Maternity & Child Care Cover

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.

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Unlimited Automatic Restoration

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.

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Duty of Disclosure

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.

What happens in case of a ‘Non-Disclosure’ Or ‘Misrepresentation’

The above example is usually considered as ‘non-disclosure’ and a ‘mis-representation’ of facts. In such cases, the insurer can

  • Void the Policy
  • Can Reject Claims
  • Can penalise you as it is appropriate
  • Can still ignore the breach of good faith and honour claims

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.

Duty of Disclosure applicable to the Insurers too!

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.

It is good to be aware of ‘Deductibles’ in your health insurance claim

As per standard industry practice, there are non-payable items in hospital bills under health insurance claims

Health Insurance does not cover 100% of the treatment cost

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’.

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Almonds are forever – the healthy snack

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,

  1. Rich in Anti-oxidants: Almonds are high in anti-oxidants that can protect your cells from oxidative damage, a major reason for ageing and disease.
  2. Best source for Vitamin E: Almonds are the best source for Vitamin E, which is linked to numerous health benefits
  3. Assists in controlling blood sugar: Almonds are rich in magnesium that helps control blood sugar. 25% to 38% of people with type-2 diabetes are deficient in magnesium. Intake of almonds may offer major improvements for metabolic syndrome and type-2 diabetes.
  4. Helps in lowering blood pressure: Deficiency in magnesium is strongly associated with high blood pressure levels. Intake of magnesium rich almonds can help control blood pressure
  5. Supports Reduction of LDL cholesterol: Eating a handful of almonds everyday can result in mild reduction of ‘bad’ LDL cholesterol in your blood, potentially reducing the risk of ‘heart diseases’
  6. Prevents oxidation of LDL cholesterol: Almonds do prevent LDL cholesterol from oxidation, which is crucial in preventing the development of heart diseases. Snacking on almonds has been shown to significantly reduce ‘oxidised LDL’.
  7. Effective in ‘weight loss’: Almonds are low in ‘carb’ and high in proteins and fibers. Due to their satiating properties, in general, nuts are a great addition to a ‘weight loss’ diet. Studies have established that almonds can enhance weight loss.

Eating 8-10 almonds a day is a wholesome snack that never makes you feel guilty.

Know what is AYUSH Cover in health insurance

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.

3 good reasons why you should opt a Hospicash cover

It will be good to have an Insurance which extends daily allowances to cover your extra expenses.

Having a health insurance with appropriate Sum Insured value will help you in getting treatments covered. But, it does not cover your 100% cost of treatment and all related expenses.

Hospital Cash Benefit Cover, either as an additional benefit under a health insurance policy or a separate cover will give you daily cash allowance for a specified period during hospitalisation.

Due to the following reasons, it is best to have an additional hospicash cover:

  1. Certain deductions in health claims are standard.
  2. If you exceed your Room Rent limits, proportionate deductions are applicable in your claims.
  3. You will always have other expenses related to your hospitalisation like costs of travel, food for attenders, etc.

Hospital Cash Benefit cover will extend you daily allowance to cover the expenses as stated above.

What you should know about ‘OD only’ renewal of Car/Bike Insurance

If your new vehicle is bought after 1st September 2018, you will require ‘OD only’ renewal..

All new cars and bikes that are sold by dealers from 1st September 2018 will have 3 years and 5 years third party insurance as per the Order of the Honourable Supreme Court of India.

That is, a new car sold on 1st September 2018 will have third party (TP) insurance coverage up to 31st August 2021 and a new bike up to 31st August 2023.

Car/Bike Insurance Policies with 1 year OD and 3/5 Years TP Covers

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