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Health Insurance Plans

WHAT IS HEALTH INSURANCE
WHAT IS HEALTH INSURANCE?
HEALTH INSURANCE PLAN IS A PRODUCT OFFERED BY INSURANCE
COMPANIES THAT COVERS ALL COSTS RELATED TO MEDICAL EXPENSES OF
THE INSURED. THIS CAN BE BOUGHT FOR AN INDIVIDUAL OR FOR AN
ENTIRE FAMILY. THE TERM OF THE PLAN IS IDEALLY FIXED AT ONE YEAR
AND IN SOME CASES ONE CAN BUY THE PLAN FOR A TERM OF TWO TO
THREE YEARS AS WELL. WITH HEALTH INSURANCE PLAN IN PLACE, ONE
GETS ENTITLED TO ADEQUATE MEDICAL HELP IN CASE OF AN EMERGENCY
OR IN A PRE-PLANNED MEDICAL EXPENSE, WITHOUT WORRYING ABOUT
THE FINANCIAL COSTS.

HERE IS HOW IT WORKS:
HEALTH PLAN TAKES CARE OF ENTIRE HOSPITALIZATION EXPENSES
SUBJECT TO MAXIMUM SUM INSURED AND TERMS OF THE POLICY. ALL
PLANS ALSO COVER PRE AND POST HOSPITALIZATION EXPENSES.
THERE IS A CASHLESS FACILITY AVAILABLE UNDER WHICH YOU CAN
AVAIL THE BEST MEDICAL CARE AT ANY OF THE NETWORK HOSPITALS &
ALL THE PAYMENT RELATED TO YOUR TREATMENT WILL BE SETTLED
FROM THE INSURANCE COMPANY DIRECTLY. THIS WAY THE INSURED CAN
IMMEDIATELY GET TREATMENT WITHOUT HAVING TO WAIT FOR
ARRANGING THE FUNDS.
 Eligibility Criteria For Health Insurance Plan!
 Health Insurance is an important policy to have as it protects your health
and provides financial security against medical emergencies. Whether you
go for individual health insurance or family floater plan, there are certain
conditions you need to fulfill which make you eligible for health insurance:
 Age Criteria:
Health Insurance for Adults Minimum entry age for adult is 18 years and
there is no maximum age criteria . In some policies entry age is restricted
from 18 to 65 Years (There are particular plans from certain insurers which
cater to senior citizens above the age of 65 years)
 Health Insurance For Children: Entry Age 91 Days to 24 Years. In some
plans maximum entry age for child is 25 years.
 Health Insurance Renewal Age For All: Health insurance plans can be
renewed for lifetime.
 Other Criteria
Further, health insurance companies wants to be sure that you are worthy
of being a client and don’t come with more than expected risk for them.
Hence, they have certain guidelines and eligibility criteria based on which
they decide to sell you a suitable health plan or may reject your application.
They check you for:
 1) Lifestyle diseases
 2) Smoking/drinking
 3) Pre-existing Diseases
 Keep your records up to date and apply for a comprehensive health
insurance through easypolicy.com!
 Key Advantages and Features!
 Health insurance plans come with a hoard of advantages and features when it comes to saving
your money without compromising on any aspect of your health.
 Easypolicy.com brings you the best of the features, enabling you to choose the best health plan
for you:
 1) Save Money
Medical care costs a lot of money, but with a comprehensive health plan in place you can focus
on getting the treatment while the majority of the expenses are borne by your insurer.
 2) Cashless Hospitalisation
All health plans offer cashless hospitalization feature, where-in you can get admitted to a
network hospital and start getting treatment without paying money from your own pocket. The
treatment cost will be settled directly between your insurance company & hospital.
 3) Critical Illnesses Rider
Health plans come with cover against critical illnesses like cancer, paralysis, kidney disorders,
diabetes, heart-related complications and the likes that usually cost a lot of money for treatment
and management. The plans pay you the entire sum insured at the time of diagnosis of such
diseases itself. You have to pay additionally for this rider.
 4) Pre and Post Hospitalisation
Private health care costs are going through the roof and health insurance not only pays for your
complete hospitalisation but for pre and post hospitalisation expenses. Expenses which you
incurred on diagnostics, pharmacy, consultation before or after your hospitalisation.
 5) You Can Get Back Maternity Expenses
You can also buy health policies to cover maternity expenses including delivery charges and
post-delivery expenses too, subject to terms of the plan.
