Home About us Services Objective Membership CSR Projects Programme by IFI Awards Gallery Media Coverage Contact us FAQ's Blog Grievance
Insurance Foundation of India
(A not for profit organization under Trust Registration Act, 1882)
 
Training Programme "Risk Assessment and Fire (Property) Insurance" on Friday, 08th Dec 2017 at PHD House, New Delhi
Conference on “Protection & Insurance of Art, Artifacts, Art Galleries and Museums”
  Date to be Announce Soon
Successfully Completed- Training Programme, Seminar & Conference List by IFINGO
Study Material on Pradhan Mantri Fasal Bima Yojna 2016
CSR (Corporate Social Responsibility) Projects
Insurance Industry News/ Updates
Newsletter by IFI
Bima/ Insurance Cartoon by IFI
IRDA (Insurance Brokers) Regulations, 2013 (English)
IRDA (Insurance Brokers) Regulations, 2013 (Hindi)
Appreciation letter from PHD Chamber of Commerce & Industry
Pan India Insurance Awareness Campaign by Shri P Chidambaram on 12th April, 2013, New Delhi
Comments on IRDA Sub Brokers Report
NGO Working for Micro Insurance
An Invitation to Insurance Company's to Support IFI
- Appreciation from Leading Insurance Companies
IFI Project Report Award
 
- Download Poster
- Rules & Regulation
Life Insurance- Private players & their foreign's partners
General Insurance- Private players & their foreign's partners
Consumer Forum Cases in Insurance
Insurance Frauds in India
Indian Insurance Sector Report
Interesting Insurance Photos
IRDA Bima Bemisal/ Insurance Cartoon
 
 
 
Introduction
 
Ques. Is the maternity expense/hospital bill payable by the Insurance Company?
Ans. It is subject to the policy condition.In most of theindividual/ family policies it is not included. In some of the group Mediclaim policies it is covered and is clearly mentioned. Generally where payable this specific claim is payable in second year of the policy. In exceptional cases In-Group Mediclaim it is covered from the beginning as the corporate buyer has negotiated the policy by paying the suitable incremental premium for availing the benefit. You should read the condition in the policy document carefully.
Ques. A lady is covered for maternity cover. Gynecologist has advised her to go in for Ultrasound test. Is the claim payable?
Ans. No, it is not payable, as 24 hours hospitalization condition is not met.
Ques. What is day surgery? Is it payable?
Ans. Day Surgery is the surgery where patient need not spend the night in hospital and is discharged after few hours. List of the day surgeries covered under Mediclaim policy of Cholamandalam is appearing in this book. They have the most elaborate list. Other Insurance Co's have shorter list and it appears in the policy document.
Ques. My credit card gives Mediclaim policy? Should I go for it?
Ans. Mediclaim policy is purchased by the credit card company. It is infact a group Mediclaim policy with certain additions/ deletions which are agreed with Insurance Company.
  In the cases of Royal Sundram policy being sold by SBI credit card you get No claim bonus of 5%. No claim bonus which you get is 15% if you go for direct policy from Royal Sundaram.
Ques. Is it true that PSU's offer the lowest rates for Mediclaim?
Ans. For a specific age one Insurance company may be lower and for some other age another one may be lower. The best way is that you calculate the premium payable on the basis of all family members. From the following comparison you will notice that Royal Sundaram is economical for this family versus other companies.
  Comparison of Different Insurance Companies rates for Mediclaim - each member covered for Rs. 1,00,000
Inclusive of Service tax   Rs.
Age Royal Sundaram Bajaj Allianz PSU's
52 2731 3135 2289
47 2275 2090 2289
22 958 1408 1470
16 958 1408 1470
Total 6922 8041 7518
Less Family discount 692 804 752
Premium Payable 6230 7957 6766
  It is generally noticed that premium variation is in the range of 4% with the exception of ICICI Lombard where the premium for the product offering floater benefit is higher. This is because this product is presented as a premium product based on Better service,
  • Medical examination cost of all that are to be insured is to be done at nominated clinic at company cost. Those who are going in for this product need not go in for routine medical tests at their own cost.
Ques. TPA & Insurance company have disallowed my claim. What is the option available for me?
Ans. You can take up the matter with head office of the insurance company. If not satisfied with their decision you can take up the matter with Insurance Ombudsmen in your area. List is given in this book. If not satisfied with their decision then you can lodge case with consumer forum at district level.
  List of Insurance ombudsmen is attached.
Ques. Underwent surgery for a retinal tear and was in hospital only for a couple of hours. Can my claim be rejected on the ground that i was not hospitalised for a minimum of 24 hours?
Ans. No, your claim cannot be rejected on this ground since the "24 hours" condition does not apply to certain surgical procedures - those that don't require extended hospitalisation.
Ques. Five years such I had by pass surgery. Four years back /Insurance policy issued & preexisting diseases was mentioned as an exclusion. It is correct that this will not be mentioned in next year policy as I have completed 4 claim five year.
Ans. Yes
Ques. It is correct that Insurance Company will pay for my tests 4 years of claim free.
Ans. Yes
Ques. I have no medical policy and I suffer from hypertension. Will I get a health insurance cover?
Ans. Definitely you can get a health insurance cover, but hypertension would be treated as a pre-existing disease and it will get covered only after a period of 4 years. Diseases which occur as a consequence of hypertension will not be covered during first 4 years.
However you get an option in the policy issued by New India and can get it covered from 2nd year onwards by paying 20% additional premium. By paying the additional premium you will get 50% coverage in the 3rd year, 75% coverage in the 4th year and 100% coverage from 5th year onwards.
Ques. Please suggest a policy that covers regular check-ups and OPD treatments, including dental.
Ans. Health insurance policies issued by non-life insurers do not cover OPD and dental expenses. However, life insurers such as the Life Insurance Corp. of India (LIC) and ICICI Prudential have come out with health insurance plans that allow the insured to accumulate a health fund. The premium paid for these policies has two portions. One portion goes towards the hospitalization cover, while the other goes into a savings account. This account accumulates money over the years. The insured person can withdraw money from this fund to meet with OPD and dental expenses.
You have two options ICICI Lombard’s “Health Advantage Plus” and Apollo Munich’s “Maxima” Health Insurance plan.
ICICI Lombard’s Health Advantage Plus covers OPD expenses from the first day of the policy. The OPD cover may vary from Rs. 2,000 to Rs. 10,000 depending on the plan opted and your age. You can claim OPD charges only once during the policy term, which means you will have to collect all the bills and get the reimbursements as and when the limit is reached.
The Apollo Munich’s Maxima covers, cash- less OPD expenses across trusted network of pharmacies for pharmacy bills, diagnostic centers for diagnostic tests and annual health check-up, dental and optical care centers for contact lenses, spectacles and dental treatments along with consultation with family doctors. In Maxima OPD cover is sub-divided. The maximum benefit allowable for 1 adult is Rs. 8,500.
In addition, both the policies do not allow, an insured person to claim OPD cost within 90 days of commencement of the policy.
<<1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 >>
 
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
Best View at 1024x768 Resolution
© 2015 Insurance Foundation of India