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Health Insurance Policy Tuesday, 29 April 2014

Health Insurance

The term ' Health Insurance' relates to a type of insurance that essentially covers your medical expenses. A health insurance policy like other policy is a contract between and insurer and an individual/ group in which the insurer agrees to provide specified health insurance covers at a particular "Premium" subject to terms and conditions specified in the policy.

  • What a Health Insurance policy would normally cover
A Health Insurance Policy would normally cover expenses reasonably and necessarily incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured.
  1. Room, Boarding expenses
  2. Nursing expenses
  3. Fees of surgeon, anesthetist, physician, consultants, specialists
  4. Anesthesia, blood, oxygen, operation theater charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, Chemotherapy, Radio therapy, Cost of pace maker, Artificial limbs, cost or organs and similar expenses.
  • Sum Insured
The Sum Insured offered may be on an individual basis on floater basis for the family as a whole.
  • Cumulative Bonus (CB)
Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage. In case of a claim, CB will be reduced by 10% at the next renewal.
  • Cost of Health Check-up
Health policies may also contain a provision for reimbursement of cost of health check up. Read your policy carefully to understand what is allowed.
  • Minimum period of stay in Hospital 
In order to become eligible to make a claim under the policy, minimum stay in the Hospital is necessary for a certain number of hours. Usually this is 24 hours. This time limit may not apply for treatment of accident injuries and for certain specified treatments. Read the policy provision to understand the details.
  • Pre and Post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expense for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease /sickness.

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