Why You Must Have a Health Insurance Policy

• High Medical Costs: Healthcare expenses in India are rising rapidly. For instance, ICU stays can cost up to ₹1 lakh per day, and hospital visits may range from ₹10,000 to ₹3 lakh.
• Need for Preventive Care: Regular check-ups help detect health issues early, promoting long-term well-being.
• Expensive Treatments: Advanced procedures and quality care are costly and often unaffordable without insurance.
• Financial Protection: Insurance covers unexpected medical bills, saving you from financial strain during emergencies.
• Peace of Mind: Focus on recovery without worrying about medical costs.
• Long-Term Investment: Provides ongoing health benefits and security for you and your family.

Things to Consider When Buying Health Insurance

• Assess Your Healthcare Needs: Consider age, medical history, and family size when choosing a plan.
• Choose a Higher Sum Insured: Opt for higher coverage to avoid out-of-pocket expenses.
• Look for Short Waiting Periods: Choose plans with minimal waiting periods for treatments.
• Read Terms and Conditions: Know the policy to avoid claim issues later.
• Check for Optional Covers: Look for add-ons for extra protection.
• Consider Affordability: Compare premiums to find value-for-money plans.
• Evaluate Claim Settlement Process: Review the insurer’s claim ratio and service quality.

General Inclusions in a Health Insurance Policy

• Medically Necessary Hospitalizations (pre & post-hospitalization)
• Day care Procedures (like cataract, dialysis)
• Preventive Health Check-ups
• Ambulance Services
• AYUSH Treatment (Ayurveda, Yoga, etc. in govt-approved hospitals)
• Doctor’s Consultation (if included)
• Critical Illnesses Coverage (as per plan)

General Exclusions in a Health Insurance Policy

• Cosmetic Surgery (unless medically necessary)
• Bariatric Surgery & Obesity Treatments (unless covered)
• Injuries from Risky Activities (e.g., skydiving, mountaineering)
• War or War-like Situations
• Self-inflicted Injuries or Attempted Suicide
• Congenital Disorders
• Unlawful Activities
• Alcohol or Drug Abuse-related Issues

Note: Always check the specific policy document for exact inclusions and exclusions as these may vary.

How to File a Health Insurance Claim

1. Cashless Claim Process

1. Inform the Insurer:
   • Planned: Inform 48 hours before admission.
   • Emergency: Inform within 24 hours of hospitalization.
2. Visit a Network Hospital: Carry your insurance card and valid photo ID.
3. Fill Pre-Authorization Form: Submit at the insurance desk with required documents.
4. Await Approval: Insurer/TPA will send an authorization letter if approved.
5. Receive Treatment: Hospital bill will be settled directly.

Note: If cashless is denied, proceed with the reimbursement process.

2. Reimbursement Claim Process

1. Inform the Insurer: Notify them within the required time frame.
2. Pay Hospital Bills: Pay upfront and collect original bills.
3. Gather Documents:
   • Signed claim form
   • Health insurance card or policy copy
   • Doctor’s certificate
   • Discharge summary
   • Original bills, receipts, and pharmacy invoices
   • Investigation reports (if any)
   • NEFT and CKYC form (if amount exceeds ₹1 lakh)
4. Submit Documents: Submit to insurer/TPA.
5. Await Reimbursement: Approved amount will be credited to your account.

Important Tips

• Always carry your health insurance card and valid ID.
• Keep copies of all bills and reports.
• Inform the insurer within deadlines to avoid rejection.
• Read and understand your policy thoroughly.