Sum Insured

Maximum amount that can paid by the Insured as mentioned in the policy

Sum insured is the maximum pay-out amount that the Insurer is liable to pay to the insured in case of a claim and/or for the whole policy period. It works on the principle of indemnity. For e.g. the sum insured is ₹2 Lakh under health insurance, and if the insured gets hospitalised and his/her expenses turn out to be ₹3 Lakh, then the Insurer is liable to pay him/her ₹2 Lakh only.

Sub-Limit

Certain claims will have a limit to the amount of money that is paid by the Insurer

Sub-limit is a disease wise limitation on the claim amount. The amount of claim for a specific disease will be limited as per terms of the policy. In other words, it places a maximum limit of amount payable for treatment of one type of disease. Sub-limits are generally included for diseases such as hernia, cataract, maternity and other ailments or procedures, depending on the Insurer & their corresponding policy terms.

Reimbursement

This is the procedure by which the policyholder pays for treatment upfront to the Hospital from their own pocket, and claim it later from the Insurer. After submission of bills, the Insurer verifies the bills and pays the amount if found in order.

Proposal Form

Proposal forms with information provided form a part of the Policy.

Proposal forms are used to give the insurance company a complete picture of the risk against which insurance cover is desired. This proposal form is the basis with which the risk is assumed before issuing the insurance policy. Any misrepresentation or non-disclosure of facts could make the insurance invalid.

Waiting Period

Certain diseases will have a waiting period before any claims are accepted.

Waiting period for a specific disease/ailment is the period from the inception of policy within which claims will not be accepted for any treatment related to that disease. The policy holder has to pay the premiums for the waiting period and such claims will be accepted after the waiting period is over.

Continue reading “Waiting Period”

Pre and Post Hospitalisation cover

Your health insurance will cover expenses related to Doctor’s fees, Medicine and diagnostic tests before and after hospitalised treatment

Pre-hospitalisation Cover

Pre-hospitalisation expenses include various charges related to medical diagnostic tests and consulting doctor fees before you are hospitalised. The doctors/physicians conduct tests to accurately diagnose the disease/ailment before advising hospitalisation and treatment.

In most cases, expenses incurred for 30 days prior to your hospitalisation are covered under pre-hospitalisation cover. Depending on the health insurance plan taken the pre-hospitalisation cover is extended for a period of 30 days to 60 days prior to hospitalisation.

The bills related to such pre-hospitalisation expenses along with prescribed doctor’s certificates can be submitted to the Insurer and get reimbursed.

Post hospitalisation Cover

Post hospitalisation expenses include various charges related to medical diagnostic tests, prescribed medicines and consulting doctor fees after you are discharged from the hospital. The doctors/physicians advise tests and medicines after the hospitalised treatment to monitor your recovery.

In most cases, such expenses incurred after your discharge from the hospital are covered under post hospitalisation cover. Depending on the health insurance plan taken, the post hospitalisation cover is extended for a period of 60 days to 180 days after hospitalisation.

The bills related to such post hospitalisation expenses along with discharge summary and prescribing doctor’s certificates and test reports can be submitted to the Insurer and get reimbursed.

Post-Hospitalisation

The policy covers certain expenses after the patient is discharged from the hospital.

Post hospitalisation expenses include all expenses or charges incurred by an individual after they are hospitalised. Doctors/physicians may prescribe certain tests to check the progress or recovery of a patient. In most cases, charges incurred by an individual for 60 days from the discharge date are covered.