Health Insurance

With the ever-increasing population, pollution has also escalated, and as a result, people are exposed to a greater risk of suffering from diseases and treatment costs are increasing day by day. Increased population also results in additional vehicular traffic and more accidents. Therefore, it has become essential to take a Mediclaim insurance policy to cater to such emergencies.

If the insured person sustains an injury or contracts any disease and if medically necessary, he/she has to incur hospitalization expenses, then reasonable and customary charges of the following hospitalization expenses will be paid:

• Room, boarding, and nursing expense
• Fees of a medical practitioner/anesthetist/consultant/surgeon
• Expenses on anaesthesia, blood, oxygen, operation theatre, surgical appliances, medicines and drugs, diagnostic materials and x-ray, dialysis, chemotherapy, radiotherapy, pacemaker, artificial limbs, organ, and similar expenses
• Expenses on tonics and vitamins only if they are part of the treatment certified by the attending medical practitioner
• The relevant expenses incurred for domiciliary hospitalization
• Extra daily allowance for the hospitalization duration towards covering of miscellaneous expenses
• Charges of ambulance in connection with any admissible claim limited
• Admissible day care treatment (less than 24 hours hospitalization), pre and post hospitalization
• Cost of health check-up – Reimbursement of cost of medical check-up once at the end of a block of every four continuous claim-free policy years, subject to a maximum of 1% of the average sum insured during the term
• Other admissible expenses

This policy will trigger when there is minimum 24 hours hospitalization. The hospital where treatment is taken should have minimum 15 beds, and the policy holder can avail cashless facility for the treatment taken or he may go for reimbursement of expenses incurred.

Normally, the policy does not cover:

• The treatment of pre-existing diseases for a certain period
• Expenses in the course of the first 30 days from the inception of the first policy, excluding accident-related treatment
• Treatment expenses of specific diseases aren’t payable up to a certain period

The premium paid for this policy can be claimed for deduction under section 80D of Income Tax Act up to Rs 25,000/-

Each one of us in our day-to-day life is exposed to risks of accidents, though exposure to some is greater than others. Besides manmade disasters, natural hazards such as lightning, flood, earthquake etc., are equally responsible for accidents.

Personal Accident Insurance has been designed for individuals or members of various groups to provide compensation or financial assistance in case one suffers from death or disability due to some external, accidental, or violent means.

Coverage:

The policy provides for payment of a fixed amount (benefit) on the happening of specified contingency caused by external, accidental and violent means. An accident may include events like:

• Rail, road, or air accident
• Injury due to any collision/fall
• Injury due to bursting of gas cylinder
• Snakebite
• Burn injury, drowning, poisoning, etc.

This is only an illustrative list, not an exhaustive list. The capital sum insured to opt depends on the annual income of the particular person.

The best part of this policy is that it compensates the salary amount for that particular period when the insured person is temporarily confined due to some accident and is unable to attend his occupation/profession.

The most crucial part of an organization is human beings. As a part of HR policy, many organizations take a Group Personal Accident Insurance cover to safeguard their employees.

Nowadays, accidents are a matter of common occurrence and can cause death or disablement. Insurance coverage would be essentially required to protect the members of an organization. A Group Personal Accident Policy is an ideal solution for this.

Coverage:

This policy has been designed to provide compensation in the event of the insured person sustaining injuries, solely and directly from an accident caused by violent, visible, and external means, resulting in death, Permanent Total Disablement (PTD), Permanent Partial Disablement (PPD), Temporary Total Disablement (TTD) or Medical Expenses Cover (OPD & IPD).

The coverage is worldwide. This policy provides for payment of specified amount (benefit) on happening of specified contingency due to the accident. An accident may include events like:

• Rail, road, or air accident
• Injury due to any collision/fall
• Injury due to bursting of gas cylinder
• Snakebite or frostbite
• Burn injury, drowning, poisoning, etc.

This is only an illustrative list, not an exhaustive list.

The proposer can either opt for a basic cover for death only, for which the premium is minimum, or one can take an upgraded cover to include Permanent Total Disablement/Permanent Partial Disablement/Temporary Total Disablement/Medical Expenses Cover.

Numerous organizations take a Group Mediclaim Insurance Policy for employees to seek protection for them. Some also take group medical insurance for family.

The policy is meant to cover hospitalization expenses incurred by the members of an organization in case they happen to suffer from a disease or sustain an accidental injury. The following hospitalization expenses will be paid under the following heads:

• Room, boarding, and nursing expense
• Fees of a medical practitioner/anesthetist/consultant/surgeon
• Expenses on anaesthesia, blood, oxygen, operation theatre, surgical appliances, medicines and drugs, diagnostic materials and x-ray, dialysis, chemotherapy, radiotherapy, pacemaker, artificial limbs, organ, and similar expenses
• Expenses on tonics and vitamins only if they are part of the treatment certified by the attending medical practitioner
• The relevant expenses incurred for domiciliary hospitalization
• Extra daily allowance for the hospitalization duration towards covering of miscellaneous expenses
• Charges of ambulance in connection with any admissible claim limited
• Admissible day care treatment (less than 24 hours hospitalization), pre and post hospitalization
• Cost of health check-up – Reimbursement of cost of medical check-up once at the end of a block of every four continuous claim-free policy years, subject to a maximum of 1% of the average sum insured during the term
• Other admissible expenses

This policy will trigger when there is a minimum of 24 hours of hospitalization. The hospital where treatment is taken should have a minimum of 15 beds, and the policyholder can avail cashless facility for the treatment taken, or he may go for reimbursement of expenses incurred.

The basic cover can be enhanced by opting for add-on covers by paying an extra premium and such add-on medical insurance cover are as below:

• Waiver for pre-existing diseases
• Waiver for first 30 days exclusion
• Waiver for first year/first two years/first four years exclusion.
• Maternity benefits and newborn baby cover from day one
• Corporate buffer

This policy is a very good tool for an organization to ensure that their employees are fully covered to meet any sort of medical emergency.