My employer is offering me a group health insurance plan. Can I get it customized as per my needs?
With a group insurance plan you do not get the liberty to customize your health insurance plan as per your requirement. In a group plan the employer fixes the terms and conditions of the plan in accordance with the health insurance company keeping in mind the overall budget of the employer. The best alternative way for you is to opt for a customized personal health insurance plan in addition to your group cover. This will offer you better protection with a customized coverage.
What is the process of claim insurance? How does it work once I request for a claim? What is the approximate timeline?
Insurance claims in India are settled as per the rules laid down by IRDA. According to regulation 8 of IRDA, insurance company is required to settle claims within a time period of 30 days after receiving all documents from the concerned nominee. Insurance companies have claim investigators who check on every claim by thoroughly investigating each claim. If the insurance company receives a feedback of any malpractice or possible fraud, the insurance company can extend the claim settlement process. The maximum deadline is 6 months from when they receive the claim request.
I am sending my daughter for higher studies abroad. Will a domestic health insurance be a good idea?
For the same sum insured, the premium offered by Indian insurer are usually cheaper than those offered by a foreign insurer or university but before you opt for an Indian insurer check the rules and regulations of the concerned university. Many foreign universities require insurance as mandatory for all foreign students. Universities in the EU and US especially have insurance policy made compulsory. Some universities have a clause where you are required to take insurance either from the university itself or an approved insurer in that country.
Group Health Insurance plans are designed by your company’s agent as well as the insurance company to offer health care coverage to a group of individuals. Due to this, a Group Health Insurance plan cannot be customised to suit a single individual’s medical condition. Only an Individual Health Insurance plan can be completely customised to suit your needs.
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Network hospitals will provide the cashless facility to individuals who have selected ‘claim processing by TPA’. The insured individual can undergo treatment in network hospitals provided that the TPA (Third Party Administrator) has given the authorisation in advance.
The list of network hospitals can be accessed at the insurer’s official website. The same website can be accessed to download the request from which should be filled in with the requisite details and submitted to the TPA so that it can approve and authorise the same.
When the TPA receives the request form along with other related medical details from the network provider or the insured individual, it will provide the network hospital with the pre-authorisation letter once it has verified the information received. At the time of discharge from the hospital, the insured individual will have to sign the discharge documents following verification and he / she will also have to bear inadmissible and non-medical expenses. If the insured individual cannot provide the necessary medical information, the TPA holds the right to decline pre-authorisation. If the medical insurance claim is declined, the insured individual can undergo treatment based on the advice of the treating doctor after which he / she will have to furnish the relevant claim documents to the TPA so that claims can be reimbursed.
In case of reimbursement of expenses:
To have claims reimbursed, the insured individual will have to furnish the relevant claim documents to the TPA prior to the due date prescribed in the policy. The insured individual can undergo treatment based on the advice of the treating doctor. The company will not cover costs related to the treatment of the insured individual neither before nor during the treatment. The insured individual will have to bear all costs incurred for the treatment. The insured individual will also have to furnish the bills along with the other relevant documents to the company / TPA for the reimbursement of claims.
The documents that must be furnished when claiming reimbursement from the company / TPA include the original claim form disclosing all the necessary details, payment receipts, original bills, hospital discharge certificate, original hospital cash memo, prescription from the chemist, investigation test reports along with the attending doctor / medical practitioner’s prescription, original payment receipt, certificate related to diagnosis and bill receipts from the attending doctor / medical practitioner, certificate from surgeon disclosing the plan or nature of operation underwent by the individual along with the diagnosis certificate supported by bills, and any other document as required by the TPA or the company.
If the company accepts the insured individual’s settlement offer, the customer will receive the payment within seven days after the offer has been accepted. In case there’s a delay in making the payment to the customer, the company will usually pay interest higher than the bank rate.
In case the company rejects the claim of an insured individual for any reason whatsoever, it will communicate the same to the individual in writing within 30 days after it has received the final document.
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Whether you are a first time flyer or a frequent flyer, and are going on a single trip or multiple trips, Travel Insurance can help you save costs. Travel insurance can be taken by anyone and can be taken for a specific period of time, according to your requirements and the the duration of your trip.
It’s advisable to get Travel Insurance since it covers unforeseen medical and financial losses
that might arise during your journey. It’s even more important to get Travel Insurance if you are travelling abroad. Your Travel Insurance will provide you cover against the following:
Trip Delays And Cancellation: Trip cancellation and delays are among the most common issues faced by travellers. Many Travel Insurance plans offer reimbursement for delayed and cancelled flights. When talking about flight delays, most insurance plans accept a claim under the condition that the flight was delayed for a minimum number of hours. Make sure you have the details on this clause. Ask your insurance company if they will cover non-refundable tickets and all other expenses that arise out of a delay. The more costs your insurance plan covers, the better it will be.
Missing Connecting Flights: If you miss your connecting flights, or your hotel booking gets cancelled due to the delay, your insurance plan can cover you for these losses.
Loss Of Checked-In Baggage: After flight delays and cancellations, the next most common issue faced by travellers is loss of checked-in baggage or damage to bags. Your insurance plan can cover loss or damage to your check-in baggage.
Do not wait till the last day to buy Travel Insurance. Also, when comparing Travel Insurance
products, ensure that you not only compare the prices, but also the benefits, exclusions etc.
Check availability of different covers like terrorism cover, hijack distress allowance etc, apart
from the typical coverage.
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