What are the Benefits of Health Shield Online?
Hospitalisation Cover for all inpatient hospitalization expenses due to accident / illness covered under the policy up to the Sum Insured. The stay in hospital should be more than 24 hours. Pre and Post hospitalization expenses, that is, relevant medical expenses up to 30 days prior to hospitalization and 60 days after discharge from hospitalization are covered. Certain procedures, which do not warrant 24-hour stay like – Cataract, D&C, Eye surgery, Tonsillectomy, Kidney Stone Removal etc are also covered. The list of such procedures is available in the policy.
The policy has certain exclusions like pre-existing conditions, I year, II year exclusions etc. Please refer the policy for details. If the admission is due to any of these exclusions, the expenses would not be covered.
The policy also provides for the following:
1. Recovery Benefit of 2% of the SI for hospitalisation exceeding 15 days.
2. Rs.1000/- towards ambulance charges, in case of emergency.
3. Rs.750/- towards Health check up after 5 consecutive claim free years.
Who is our Health TPA?
Our Third Party Administrator is “Medicare T.P.A. Services (I) Pvt Ltd”.
What is pre-existing conditions waiver?
Normally, all pre-existing illness at the time of taking the policy is excluded from the cover. However, if you continue to be with Health Shield Online for 4 years, consecutively, pre-existing diseases will not be excluded from the 5th year onward.
Why have we tied up with a TPA?
As TPA are Health Care organizations they have tie ups with many hospitals and hence we could provide the benefit of Cashless Facility to our customers. Also they facilitate for ambulance referral, surgeon’s referral and specialist’s referral.
What do you mean by Cashless facility?
With the Health Card you and your family members get access to the cash less facility from the Medicare network of hospitals.
This means you can walk into any of the 3000-networked hospitals across the country and get treated (for diseases which fall under purview of cover) without having
to pay for your bills first and then claim from us.
If you do not get admitted to a networked hospital, your expenses will be reimbursed within 7 days of receipt of complete documents from you.
Is there an Income Tax exemption and if ‘Yes’ under which section?
Premium paid under this Policy towards self, spouse, 2 dependent children and dependent parents are exempt from Income Tax under section 80D of the Income Tax Act.
What is the IT exemption limit?
Rs.15000/- is the limit.
What do you mean by Pre and Post hospitalization?
Pre and Post hospitalization expenses – covered for all relevant medical expenses incurred 30 days prior to hospitalization and expenses incurred during 60 days after hospitalization.
By RELEVANT EXPENSES we mean all expenses pertaining to the disease for which he is hospitalized prior to hospitalization. For example, a person maybe required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor’s consultation fees for this, the expenses on tests and medicines 30 days prior to hospitalization for that particular disease are covered.
RELEVANT EXPENSES for post hospitalization 60 days after getting out of hospital. For example, the subsequent follow up consultations with specialists, medicines and test expenses are covered.
What is the benefit of carrying a health card?
You and your family members get access to the cash less facility from the Medicare network of hospitals.
Also, in the event of any unforeseen accident a third party can identify your Insurance Company and arrange for necessary emergency treatment.
Can a customer have more than one Health policy?
Yes, he can have. But each company will pay rateable proportion of the loss. In case a customer has Health Insurance from Insurer ‘A’ for Rs. 1 Lac and Health Insurance from Insurer ‘B’ for Rs. 1 Lac, in case of a claim each policy will pay in the ratio of 50:50 up to the SI.
Is there a cumulative bonus available in this offer?
A cumulative bonus of a slab of 5% is applied on Sum Insured for every claim free year.You can accumulate up to 10 slabs of Cumulative Bonus.
Cumulative Bonus will be reversed by 2 slabs in case of claim.
List 2 important exclusions that are not covered?
- Disease contracted during the first 30 days of commencement of policy.
- All diseases / illness / injury existing at the time of proposing this insurance.
I travel abroad frequently. Will this policy cover my hospital expenses Overseas?
The cover granted under this insurance is valid for treatments taken in India only.
What are the medical check-ups that we need to undergo to enroll myself? And who will bear the cost?
