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Introduction
 
Ques. I already have a health insurance policy. Should I still buy a life insurance policy with the riders?
Ans. Health Insurance Policy covers your hospitalization needs. Life insurance covers your retirement needs. Adding of critical illness rider will take care of incidence of you getting critical illness like cancer.
Every product is different and fulfills different needs. Study it and make a decision.
Ques. hi! are the new clinical and pathological tests, not available in India and done abroad covered under the mediclaim rules of the country? If no, are efforts being made to do?
Ans. You are only permitted by some insurance companies to take e-opinion. Your suggestion is very good and we feel Insurance companies will start offering the same. If Textile industry is permitted to get flammability tests done on garments in Hong Kong then why Insurance companies should not permit clinical and pathological tests (not available in India), which are to be conducted in foreign country.
Ques. Is there a mediclaim policy which is truly 100 percent cashless?
Ans. Yes, nearly 100% policies are cashless. You will appreciate that it can be cashless in case of planned hospitalization as well. Supposing you are involved in an accident and are taken to the hospital – you may have to pay advance to the hospital. In few hours time coordination can be done and the hospital may have the message from Insurance Company for cashless hospitalization.
Ques. I am having Health First policy of Tata AIG so I am covered for Mediclaim/hospitalization. Therefore I do not need any other policy?
Ans. Health First is a product of Tata AIG Life. You are aware of that a Non Life Insurance Company or a Health Insurance Company (like Star) issues Mediclaim policy. Health First covers the following 12 critical illnesses only :
  • Cancer
  • Stroke
  • First Heart Attack
  • Coronary Bypass Surgery
  • Chronic Renal Failure
  • Major Organ Transplant
  • Aorta Surgery
  • Alzheimer's Disease
  • Benign Brain Tumor
  • Heart Valve Surgery Paralysis
  • Parkinson's Disease
  • Total Blindness
It will not cover hospitalization due to other diseases or accident. Therefore having of Mediclaim policy from a non life insurance company in addition to Health First will be in your interest.
Ques. Will like to have insurance cover of Rs12,00,000. Which insurance company will issue it?
Ans. Most of the insurance companies issue policy for Rs. 5,00,000 only. Cholamandalam issues Mediclaim policy of Rs. 10,00,000 subject to certain earning norms being fulfilled. In view of the medication costs/treatment associated with certain ailments various Insurance Companies are considering to increase the sum assured to Rs 10,00,000. In the coming months suitable notifications are expected from IRDA as well as insurance companies. You cannot be covered for Rs. 12,00,000.
Ques. Someone had mediclaim policy and he had to pay nothing for treatment in a hospital. Which company provides this good service?
Ans. TPA's (Third Party administrator) are approved by IRDA. They provide service with respect to coordination of treatment in hospitals/settlement of bills on behalf of Insurance Companies. Every Insurance co offers this cashless settlement facility. Even if TPA settles the bill with hospital you may have to submit your bill to TPA with respect to bill for 30 days prior to hospitalization and 60 days post hospitalization. There is a list of TPA's given in this book. In your insurance policy the name of the TPA with whom you should coordinate is given. The name is also given on the ID card issued by theTPA to you. Toll free number of TPA is given on ID Card and you can dial it from any part of the country on free of cost basis.
Ques. Is there any difference between TPA's?
Ans. All TPA's are approved by IRDA. Some of them charge 6% of premium as the service charge and some of them charge 10% of premium as the service charge. This cost is ultimately being paid by the insured only. It is included in the premium being charged from insured.
Ques. Can we say an insurance co will be attached to one TPA only?
Ans. Not necessary. An insurance co may be using more than one TPA.; Sometimes they use one TPA for individuals/ families and another one for Group Mediclaim policyholders.
Ques. We have group insurance policy for our organization. Do we have choice of selecting one of 4 TPS empanelled with Insurance Companies?
Ans. Insurance companies will by to push then favourble TPA. You have the right to invite various TPA's, let them make presentation, reply to your queries and then select a TPA. Infact as an aware consumer you should insist for this.
Ques. At present I am covered under group Mediclaim policy, which my employer organization has provided. When I retire at the age of 60 then I will take a policy in my name. Please comment?
Ans. Theoretically you can take the Mediclaim policy when you are 60.In practice it may not be so. Most of the Insurance Companies are not underwriting policies for those who are above 50 years. ICICI Lombard is the only one but the policy you can take here is having the maximum limit of Rs. 2,00,000 only. It means even if you are covered for Rs. 3,00,000 under the group policy of your employer you may have to agree for sum assured of Rs. 2,00,000 at a time when due to age your need may be higher.
Royal Sundaram can insure you at this stage, provided your child is the proposer and also takes the same sum assured. It means if wish to get insured for Rs. 3,00,000 then your son, his wife should also be covered for Rs. 3,00,000 each. Royal Sundaram has maximum limit of Rs 3,00,000. Let us take an example.
At the age of 49 years you take policy of Rs. 5,00,000 then you will be paying Rs. 6500/year. Till the age of 70 you will pay Rs. 6500 x 21= Rs. 132000.If at the age of 60 years you tak ICICI Lombard policy then from 60 to 70 years for coverag Rs. 2,00,000 you will pay Rs. 14000x10 = Rs. 1,40,000. This shows that it is better to take a policy on your own account in addition to your employer scheme.
Ques. A patient is treated at home for fever. Are the fever treatment bills payable by the Insurance Company?
Ans. If family doctor or consultant doctor does the treatment of the fever at home then it is not to be paid by the Insurance Company.If due to critical state of the patient or due to epidemic the patient is admitted in a hospital then the claim is payable provided 24 hours hospitalization condition is met.
Ques. Due to accident a person is treated in a hospital and bandage/plaster is put. He is discharged after 3 hours. Is the treatment cost payable by the Insurance Company?
Ans. No, it is not payable, as 24 hours hospitalization condition is not met.
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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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