 6) OPD Benefits
Various insurers provide you comprehensive health cover by reimbursing your claims for
consultation, diagnostics & pharmacy as Out Patient Department (OPD)
 7) No claim bonus
If you don’t file for claims in a given policy year, the subsequent year can earn you a no claim
bonus (NCB) or cumulative bonus (CB) that results in enhanced sum insured. Depending on
the insurance plan and insurer, it can start at 5% increase and go up to a maximum of 150%
during subsequent continuous claim-free years.
 8) Cover for Pre-existing Diseases
The health plans also cover pre-existing diseases even though there is a waiting period before
the disease gets cover. It varies from plan to plan.
 9) Annual Health Check-ups
Many insurers offer free annual health check-ups to woo the buyers. These can be conducted at
the empanelled centre and the insurer pays the expenses to the centre directly. If the insured
gets it done from some non-empanelled centre, he can get the reimbursement after submitting
the necessary bills up to the amount as mentioned in the policy documents.
 10) Restoration of Benefits
Even if you have utilised the entire sum insured due to hospitalisation, some plans will restore
the entire amount within the same policy year at no extra cost. The extra amount can be used
for different disease & different individual.
 11) Day Care Procedures
Some medical treatments like chemotherapy or dialysis may not require 24hours or more of hospitalisation.
For such day care expenses, insurers have special provisions that help you get treatment without paying from
your resources.
 12) No Capping
Even though a lot of plans fix an upper limit of expenses like in case of room rent or doctor visit, certain plans
come with no capping!
 13) Online Wellness Programmes
Insurance companies run online wellness programmes to help their customers learn more about their health,
engage with experts through video chats and avail various discounts and free deals while dealing with the
insurers. Customer can redeem their earned points & can avail the discount in the renewal premium
 14) Senior Citizen Plan
Old age comes with lot of medical complications and that is when you require maximum medical help. Health
plans help you to meet all expenses related to health related issues even during your old age.
 Get covered for all your medical contingencies. Choose the best suited health plan now at easypolicy.com!
 15) Additional Riders
One cannot buy health plans that cover all possible risks as no plan offers such coverage. But one can buy the
best plan possible and then buy some additional riders to cover some additional risks by paying little bit of
extra premium.
 16) Top-up Plans
You can avail of this feature under which you can pay for your hospitalisation expenses after your basic sum
insured is exhausted. In simple words Top-up plans or Super Top-up plans help you to enhance your existing
sum insured as provided in your current insurance policy by paying a bit of extra premium rather than buying
an entirely new policy that can prove to be a complicated and costly process.
 Get covered for all your medical contingencies. Choose the best suited health plan now at easypolicy.com!
 Benefits of Health Insurance Plans!
 A health insurance plan is an important part of your financial planning which should be in place
for safe, secure and healthy life.
 Health Plans come with a superfluous host of benefits that cover all your medical needs as well
as contingencies:
 Here are all benefits (inclusions) you can get from your health insurance plan:
 Cashless hospitalisation in network hospitals of your insurance provider. Pre and post
hospitalisation expenses are also covered.
 Critical illness cover if you are diagnosed with life threatening diseases like cancer, tumour or
kidney failure etc. In such cases the insurance company pays a lump-sum amount at the time of
diagnosis, to start the treatment at the earliest.
 Pre-existing diseases cover if you are already suffering from a severe ailment, at the time of
buying the plan. The treatment expenses are compensated by insurance provider.
 Apart from the above, the other expenses that can be covered under your health plan, based on
type of plan and additional riders, are:
 Critical illness
 Personal accident
 Hospital daily cash
 There are some expenses that are never covered in your health insurance plans:
 Cosmetic Surgeries are not reimbursed.
 Orthodontic Surgeries (Teeth Beautifying) are not reimbursed.
 HIV/AIDS, STDs, infertility, hormonal replacement therapy, weight management services,
treatment of congenital anomaly etc.
 Non consumable listed by the insurance companies are not covered
 Importance of Health Insurance!
 On the list of priorities in our life, health insurance must be amongst the top ones. It is very
important to have a secure health and ample funds available, in case you encounter uncalled for
health contingencies.
