General Query
What is the meaning of insurance?
Insurance is a protection against financial loss arising on the happening of an unexpected event. Insurance companies collect premiums to provide for this protection and losses are paid out of the premiums collected from the insuring public.
What is underwriting?
Underwriting of a risk involves consideration of material facts on the basis of which a decision will be taken whether to accept the risk and if so at what rate of premium.
Why should I fill up proposal form for buying Insurance?
Insurance is a contract between the insured and the insurer and the proposal form acts like offer from insured side. Moreover, it contains all the required information for the preparation of the policy which is a contract document.
Can I hand over my insurance premium cheque or cash to my agent and is he authorized to issue a receipt?
As per the present provision, the contract of insurance is between insured and the insurer. The role of intermediaries like agent is only for facilitating this process. Thus an Agent can accept premium and cannot issue receipt. Health Insurance – Medishield (Individual Policies) What is a TPA? TPA stands for Third Party Administrator. They are Health Care organizations and have tie ups with many hospitals and hence could provide the benefit of Cashless Facility to customers.
Who is our TPA?
Our Third Party Administrator is “Paramount Healthcare Pvt. Ltd.”. 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 Paramount network of hospitals. This means you can walk into any of the 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.
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 Medishield (individual) for 4 years, consecutively, pre-existing diseases will not be excluded from the 5th year onward. Will this policy cover hospital expenses overseas? The cover granted under this insurance is valid for treatments taken in India only.
What is the procedure for availing cashless facility?
In case of planned hospitalization, Paramount (our TPA) requires the first prescription with the details of the case history and indicating following details: 1. The provisional diagnosis or the reason for getting admitted. 2. The proposed date of admission 3. The approximate expenses 4. Name of the hospital and consultants 5. Approximate duration of stay at the hospital 6. Attach a doctor’s prescription to the admission note. The above documents will have to be delivered to Paramount at least 72 hrs before admission.
What happens if I don’t avail 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. I already have medical insurance with another company for the past 3 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
Is there an Income Tax exemption and if ‘Yes’ under which section and what is the exemption limit?
Premium upto Rs. 35,000 is eligible for deductions under Section 80D of Income Tax Act, 1961. However there are sub-limits within this over-all limit. Premium upto Rs 15,000 is eligible for tax deduction for self, spouse and dependant children . Additionally , premium upto Rs 20,000 is eligible for tax relief for parents health cover if they are senior citizens ( otherwise Rs 15,000 is eligible).
What are the benefits of Medishield (individual)?
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. However, this is not applicable to specific treatment like Dialysis, Chemotherapy, Radiotherapy, eye surgery, dental surgery, Lithotripsy, Tonsillectomy or D & C which requires lesser time. Pre and Post hospitalization expenses, that is, relevant medical expenses up to 60 days prior to hospitalization and 60 days after discharge from hospitalization are covered. The policy has certain exclusions like pre-existing conditions, firs 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.
What do you mean by Pre and Post hospitalization?
Pre and Post hospitalization expenses – covered for all relevant medical expenses incurred 60 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 60 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.
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 subject to a maximum of 50% 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 45 years a medical check-up with the following tests is required- an ECG (print out with report), Fasting Blood Sugar, Post Blood Sugar and Urine Sugar report. The cost will be borne by the insured.
Is maternity covered?
Maternity is not covered.
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.
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.
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