Brief Information about Health Insurance
General Insurance:
Broadly, General insurance is divided into 3
Categories i.e.
1.
Personal
Insurance
2.
Liability
Insurance
3.
Property
Insurance
Personal Insurance has 2 major aspects i.e.
1.
Mediclaim
Policies
2.
Personal
Accident Policies
Mediclaim Policies:
Introduced in India in
1981. They offer Health insurance and can be issued as Individual policies or as
a Group Policy.
Health
Insurance:
·
It
is a type of insurance coverage that covers the cost of an insured individual's
medical and surgical expenses. Depending on the type of health insurance
coverage, either the insured pays costs out-of-pocket and is then reimbursed,
or the insurer makes payments directly to the provider.
·
A
Health Insurance policy reimburses the insured for medical and surgical
expenses arising from illness or injury that leads to hospitalization
Inclusions:
Following
expenses are reimbursed
1.
Nursing
expenses, Anaesthesia and other specialist doctor Fees.
2.
Operation
theatre, Room and Boarding Charges
3.
Treatment
in a Hospital which has to be
·
Registered
·
Has
an Operation theatre
·
Has
atleast 15 Patient Beds (10 for C class Cities)
4.
Requirement
is that Patient should be admitted for atleast 24 hrs but this condition not
applicable in case of – “Dialysis, Chemotherapy, Dental Surgery etc”.
5.
Medical
Expenses 30 days prior to and 60 days after hospitalization are also paid provided
incurred for same ailment for which he is hospitalized.
Exclusions:
Following
Expenses are excluded from the Policy:
1.
War
and Nuclear Perils
2.
Pre-existing
Disease, AIDS, Hearing Aids and Spectacles
3.
Certain
ailments are excluded for the first 30 days from the start of policy and some
ailments are excluded for the first year such as Cataract, Hernia, Piles as
they take time to develop.
Notes:
1.
These
Policies can be issued in age group 5-80 years. However Children can covered
between 3 months and 5 years too if one of the parents have taken a Mediclaim policy.
2.
Principle
of Contribution Shall Apply.
3.
Policy
can be cancelled by 30 days Notice. If cancelled by insurer, refund is made on
Prorate basis. If cancelled by insured, refund is based on Short period basis.
Deductions
by Government:
Persons
Covered
|
Exemption
Limit
|
Check-up
Exemption
|
Total
|
Self,
spouse and children
|
Rs.
25000
|
Rs.5000
|
Rs.30000
|
Self
and family + parents
|
Rs.25000+25000=50000
|
Rs.5000
|
Rs.55000
|
Self
and family+ senior citizen Parents
|
Rs.25000+30000=55000
|
Rs.5000
|
Rs.60000
|
Self
(senior citizen) and family and Parents (senior citizen)
|
Rs.30000+30000=60000
|
Rs.5000
|
Rs65000
|
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