 Here are the reasons why a health plan is absolutely necessary:
 1) Protection of Health
Health insurance policies not only come to your aid at the time of hospitalisation, but some of
them also help you in getting free medical check-ups and timely medical care counselling. Most
people are inclined to get counselling when they know they won’t have to bear the expenses.
With expensive doctor visits and prohibitive costs of medical tests, it is obvious that health plan
covering such expenses comes as a saviour!
 2) Financial Support during Emergencies
During emergencies, cashless treatment helps in getting adequate and timely treatment without
the dependants of the insured having to scramble for funds.
 3) Protection against Rising Health Expenses
While advancement in science and technology has helped in getting better medical care, the
cost of such treatments has also gone through the roof. An adequate sum insured with a health
plan can help you to get proper medical care, no matter what your financial status is! The
insurer takes care of money matters while you can focus on getting the right treatment.
 4) Productive Utilization of Own Savings
We save money to pay yearly premiums for health insurance policies. We
may not need to use the health policy benefits every year and it may look
like waste of money in the short-term. But the day you need to be
hospitalised, all these indirect savings will come to your aid by saving your
life and getting you satisfactory medical treatment.
 5) Source of Credit
Not everyone has enough of a bank balance or sufficient cash at home to
face medical emergencies. Health insurance can help you buy time to make
hospitalisation payments. Even if you have to somehow pay from your own
pocket initially, due to any reason, you can always claim it back.
 Understand the need of health insurance more clearly:
 Types of Health Insurance Plans!
 There are different kinds of health plans catering to individual health requirements and lifestyle
needs.
Following are the various types of health plans for you to select from:
 1) Individual Policy
As the name states, you can buy it for yourself and covers only your health related expenses.
 2) Family Floater Policies
These polices cater to entire families including spouse and children and in some cases it
includes parents & extended family too under a single umbrella policy. These are comparatively
cheaper than individual plans
 3) Critical Illnesses Plan
This plan is to provide health benefits for critical illnesses like cancer, paralysis, stroke, heart-
related ailments and the likes. Under these plans, the insured is paid the entire sum insured at
the time of diagnosis itself rather than waiting for the treatment to get over.
 4) Maternity Policies
These are the plans that take care of maternity related expenses including hospitalisation, upto
2 delivery & MTP expenses and cover the new born baby expenses for a certain period of time.
 5) Senior Citizen Plan
Senior citizens are the most vulnerable lot, who require expansive medical care that results in
massive expenses too. Senior citizen plan can help them get adequate care without burning a
hole in the pocket.
 6) Cardiac Care Plan
These are cardiac special health insurance plans since the cost of treatment has risen drastically
in last few years. These plans cover all heart-related ailments and surgeries.
 7) Diabetics Plan
These plans cover the insured for diabetes and its related complications even if the
customer is suffering from the disease at the time of taking the policy. Diabetes can
be covered from day 1 or after a waiting period depending on the plan. There are
only a handful of players in the market providing such coverage so choose carefully.
 8) Dengue Care Plan
Dengue comes back as an epidemic every year and the cost of treatment is extremely
high as well. With such plans one can manage the disease if it strikes despite all
precautions.
 9) Personal Accident Plan
An accident can happen anywhere, anytime. The result could be disability, partial
disability and long periods of recovery and rehabilitations. The personal accident
plan gives u a lump sum amount & helps to cope up with expenses during this
period including hospitalisation expenses and routine household expenses.
 10) Top-up Plans
Top-up plans provide the benefit of higher insurance coverage at only a marginally
higher cost. They can be a good supplement to your primary health cover. Top-up
plans come with a deductible or threshold limit, you need the claim above the
deductible in a single claim to trigger the Sum Insured for plan.
 11) Super Top-up Plans
Super Top-up plans provide the benefit of higher insurance coverage at only a
marginally higher cost. These plans come with a deductible or threshold limit, you
need the claim above the deductible in a multiple claim to trigger the Sum Insured
for plan. This plan is better than the top-up plans.
 12) Cancer Care Plans
Even though cancer is part of critical illnesses plan, a health policy dedicated only
for cancer is more beneficial if the insured has a family history of the said disease.
This way one can have access to substantial amount of funds for managing and
treating the disease.
 13) Extended Family Plans
Certain insurers also provide health insurance coverage to siblings and extended
family including family of spouse etc. This gives comprehensive health coverage to
entire family.
