Some health insurance plans offer accidental death and disability benefits as a standard inclusion or as an additional cover. A specified percentage of SI or a lump sum amount will be paid for accidental death and specified benefits extended in case of accidental disability.
Few health insurance plans allow you to undergo treatments abroad, usually excluding US and Canada. This comes as either a standard benefit or an additional benefit. Some insurers allow treatments in US and Canada also with an additional premium.
Extended Cumulative Bonus (ECB) is an additional cover that offers added cumulative bonus for claim free years. This is over and above any normal cumulative bonus that may be a standard benefit in your health insurance plan.
Continue reading “Extended Cumulative Bonus”Maternity and Child Care covers allow expenses related to pregnancy, child birth and health cover for new born baby. Usually, these expenses are excluded in a standard individual health insurance policy. However, waiting period applies for this additional cover as per terms of the respective insurers.
Continue reading “Maternity & Child Care Cover”This additional cover allows reduction in waiting period for Pre-Existing Diseases (PED) from a usual 36 or 48 months to 24 months by paying additional premium.
Continue reading “Waiting Period Reduction”In case if the Sum Insured in your health insurance gets exhausted during a policy year, this additional cover refills Sum Insured for the same period unlimited number of times. This is over and above Automatic Restoration, which refills SI only one time during a Policy year.
Continue reading “Unlimited Automatic Restoration”It is important to disclose all material facts in the Insurer’s proposal form
All insurance policies are issued based on the material facts disclosed to the Insurer by you as the proposer (buyer of the insurance policy). The Insurer decides whether to accept the risk or not and if he decides to accept, calculates the premium to be collected only based on the material facts of the risk provided by you.
So, the Insurance contract between you and the Insurer is completely based on the facts provided by you in a proposal form and you are bound by duty of disclosure of all material facts known to you with regard to the risk you are covering under the insurance.
For example, you renew your car insurance policy with another insurer as you find them cheaper than existing insurer. In case, if you forget or fail to disclose that your car met with an accident in the previous year, based on the assumption that there is ‘no claim’, your new insurer will offer you the No Claim Bonus that you are actually not eligible for.
The above example is usually considered as ‘non-disclosure’ and a ‘mis-representation’ of facts. In such cases, the insurer can
As per a recent Supreme Court judgement, wilful non-disclosure of previous accident incidence is considered as fraudulent misrepresentation and entails penalty equivalent to the percentage of NCB deducted from a fresh claim. For eg. in such a case if the fresh claim amount is Rs. 1,00,000/- and the NCB on the renewal premium availed is 45%, then Rs. 45,000/- will be deducted from the claim in addition to the NCB amount of the premium.
In case, if the insurer reviews the claim and understands that the non-disclosure was not wilful or fraudulent, the insurer may allow the claim without any deductions. However, such a decision will be at the sole discretion of the Insurer.
It is essential for all buyers of insurance to disclose all relevant, known and material facts asked by the insurer in a proposal form. Insurer also has the duty of disclosure to all insurance buyers on the terms, conditions and coverage agreed under the insurance policy in clear, intelligible and transparent language.
As per standard industry practice, there are non-payable items in hospital bills under health insurance claims
You should be aware of what is payable and not payable on your hospitalisation claim by your health insurer. All insurers will require an itemised bill for the purpose of processing the claims, whether it is a cashless or a reimbursement claim.
Certain of the items in the bill, charged by the hospital, are not payable by the Insurance Company, as an Industry standard. These non-payable charges in the hospital bill are called ‘Deductibles’.
Continue reading “It is good to be aware of ‘Deductibles’ in your health insurance claim”
A handful of almonds per day offers an essential pack of nutrition to your body. They are rich in monounsaturated fats, fiber, proteins, Vitamin E, Manganese, Magnesium and other nutrients.
Being a powerhouse of nutrients and a ‘close to perfect’ food, Almonds offer many health benefits,
Eating 8-10 almonds a day is a wholesome snack that never makes you feel guilty.
Ayurvedic and other alternative treatments are also covered under health insurance
As per the directions of IRDAI in 2013, health insurance companies started covering Ayurvedic, Yoga and naturopathy, Unani, Siddha and Homeopathy treatments (known as AYUSH) in their health insurance covers.
Health insurance plans in India provide a portion of overall Sum Insured (SI) towards these alternative treatments as they are popular in India. The health insurers usually sub limit the SI for AYUSH as a percentage or an absolute limit of the overall SI.
If you have a health insurance policy with a Sum Insured of Rs.5,00,000/-, the policy will sub-limit the AYUSH cover for eg. to 10% of SI or an absolute value of Rs.50,000/-. So, the insured person can avail a reimbursement of any claims related to the said alternative treatments up to a limit of Rs.50,000/-
It is to be noted that AYUSH cover is applicable only for in-patient treatments taken in Hospitals certified by National Accreditation Board or Quality Council of India.
