FAQs ON THE PROPOSED HEALTH INSURANCE SCHEMEFACILITATED BY AFGIS

FOR AIR VETERANS

SL QUERY CLARIFICATION
NO
1. Who will be the insurance AFGIS while working on this concept of health
agency /TPA for the insurance, had discussions with all the leading
proposed health insurance insurance companies providing medical insurance viz
scheme? Star Health, HDFC Ergo, Care health and ICICI
Lombard. Finally, after comparing all plans, premium
and conditions, ICICI Lombard was zeroed in as Third
Party Agency (TPA) and they will be providing the
insurance cover
2. What age group will the The insurance policy premium worked out isfor age
insurance policy be group 57 to 80 years. However for Short Service
covered? Commission officers and airmen retiring early, a
category of 35 to 56 and for veterans above 80 years,
separate premium can be worked out depending on
response & willingness from the Air Veterans.
3. What does OPD cover OPD cover will include dental, vision, pharmacy,
include? diagnostics and consultations and will be on floater
basis i.e. amount can be utilized by both husband &
wife during the term of policy.
4. How will OPD bills Reimbursement of OPD bills will be faceless through
bereimbursed? “IL app” of ICICI Lombard. Further the app will also
provide other services such as consultation, customer
care help, settlement of claims status etc.
5. Is the health Insurance Hospitalization expenditure will be on cashless
cashless &what will be the basison the basis ofa card issued by the TPA to the
claim settlement process? policy holders. All diseases will be covered and there
Is there any limit of will be no limit on expenditure on any particular
expenditure for particular disease. Only condition for reimbursement of
disease? expenditure is that the expenditure should be within
the overall limit of the plan selected.

6. Benefits of proposed Benefits of scheme include OPD cover, tax deduction

 scheme under 80 D, faceless reimbursement of claims
through IL app, best in class claim settlement ratio,
wide range of hospital network etc. Also, after
negotiations, the requirement of medical examination
was waived off and many other benefits including
reduced premium as compared to plans available in
the markets was arrived at.
7. Why PED for one year & As regards Pre Existing Diseases (PED), generally
whether policy starts from the insurance companies have a clause of waiting
day 1? period up to 4 years.However after negotiation with
the insurance company, they have agreed for PED
clause for a period of onlyone year for those diseases
for which individuals are already on medications.
However, PED doesn’t debar from reimbursement of
hospitalization expenses for diseases contracted after
commencement of the policy. So, technically the
policy starts from Day 1.
8. Is the scheme also For the proposed scheme 2 adults that are eligible
applicable for parents / In are husband and wife.
laws?
9. Will the proposed scheme This proposed scheme is in addition to the existing
will have effect on existing ECHS and in no way would dilute or discontinue
medical arrangements? existing medical arrangements which presently Air
Veterans have through ECHS.

Note:Presently, only opinion of the Air Veterans is being sought on the scheme. Based
upon the response, a final proposal will be made and circulated for acceptance by the Air
Veterans.