 14) Worldwide Emergency Cover Plan
For those travelling frequently all over the world for business or leisure purposes
can avail such plans to take care of the emergency hospitalisation expenses in a
foreign country. Make your health insurance search easy at easypolicy.com!
 Make your health insurance search easy at easypolicy.com!
 What Is Cashless Medical Insurance? What Are The Benefits?
 All insurance companies these days offer cashless medical insurance, to help us live
a stress-free life and put our energies into getting treatment in case of medical
emergencies instead of running around for funds.
Let’s understand in details how these help us:
 A cashless medical insurance is one that helps the insured patient to
immediately get admission in a hospital without waiting for the funds to be
arranged to start the treatment

 2) How Does It Work?
 Cashless medical insurance plans work in following two scenarios:
A) During Planned Medical Treatment: In case you’re getting admitted as per
the plan, you can check which hospitals are affiliated with your medical policy and
then get admitted in the one that works out the deal for you after clearing details
with the TPA (Third Party Administrator appointed by insurance provider).
 B) Emergency Hospitalisation
In such a scenario, produce your health insurance card to the TPA present at the
hospital and as per guidelines they would have to process your claim within 6 hours.
So you get a confirmation whether you’re getting the cashless claim or not almost
immediately without obstructing the medical treatment!
 3) When Would These Not Work?
 Cashless medical policy is not applicable to attendant or visitor charges,
ambulance expenses, toiletries, service charge, documentation charges and few
other smaller medical expenses defined by different insurance providers in their
respective policies. 4) Can The Claim Be Rejected?
Yes, the claims can be rejected in case the information given in the form at the time
of applying for the policy is incorrect, if the insurance policy doesn’t cover the illness
for which you’re admitted or if the insured amount has been exhausted already!
 5) Things to Remember
 Always check the network hospitals before getting admitted.
 Save all the bills, documents and hospitalization paperwork for future references at
the time of filing the claims.
 The bill amount to be reimbursed should be less than or equal to your insurance
amount.
 Read the terms and conditions carefully while buying a cashless medical
insurance policy because certain conditions might not make you ineligible for
cashless treatment.
 The major benefits of cashless health insurance plans are:
 You do not have to arrange for immediate funds in case of
emergencies., to pay upfront cash at hospital desk. Just focus on the
treatment.
 You do not have to worry about the paperwork to be submitted to
file the claims. TPA appointed by insurance company will take care
of everything by coordinating directly with the network hospital.
 Quick resolution in case of emergencies is provided by the TPA. If
you are not able to get the treatment at a network hospital, you can
still claim re-imbursements after submitting relevant documents.
 Cashless medical insurance is a perfect tool for ordinary consumers
seeking adequate medical treatments without having to worry about
the money arrangements.
 Factors That Affect Health Insurance Premium!
 Health Insurance is important and a must have for you and your family.
However, it is also important to consider the premium amount that you would have
to pay, to ensure the best suited policy as per your needs.
 Here is an insight on the factors that affect health insurance premium, for you to
decide on the best.
 Combined Insurance at Lower Premium
Family floater policies come at a lower premium but higher sum insured. Only if the
senior citizens at home are excluded from the plan, as policies for senior citizens
who are prone to health crisis, come at higher premiums.
 Add-ons (Riders) Come At Extra Premium Cost
Additional riders for extra medical cover and additional services come at higher
premiums. These riders include critical illness cover, personal accident cover,
hospital cash etc. If you check your needs thoroughly and decide that you may not
need such add-ons, or choose that you would really need, you can pay a lower
premium for health insurance policy.
 Deductible Brings Your Premium Down
In case of a medical emergency, a part of the cost will be borne by the policyholder
and the rest is taken care of by the insurance company. Higher deductible chosen by
you, lower the premiums!
 Age & pre-existing disease:
You attract lower premium rates if you and your family are living a
healthy lifestyle; i.e. non-smoking, non-drinking & does not have
any pre-existing disease at the time of policy issuance. Make sure
you provide correct information while buying the policy.
 Online Medical Insurance Comes At Lower Premium
If you buy your medical insurance online, you pay lower premiums.
Many insurance companies provide the discount if the policy is
bought online.
 Keep these factors in mind, and zero to the best health insurance
policy with lower premiums, only at easypolicy.com!
 Why Should You Buy Health Insurance!
 If you think you do not need health insurance, think again!
There are a lot of valid reasons why should you buy health insurance plans for you, and
your family.
