What are the details on Maternity Coverage?

Is Maternity covered under health insurance policy?

Maternity Charges
Most of the Health Insurance do not cover maternity charges.  Presently there are two companies namely Max Bupa and Apollo Munich in Exclusive & Premium plan allows reimbursement of (or cashless) maternity expense. The waiting period is 2 years in case of Max Bupa and 4 years in case of Apollo Munich.

Very recently Star Health has launched Wedding Gift where in maternity expense are allowed. While Max Bupa & Apollo allows admissibility of claim for two deliveries, Star allows only one delivery. Further it is important to note that in case couple already has 2 children, couple is not eligible for maternity expense.

Further there is submit for normal & caesarean delivery. Please refer to company product brochure for details

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What is a cashless facility

Know about cashless facility for health insurance policy

This is the most important criterion since it gives mental peace that insured does not need to have cash in bank for getting treatment done. Many of the insurance company have Third Party Arrangement (TPA) which on behalf of the Insurance Companies, empanel Hospital for cashless facility, gives authorisation for claim settlement in case any claim arises and settles the claim of customer. The recent turf between TPA & public sector insurance companies was matter of grave concern to consumers. This definitely benefited Insurance Companies as they have now limits for most of the surgical process based on grades of the hospital and hence reduced costs, big hospital chains like Apollo, Max, Medicity etc. Are still not covered under cashless facility and customer needs to pay and then claim. Private insurance companies continue to provide Cashless facility. Many insurance company are now shifting to inhouse settlement of claims since this saves cost (TPA charges) and improves service standards.

Number of hospital where cashless facility is being offered is an important parameter while selecting a company for buying Health Insurance. More than the absolute number of hospitals covered by insurance company, it is important to see that the particular hospital from where you take treatment and/or are comfortable in getting treatment is covered under the empaneled list. You must keep the list of hospitals which are located in 5 Km radii from your residence, empanelled with your Insurance company always handy. The list of hospitals is never a constant and keeps changes. So visit the list of the hospitals on website of the insurance company once in three months and keep yourself posted on any change. ICICI Lombard boasts of one of the largest network of hospitals (over 4500) and Apollo Munich has over 3500 network hospitals.

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Is there any minimum or maximum age of entry?

What is the maximum age of entry for health insurance policy?

Maximum Age of Entry
Maximum age of Entry means till what age Insurance Company are willing to underwrite Health Insurance. Most of the Insurance Company specify Age 60 as Maximum Age of Entry – thereby meaning any person who is aged 61 will be issued fresh Health Insurance policy. For calculation of age, nearly all the companies consider age completed as on the date of filling up of the application form. Thus person who is aged 60 years and 364 days can take fresh health insurance subject to medical underwriting.

Max Bupa presently issues Health Insurance for person aged above 60 subject to Medical Underwriting. Public sector Insurance Company have announced Senior Citizen Health Insurance Company wherein person aged 70 can take Health Insurance of up to Rs 2 Lac, subject to medical underwriting.

Star Health Insurance has Red Carpet Health Insurance for Senior Citizens.

Maximum Renewal Age:
It is as per author, the most important criterion for deciding which company should one choose for taking Health Insurance. Most of the Health Insurance companies specify 65 to 70 as upper age for renewal. What happens if person survives beyond the maximum age? The maximum age of entry (i.e. for buying) in Health Insurance is 60 in most of the companies (Senior Citizen Plan launched by Public Sector Insurance companies allows coverage of Rs 1 to 2 Lakh, provided person is medically fit) and person with history of Heart Disease or Sugar, the two most common diseases are avoided by nearly all the companies ever at younger age. Presently only two companies Apollo Munich and Max Bupa provides whole life coverage.

Considering that maximum upper age of buying a fresh Health Insurance is 60, those who have Health Insurance provided by company should go for independent Health Insurance as soon as they achieve 50 years of age. Most of the companies cover Pre Existing Diseases (PED) after four continuous claim free years from same company. This assumes that his personal Health Policy will not be used in case of any hospitalization.

An important factor to remember is in case person has taken Health Insurance from two companies (say Rs 6 Lakh from employer’s group insurance company and Rs 4 Lakh from own resources), any claim will be settled by both companies in proportion of the coverage given (in this example employer health insurance provide will settle 60% of the claim amount and other insurance provider ill settle 40% of the claim). Insured person normally thinks that he will take claim from other insured company only after he exhaust the limit. In case claim amount is larger (in this example more than Rs 6 lakh) or is likely to be of long duration and larger amount, it would be better to declare both insurance at time of lodging of the claim so that the other company does not decline claim stating PED (Pr-existing Illness) as reason.

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What is a liability limit in health insurance policy?

Know about Liability Limits of your health insurance policy.

Liability limit specifies sub-limits for particular disease or component of expenses incurred on hospitalization. Most of the policies from Public Sector as well as Star Health Insurance and IFFCO Tokyo specifies cap (limit) on Room Rent Charges 1% to 2% of Sum Insured (SI). There can be also be cap (limit) in absolute figure (Star Health Insurance specifies 2% of SI or Rs 4000/- in Class A cities). Hence SI plays important role in buying Health Insurance from these companies. Max Bupa, Apollo Munich, ICICI Lombard etc. do not specify any limit on liability (ICICI Lomard specifies limit of Rs 20000/- for Cataract).
Some plans specifies limit on expenses to be reimbursed on any one hospitalization. While Apollo Munich, ICICI Lombard, Star Health do not specify any limit, National Insurance floater plan specify limit of up to 50% of SI on any one illness.

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What is warming up period in Insurance?

When does the health insurance policy you purchased get active?

Warming Up Period:
Health Insurance provides reimbursement of expense incurred due to hospitalization. Hospitalization due to accident is covered from the day policy is underwritten (Reader please note that mere acceptance of check or even clearance of check from your account does not mean that Health Insurance has commenced. In case Health Check up is required – specially those who are above age 45, policy is underwritten only after receipt of the medical reports) Warming Up period refers to waiting period before Insurance Company will entertain any claim for hospitalization due to illness. Normally it is 90 days – thereby meaning that hospitalization due to illness will be covered after 90 days of commencement of policy. Only Max Bupa presently offers waiting period of zero days.

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