Simplest Guide for Health Insurance in India

I have taken an health insurance policy from TATA AIG in june 2010 and on 29 june i have admitted in an 100 bed hospital due food poisoining and after discharge from hospital i am trying to contact those peopel for lodge of my claim but they are nither picking up my phone nor responding my sms and nor responding information given on their website, these people are just harrashing us at the time of booking of policy and force us for that and at the time of genine claim when then a person is suffering from his desease he also suffer for them………. shame on those insurance provider.v9 TATA AIG). please dont take any one policy from this company these are onlt cheater.

Dear friends, never take a policy from star health. That is my experience. I have submitted claim No: 7320
in May 19,2010 and when ever i inquire about the status, they will say, we will call back and after that no response. I called them around 10 times and never got a response from them. Now i really got desperate and i feel that i will never get a refund from them. So i am planning to give a complaint against star health , trivandum, plammoodu office in consumer court. so never get in trap with star insurance hearing the sweet words of agents. a very very bad company.

Greetings,
ICICI LOMBARD has issued me health insurance policy in the year 19th July 2006 and the same has been renewed by Health Insurance Renewal by the above number in July 2008. At the end of the month of July 2008 I have been detected with cancer of stomach and has been operated for the same. The said insurance company has paid me the sum assured for 2 yrs in 2008-2009 & in 2009-2010.

Now when the time for renewal of the policy has come and as I am perusing the matter with them & their back office, I had come to know & told bluntly about their reluctance to renew the same as I am being detected with cancer.

On the other hand New India Assurance Company of which I have also get the policy of heath insurance, they had renewed the same in the month of April 2010.

Please help me in this matter.Thanking you & oblige.

rajnish mayekar
9819047127

General conditions of the policy are as follows-

• You can take a Top up plan or a Super top up for an individual or as a family floater.
• There is a waiting period of 4 years for pre-existing ailments cover with all the companies.
• No expense will be covered till 30 days of buying health insurance policy.
• All expenses should be above the threshold limit for it to be payable.
• You can buy a top up policy even if you don’t have a health insurance policy covering the first level expenses.
• Pre and post hospitalization charges will be payable if the claim amount is above the threshold limit for Top up policies.

To know more see Top- Up your Health Insurance Policy!

Super top up is also like a top up policy the only difference is that for a top up policy, the expenses for a single treatment should be over the threshold while in a Super top up, the total amount of expenses in a year needs to go above the threshold level for the policy to be effective.

For example: For Mr. Sharma, a top up of Rs. 10 lakh will be ineffective as the cost of both his bypass and his mother’s knee replacement is under Rs. 3 lakh. But if Mr. Sharma opts for a super top up, since the cost of treatment in the year comes to Rs. 4.5 lakh, the additional Rs. 1.5 lakh will be paid by the company providing the Super top up.

Thus between Top-up and Super top up, Super top up is more beneficial for the customer.

To know more see Top- Up your Health Insurance Policy!

Top-up is a policy that provides an additional cover to add to your existing cover in a very economical way. If the cost of hospitalisation exceeds the ground policy cover, top-up health insurance takes care of the extra amount.

Suppose, a person has a medical policy of Rs 3 lakh from employer or has bought it himself, he has the option of buying a top-up of Rs 7 lakh. Now he has a total health insurance cover of Rs 10 lakh.

But it is from two different companies. In an emergency, if this person is hospitalized and the total expenses incurred are Rs 5 lakh the ground policy insurer will pay Rs 3 lakh and the remaining liability of Rs 2 lakh will be borne by the top-up insurer.

To understand top up plan better see Top- Up your Health Insurance Policy!

A pre-existing disease refers to any illness, injury, or medical condition that existed prior to the date of the commencement of the policy. This can include Diabetes, Hypertension or even Cancer.

Treatments for pre-existing diseases are covered and are payable by the insurance company, but only after the policy has been effective for a certain amount of time. Waiting periods for pre existing diseases typically range from two to four years, depending upon the insurance company and the type of pre-existing disease.

For senior citizens though, there are plans that cover pre existing conditions after a waiting period between one to two years as well.

To know more see Waiting period in a Health Insurance Policy

The ailment-specific waiting period

This refers to the number of years one has to wait for treatment of specific ailments to be payable under the health insurance policy. This differs from company to company. But generally, across all companies, during the period of insurance cover, the expenses on treatment of specific diseases and surgeries for specified periods are not payable if contracted during the early currency of the policy.

For instance,

• ENT disorders and surgeries, Polycystic ovarian diseases are covered only after 1 year from the date of commencement of the policy.            
• Diabetes, Hypertension, surgery of Hernia are payable only after 2 years from the date of commencement of the policy.
• Age related Osteoarthritis and Osteoporosis is payable only after 4 years from the date of commencement of the policy.

For this reason it is essential to completely be aware as to treatments for which all ailments are payable and after how many years as per the policy wordings of the company from which you have purchased your health insurance policy.

To know more see Waiting period in a Health Insurance Policy

 “Waiting period” is a part of your policy and determines from when you benefit from the policy, so it is pertinent that you have a complete understanding of the waiting periods in the health insurance policy you buy….

The initial waiting period

This refers to the 30 day waiting period – from the date of the commencement of the policy until the first 30 days – within which you will not be covered for treatment of any disease or ailment, except treatment for accidental external injuries that require 24 hours hospitalization.

To know more see Waiting period in a Health Insurance Policy

Firstly, there is a two-to-four year waiting period before which for pre existing diseases can be covered under the health insurance policy. Secondly there is a 30 day waiting period from the date of issue of the policy, within which you will not be reimbursed the hospitalization expenses, unless, the treatment refers to accidental injuries. Thirdly, certain specific diseases are not covered for certain periods of time, varying from policy to policy, for instance, hypertension may not be covered for two years from the date of policy, while joint replacement may not be covered before four years from the date of issue of the policy.

To know more see Basics of a Health Insurance Policy