For those above the age of 50 years a medical check-up is required. An ECG (print out with report), Fasting Blood Sugar, Post Blood Sugar and Urine Sugar. The report should not be more than one month old.
I am 45 years old, my father is 76 years old and my mother is 68 years old, can I apply for Health Shield Online ?
This insurance is available to persons between the age group of 91 days and 50 years at the commencement date of the policy. Renewals are available up to 70 years.
What is the procedure for availing cashless facility?
In case of planned hospitalization, Medicare requires the first prescription with the details of the case history and indicating following details:
• The provisional diagnosis or the reason for getting admitted.
• The proposed date of admission
• The approximate expenses
• Name of the hospital and consultants
• Approximate duration of stay at the hospital
• Attach a doctor’s prescription to the admission note.
The above documents will have to be delivered to Medicare at least 72 hrs before admission.
What happens if I don’t avail the cashless facility? Is there a reduction in premium for not availing the cashless facility?
In case of an eligible reimbursement, the claim will be settled 7 days from the date of receipt of complete set of documents.
There will not be a reduction in premium for not availing the cashless facility.
Is maternity covered? If yes, what is the limit?
Maternity is not covered.
I already have medical insurance with New India for the past 4 years. If I enroll today will I get continuous cover or will the cover start afresh?
If you have already insured with another Insurance Company, it is better to continue. Our Policy does not offer continuity. Policy would be considered as fresh.
My father is suffering from BP & Diabetes. Supposing he gets admitted for a heart ailment, will you pay?
We will not pay for Heart ailments during the first 4 years, since Heart Disease is considered as a complication of pre-existing condition.
How can I intimate the TPA if there is an emergency hospitalization?
The help line number is provided in the booklet. The 24 hour Helpline numbers for the 4 metros will be mentioned on the back of the plastic Health Shield Card which will be given to the customer along with the policy document.
If I avail the cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?
Yes a part will have to be borne by you if it consists of inadmissible amounts that are listed in the booklet.
Where can i get the Product Highlight in the web?
Product Highlights are detailed in our website.
My wife and children are residing at Bangalore while I am here in Chennai. My parents are in Tanjore. Can I cover all of them? How will my parents avail the cashless facility?
You can cover all of them. Our network hospitals are available across the country. If there is no network hospitals at the place of your residence, you could opt for reimbursement mode of settlement.
Can I have more than one insurance policy for myself, one from Royal Sundaram and one from another company?
Yes, you can.
What happens in case of an Emergency hospitalization where Cashless facility is not authorized to me?
The liability for making payment to the Hospital will rest on you.
However you may submit your Claim with all necessary documents in original. Subject to Claim scrutiny, admissible amount will be reimbursed.
The amount due to you will be paid within 7 working days from date of receipt of all documents.
Will the medical costs be reimbursed from day one of the cover?
There is a general waiting period of 30 days. Please refer policy documents for further details. But this shall not apply to an accident which happens from the time of cover.
Will I get a discount at the time of renewal if I do not file any claim during that year?
We give you a cumulative bonus for each claim free year. You will get an additional cover of 5% every year subject to a maximum of 50%.
We do not give any discount on the premium amount. However if you make a claim in a particular year, your cumulative bonus will be reduced by 2 slabs ie., 10%.
What is the provision for tax exemption on Premium paid ?
As per current IT rules you can get an exemption up to a maximum sum of Rs.15, 000/- from your taxable income under Section 80 D for Health Insurance Premium paid for self, spouse, dependent children and dependent parents.
What should I do in case I lose my Membership card?
Please inform us. We will replace it immediately at additional cost.
Will I get a refund of premium if I cancel my policy?
Yes, however, refund of premium will be on short period rates. Please go through the policy conditions for exact details.
Should any documents be produced to apply for the policy?
No documents are necessary. When you receive the policy documents, as a part of Welcome Kit there will be a Relationship form. This form needs to be filled and returned to us along with photos of all insured persons.
Note:
This is only a summary of the product features.The actual benefits available are as described in the policy, and will be subject to the policy terms, conditions and exclusions.Please seek the advice of your insurance advisor if you require any further information or clarification.
Or visit: Royal Sundaram Health Insurance
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