What are the benefits of taking health insurance?
Health insurance covers you and your family against expenses that you may incur on hospitalisation (or domiciliary hospitalisation) and/or other related expenses in a hospital or nursing home in India for treatment of a disease.
With the rising incidence of diseases and cost of treatment, any illness can mean substantial financial outgo for you and your family. Health insurance allows you to plan for such events without feeling the financial burden of treatment. It also allows tax saving since the premium that you pay on your health insurance policy is eligible for tax deduction under Section 80 D of the Income Tax Act. (Up to Rs.15000 for an individual or Rs.20000 for senior citizen of over 65 years of age)
How much health insurance does one need?
You can decide on the amount based on the number of family members to be covered under the policy, the age of family members, the expected costs of treatment and the amount of premium you are willing to pay.
Is there an age limit to buy a health insurance policy?
All insurance companies prescribe their own age limits for health insurance. Reliance General Insurance covers individuals from 3 months to 65 years of age, which can be renewed upto the age of 75.
My child is 11months old; can he be insured under a health insurance policy?
If your child is between 3 months – 5 years of age, he can be covered as part of a family floater policy with one or both parents. Once the child is more than 5 years, you can choose between continuing the family floater policy and taking a separate policy for the child.
Which family members can become a part of Health insurance policy?
The policy covers self, spouse and two dependent children below the age of twenty-one years under a family floater policy. For rest of the family members, you can take separate individual policies.
What is the minimum / maximum amount of sum insured?
The minimum amount of sum insured is Rs. 1 lakh. The maximum amount is upto 5 lakhs.
What is the eligibility criterion to avail of the Health insurance policy?
Anyone between the age of 3 months and 65 years can take a health insurance policy (in case of a silver plan till 60 years of age and in case of a gold plan till 55 years of age).
What are pre and post hospitalisation expenses?
Pre and post hospitalisation expenses means the medical expenses incurred during a period before and after hospitalisation for any disease / illness / injury sustained which is covered under your Policy. The period before and after hospitalisation that is covered depends on the type of policy opted for. For e.g., in the case of a Gold Health Insurance, the period considered for pre-hospitalisation expenses is 60 days before admission to the hospital / nursing home, while the post-hospitalisation period is 90 days after discharge from the hospital.
What is recovery benefit? Is it covered?
Recovery benefit is a lump sum payment made to the insured person as compensation in case the insured is hospitalised for more than 10 consecutive days. A lump sum benefit of Rs. 10,000 is paid under the Gold policy.
Can an insurance company decline to give cover under their insurance policy?
All insurance policies are issued at the discretion of the insurance company and as such an insurance company can decline your policy proposal.
What is cashless facility?
Cashless claims facility is available in the network of tied-up hospital where the company settle claims directly with the hospital / nursing home without you having to pay any amount to the hospital directly.
The way it works is that in the case of pre-planned hospitalisation, if the chosen hospital is included in the network of cashless hospitals, you need to send Reliance General Insurance a claim form along with certification from the doctor about the nature of illness and treatment. Once the Third Party Administrator receives the information, and if the claim is admissible, the TPA sends you a pre-authorisation, in a matter of few hours, for the cashless claim. Then, the company will settle your hospital bills directly. In the unfortunate event of an emergency if the insured person is admitted to a tied-up hospital, you have to inform the hospital of your intention to use the cashless facility. The hospital will then help you with the authorization process.
Are there any taxation benefits if one takes health insurance policy?
The premium paid on a health insurance policy is eligible for deduction under section 80D of the Income Tax Act. The amount of deduction available is up to Rs.15000 for individuals or Rs.20000 for senior citizens aged above 65 years and paid the premium from their account.
What are the various exclusions in your Policy?
There are certain ailments that are not covered for the First year, but are covered subsequently such as
* Cataract
* Benign Prostatic Hypertrophy
* Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy
* Dilation and curettage
* Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis
* Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant /adenoids and hemorrhoids
* Dialysis required for chronic renal failure
* Gastric and Duodenal ulcers
Disease/ Injury existing before inception of health insurance policy, also called pre-existing disease, is only covered from the 3rd year of the policy in case of a silver/gold plan (after 2 continuous renewals) and from the 5th year onwards (after 4 continuous renewals)
Apart from these there is a list of permanent exclusions mentioned in your policy document. It includes any disease contracted during the first 30 days of inception of policy, non-allopathic treatment, pregnancy & childbirth related diseases, Intentional self-injury, injury under influence of alcohol, drugs; diseases such as HIV or AIDS, etc.
Does Reliance General Insurance have hospital tie – ups that provide cashless checkouts as part of health insurance policy?
Reliance General Insurance provides cashless claims facilities at a network of over 3000 hospitals. The list of hospitals will be sent to you along with your policy pack and includes most major hospitals and nursing homes across over 300 cities.
In case you are admitted to any hospital not covered in our network, you need to inform the TPA of the admission within 7 days of hospitalisation.
You will have to pay the bill to the hospital, and the claim will be settled in your name after discharge from the Hospital. You will need to submit all original bills, discharge card, prescriptions, medical reports etc. along with your claim form.
What are emergency medical expenses?
Your hospitalisation expenses due to an emergency illness/injury are covered under your Reliance Health Care insurance policy. You can avail of the cashless facility in times when there is emergency hospitalisation. It is part of your health insurance policy and you need not pay an extra premium for it.
What is a floater policy? How is it beneficial to take it?
In case of a floater policy, all members of the family are covered under one single policy. A single premium is payable for the entire family and the amount of cover (Limit) “floats” over the entire family. This means that it offers you the flexibility in terms of the cover available for each member of the family during hospitalisation. The limit can be used by any member of the family, and for any number of times.
For eg. If you take a floater policy of 5 lakhs for your family, there is no fixed limit of how much of this amount is used for a single-family member. The claim amount during the year is restricted to Rs. 5 lakhs for all family members put together.
If you take a normal group insurance policy in place of a floater, you have to define fixed amounts towards each family member and any unused amounts from one family member cannot be transferred to another member. Hence it is restrictive.
What is domiciliary hospitalisation? What is covered under it?
Domiciliary hospitalisation means treatment done at home in India for a period exceeding three days for disease, illness or injury, which in the normal course, would require hospitalisation. This could happen if either the condition of the patient is such that he/she cannot be moved to Hospital/Nursing Home, or the patient cannot be admitted to Hospital/Nursing Home for lack of accommodation.
In such cases, the cost of the treatment as well as expenses, if any, on employment of qualified nurses, employed on the recommendation of the attending Medical Practitioner is covered. The cover is limited to a maximum of 10% of the sum insured and will be payable once the treatment exceeds 3 days and it has to be applied for at the time of taking the policy.
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: Reliance Mediclaim Insurance
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