citizen
Ques. My father recently crossed 60 and he is diabetic. I want to buy health insurance medicliam for him. Please suggest some good plans and their benefits.
  You have 2 options

Option1. Get policy from any insurance company with exclusion of diabetes for 4 years.
Exceptions are- L + T where it will be covered after 2 years Bajaj Allianz Silver Health- where it will be covered after 1 year

Option2. Get policy from one of the following companies.
(a) Star Health- Diabetic Care: You will have to pay 30% of the claim amount.
Rejected Claims
Ques. My father was a member of Country Vacations Club, Hyderabad, which offered a cover of Rs.5 lakh to each member under a group accidental policy from HDFC ERGO General Insurance. My father passed away in an accident on August 17, 2007. I and my family were not aware of the policy. We came to know about it when we approached the club to transfer the membership to my and my wife’s names. This was in August 2010. We then took the policy details and forwarded the claim form to the insurance company. But the company rejected the claim saying there was a delay in making the claim. Which is the proper forum where we can get our grievance redressed?
Ans. Write a specific letter to Chairman of the Insurance company to review the case and release the claim amount. If no positive response is received within 1 month then take up the matter with Insurance Ombudsman of your state. There are good chances that your problem will be solved.
Disease After Taking Policy
Ques. I want to know if, after taking a life insurance policy, the insured person suffers from a disease, is it obligatory on his/ her part to inform about it to insurance company?
Ans. No- it is not obligatory.
Ques. I delivered a premature child five months ago. Can I buy a health policy for him now?
Ans. As child is more than 90 days old yes, you can get the name added to your Health Insurance policy by paying premium for remaining period of the policy. If you would have Max Bupa policy and maternity claim was also paid by them then the name of the child would have been added immediately and without any additional payment.
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Global Insurance Conferences/ Events
ASSOCHAM - 10th Global Insurance Summit on 22nd September 2017 at Hotel Taj Lands End, Mumbai   more........
 
Upcoming Seminar
ASSOCHAM - 10th Global Insurance Summit on 22nd September 2017 at Hotel Taj Lands End, Mumbai
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