Let’s share with you some of the most important reasons that why should you buy health
insurance:
 1) To Take Care of Emergencies
In case of medical emergencies like an accident or sudden health disorder, you might find
yourself short of cash or funds. For those times, buy health insurance and deal with the
emergency in a calm and rational manner.
 2) To Assure the Cost of Hospitalisation
Nowadays, private medical care is beyond the means of most of the population and government
hospitals don’t promise world-class medical care. To meet the rising cost of private hospitals, it
is very important to have an insurance cover and to buy health insurance.
 3) To Keep Safety against Ever Growing Diseases
In this age of high stress and fast-paced life, diseases are striking harder and faster than before.
If you buy health insurance policy, you can sleep well at night with the thought that you
have secured yourself and your family to a large extent!
 4) To Avail Tax Benefits
Now this is the most common reason for people to buy health insurance plans! Even if it should
not be the main reason, it does hold true when it comes to smart investments. Not only one
safeguard against contingencies, this investment also helps in saving some hard money for
better usage!
 5) It Is Easy
Yes, it is not difficult at all to buy health insurance these days
with the advent of internet and technology at your service 24X7! All
you have to do is find out all possible information about various
insurance products online, shortlist the ones that suit your needs
and buy! The whole process is simplified for you so that even the
technical jargons don’t scare you away.
 If you want to stop getting worried about the health and well-being
of your family, the best idea is to buy health insurance plans!
Do it now only at easypolicy.com!
 Tips To Buy Health Insurance!
 Easypolicy, your most trusted insurance advisor, present some effective tips to buy health
insurance!
 1) Analyse your needs in details and decide whether to but a family floater or individual
health plans. With elderly in the house, or someone suffering from critical disease, it is always
advisable to buy individual policy.
 2)Look out for best health insurance company that offers good customer services, has
good liquidity ratio, excellent market standing with exemplary claim settlement records.
 3) Choose the right sum assured to get adequate medical care in times of emergency. Do
not under-insure to save premium.
 4) Make appropriate comparisons on various health plans available, to find out the
benefits, deductibles, sub-limits, riders etc. to make the best choice.
 5) Keep your focus on larger expenses like limits on room rent, doctor’s visiting charges,
ICU charges etc., and avoid to choose basis smaller expenses like ambulance services or daily
cash. Bigger expenses covered will make your medical insurance really helpful.
 6) Check the network hospitals of the insurer, that they are well equipped, reputed and
near to you, in case you need to go for a cashless treatment or otherwise.
 7) Go through the terms and conditions related to pre-existing diseases, waiting period
etc., carefully before finalising, as the claims are settled strictly based on the terms, especially in
the finger print.
 The best health policy is one that provides you with the maximum benefits at lowest possible
premiums. Compare at esypoicy.com and reach that best policy, NOW!
 Why Should You Compare Health Insurance?
 There are multiple health insurance companies and each one has different health
plans to offer.
Primarily, Health Insurance is entirely based on individual needs and priorities. If
you don’t compare health insurance plans and buy the first policy you come across,
then you might lose out on some important benefits or lower premiums.
Here at Easypolicy, we are committed to give you right and best information.
Therefore, we bring to you some of the advantages of comparing health plans to
enjoy maximum benefits out of them:
 1) Coverage Amount/Sum Insured (SI)
Different health plans offer you different sum insured. This depends not only on
your age, health conditions, lifestyle etc., but also on the insurer’s pricing strategies
and risk taking abilities. More the sum insured you’re offered, less you pay from
your own pocket in times of crisis. Comparing health plans would ensure that you
get the best coverage amount given your background and may even cost less than
your expectations due to competitive pricing by various insurance companies.
 2) Capping
A lot of health plans will put a limit to expenses you can claim for during
hospitalisation. These include upper limits on room rent, doctor visits and other
overhead charges. There are also certain plans that have no capping at all. To find
out the best amongst many, compare all health plans!
 3) Co Pay
This is a feature in all major health plans under which the insured agrees to pay a fraction of the
total medical cost from own pocket and the balance amount will be paid out of the insurance
policy. For example, if the policy states a co-pay of 10%, then the insured will pay 10% of the
total cost of hospitalisation and balance 90% will be paid out of his insured sum. Each plan has
different terms and conditions regarding co-pay so comparing them make it beneficial for the
insured to get the best deal.
 4) Pre-existing Cover
The health insurance companies are very particular about which diseases to cover. When it
comes to pre-existing disease, there is a waiting period so as to lower their exposure to risks.
However, this waiting period varies for every insurance plan. Comparing helps to choose the
plan with lowest waiting period or no waiting period at all!
 6) Network Hospitals
Availing medical care in network hospitals associated with health insurers helps you to get
cashless hospitalisation as well as help in managing the complete paperwork. This is apart from
getting adequate and economical medical care. Selecting an insurer with the maximum number
of network hospitals and in your vicinity should be the goal of customers.
 7) Sub-limits
These are the limits set on the treatment of certain ailments. For example, you undergo a
kidney surgery and spend Rs. 1lakh for it. But if your insurance policy has set a sub-limit of Rs.
40,000/- on kidney surgery, then you can only avail that amount as claim and will have to bear
the remaining cost out of your own pocket. Better to compare different plans and select the one
that has no sub-limits or lowest slabs.
 Compare all the available health insurance plans floating in the market, only at easypolicy.com.
 How Easy Policy Helps You To Choose The Best Health Insurance Plan?
 When it comes to choosing a health insurance plan, it becomes a challenge for a lot
of people due to the technicalities involved.
 Also, availability of a lot of options is overwhelming, especially when one is not well-
versed with the terms and functioning of the insurance process.
 To make things simpler and easier for you, Easypolicy is at your service to guide
you, assist you and help you to make the right decision and buy the best health plan
for you and family.
 Here’s how Easypolicy works to make buying health plan, a cakewalk for you:
 1) We Provide Easy Process
We have ensured to keep this site as simple as possible. This helps you to search
different health products in an easy manner and have access to every information
about the insurance products in a user-friendly way.
 2) Fast Access to Information
You can have access to information in real quick time so that you can take quick
decisions. Moreover, the information is up to date and absolutely accurate that
helps you in taking the right decisions.
 3) Guidance through Claim Process
Handling claims is the responsibility of the insurance company, but
Easypolicy guides you through every step of the process. We will assist you
throughout right from filling of the forms till you receive your claims.
 4) Paperwork Is Extremely Easy
One of the most cumbersome processes while buying insurance is
considered to be filling up of the forms. Easypolicy simplifies it for you by
providing easy-to-understand forms that can be filled without any expert
guidance.
 7) Our Advanced Feature Filters Are a Great Help
Easypolicy will help you to find health plan that meet your specific
requirements. In case you want plans with certain features, our advanced
feature filters can shortlist them for you in no time so that you only buy
what you need.
 When you are at easypolicy.com, you are at home!
 Health Insurance Renewal Process!
 Health insurance renewal is very important. You insurance company will send you a
reminder prior to the date of expiry, but you also must be aware of the date, when
the renewal is needed, so that it can be done in time.
 A timely renewal of health insurance policy will ensure that you do not lose the
benefits such as waiting periods and NCBs (No Claim Bonus). If you fail to renew
the policy in time, your policy will lapse and you will lose any continuation benefits.
 A few things to consider before you renew your health insurance policy:
 If you fail to renew your policy before expiry, there is a grace period of 30 days
allowed by the insurance provider. Make sure you use that period to enjoy the
continuing benefits of the policy.
 You can upgrade your policy to a newer policy or you can change your insurance
provider and go to another, if you are not satisfied with the existing benefits, or the
insurance company. This is called health insurance portability.
 Once the above are checked and in place, you can approach your health insurance
provider directly for the renewal, or get the renewal done online, through their
website. You can easily renew your health insurance policy through easypolicy.com
also.
 Facts that you must know before you go for renewal:
 If you make any claim during the period between policy expiry and
renewal, it will not be entertained. You must pay the renewal
premium within the grace period.
 If you want to go for health insurance portability with a new
insurance provider, you are eligible for continuing benefits of the
previous policy and your new insurance provider must take care of
that.
 Check your health insurance policy expiry date and renew today
before you lose any benefits! Do it at easypolicy.com!
 Health Insurance Claim Process
 There are different claim processes based on the type of claim you
are making with your health insurance provider.
 Cashless facility: In this facility company settles the medical
treatment cost of the insured in the network hospitals of the
company. Insured is provided with a cashless card at the time of
policy purchase which the insured need to extend to the network
hospitals along with valid ID proof at the time claims are being
made .Approval for cashless is provided by the Insurer after the pre
authorization form is submitted to the insured in electronic form.
 Reimbursement: In such case, Customers pay the bills for
hospitalization on their own and later, get reimbursed from the
insurance company after suitable documents are submitted to the
company.
 Claim Process for Cashless Hospitalisation:
 1) Inform your insurance provider about the need of hospitalisation.
2) Get admitted to a network hospital and present your health insurance id
card to the third party administrator (TPA) desk or claim desk present in
the hospital to access your insurance details.
3) Insurance company/TPA will get in touch with hospital authorities to fill
up a pre-authorisation form with the all treatment details, medical scans,
other required documents, etc. and send it to the insurer for approvals.
4) The insurer will check the documents, once satisfied with documents
and eligibility for cashless claim, they will send a go-ahead to the network
hospital to give the treatment.
5) At patient discharge, the medical facility will send all the bills along with
complete health and medical records and any other documents, if needed,
to the insurer for final claim settlement.
6) Deductibles, co-payments and other exclusions mentioned in the policy
will not be paid by the insurer, rest payments will be made to the hospital.
 Claim Process for Reimbursement from Single Insurer:

 1) At the time of hospitalisation, send the information to your
insurer.
2) Once the treatment is done, fill the claim form available at
insurer's website.
3) Attach all relevant and required documents such as medical
reports, hospital bills, discharge summary and any other supporting
documents in original, with the claim form and submit to insurer.
4) Keep all the health and medical documents, in case they are
required by the insurer.
5) Follow up and coordinate with the company or TPA to make sure
all the documentation is complete and claim is processed.
6) If everything remains in order, your health insurance claim
should be approved in 30-40 days
 Claim Process For Reimbursement from Multiple Insurers:
 1) At the time of hospitalisation, send the information to all the insurers.
2) After getting discharged, select the insurance provider with which you want to file
the claim first and fill their claim form.
3) Attach all relevant and required documents such as medical reports, hospital
bills, discharge summary and any other supporting documents in original, with the
claim form and submit to first insurer.
4) For multiple claims with multiple insurers, photocopies are not acceptable as per
terms of the claim. Make sure to collect multiple attested copies of all documents
from the hospital to be submitted to other insurers.
5) Once the first insurance company settles the claim, they will issue a letter
confirming that they have the original documents, and the claim is settled.
6) Attach this letter with the form and set of documents, to be submitted to the
second insurer. In a cover letter, state clearly that you have received X amount from
another insurer against your claim!
7) Follow up and coordinate with TPA to make sure all the documentation is
complete and claim is processed.
8) If everything remains in order, your health insurance claim should be approved
in 30
9) For more insurers, repeat the same process.
 Remember, if your documentation is in order and you have taken care of all the
requirements, no insurance company can deny your health insurance claims.
 What is Health Insurance Portability? What Are the Benefits?
 What is Health Insurance Portability?
To get better policy benefits along with the gained benefit from the existing
health insurance policy ,you have the option of portability through which
you can change your health insurance policy from one insurance company
to another .When portability is done you don’t have to avail the fresh
waiting periods related to named ailments and pre-existing diseases for the
period you have already spent in your previous health insurance policy.
 How do you apply for medical insurance portability?
In case you do not feel sufficed by the services of your existing insurance
provider, or the list of network hospitals is not up to your expectations, or
the sum assured doesn't compensate your medical expenses, you can apply
for portability by submitting a written request to new insurance provider.
This must be done at least 45 days prior to the expiry of existing medical
plan. In case all the portability conditions are met, you get your medical
insurance ported within 15 days.
 What are the benefits of Medical Insurance Portability?
The major benefits that you can enjoy by shifting your medical policy are:

 1) More competitive or lower premiums for the same sum assured.
2) Better services on offer than the previous insurance provider.
3) Smoother claim settlement process. Portability can help you tie up with
an insurer with good claim settlement ratios.
4) Option to buy an upgraded health plan which was not available initially
when you bought the policy.
5) Existing health insurance benefits like bonuses, waiting periods for
pre-existing diseases etc. are carried forward to the new plan with new
insurer.
6) The stipulated waiting period of 30 days from the commencement of
policy to enjoy the benefits of health plans gets waived off in a ported
policy.
 Resource From: https://www.easypolicy.com/health-insurance