With the rising cost of healthcare, having medical insurance has become a necessity. However, even a comprehensive health insurance policy may not be sufficient in case of a major illness or surgery. This is where top-up and super top-up healthcare plans come into the picture. Top-up and super top-up medical insurance policies provide added coverage over and above your active healthcare policy, which can be especially helpful in case of a medical emergency. Let’s understand the distinction between top up vs super top up health insurance.

Top-Up Health Insurance

A top-up health insurance plan provides additional coverage but comes into effect only when the sum insured by the existing policy gets exhausted. The premium for a top-up plan is relatively low compared to a regular health insurance policy, as the coverage comes into effect only after the deductible amount is exhausted. However, the deductible amount can vary depending on the insurer and the plan.

Super Top-Up Health Insurance

A super top-up health insurance plan is similar to a top-up plan, but the coverage comes into effect when the cumulative medical expenses exceed the deductible amount, regardless of whether the expenses are subject to a single hospitalisation or multiple hospitalisations in a policy year. For instance, if you have a super top-up plan that has a deductible of Rs 3 lakh and a sum insured of Rs 10 lakh, and you incur medical expenses of Rs 7 lakh in a single hospitalisation and Rs 2 lakh in another hospitalisation in the same policy year, then the super top-up plan will kick in and cover the remaining Rs 2 lakh.

The premium for a super top-up plan is more than a top-up plan but provides a higher coverage amount; it is more comprehensive in terms of coverage.

Difference Between Top-Up & Super Top-Up Plans in Health Insurance

There are several points of differences between top up vs super top up. For instance, in a top-up plan, the coverage comes into effect only when the medical expenses exceed the deductible amount. In contrast, in a super top-up plan, the deductible amount gets set at a higher level than the existing policy's sum insured. The coverage comes into effect when the total medical expenses in a policy year exceed the deductible amount.

There is a difference between health insurance top up vs super top up in terms of coverage too. In a top-up plan, the coverage is limited to the sum insured by the current health insurance policy. For example, if the sum insured of the existing policy is Rs 5 lakh and the top-up plan has a coverage limit of Rs 10 lakh, the maximum coverage amount will be Rs 10 lakh minus the sum insured of the existing policy. In contrast, in a super top-up plan, the coverage amount is higher than the sum insured by the existing policy. For example, if the sum insured of the existing policy is Rs 5 lakh and the super top-up plan has a coverage limit of Rs 10 lakh, the maximum coverage amount will be Rs 10 lakh minus the deductible amount.

Another point of differentiation between top up vs super top up is the premium. The premium for a top-up plan is usually lower than that of a super top-up plan, as the coverage is limited to the deductible amount. However, the premium for a super top-up plan is higher, as it grants a higher coverage amount.

Both plans provide extra coverage. However, the selection between the two depends on one’s distinct requirements and budget. If you have a low budget and want additional coverage, then a top-up plan may be suitable for you. However, a super top-up plan may be a better option if you want comprehensive coverage and are willing to pay a higher premium. Note that you should be well aware of the differences between top up vs super top up health insurance so as to make a well-informed choice.

If you get diagnosed with a cataract, and your ophthalmologist advises surgery, you may be curious about the question, “Is cataract surgery covered by medical insurance”. Well, the good news is that your health insurance can indeed cover cataract surgery, but there are essentially a few things you need to be aware of before scheduling your procedure. For example, your policy may only cover 80% of the surgery cost, leaving you responsible for the other 20%. Also, your policy may not cover additional expenses related to the surgery. So, it’s crucial to thoroughly read your plan’s terms and conditions before signing up for it or scheduling your surgery.

 Let’s explore the types of cataract surgeries available in India, the waiting period associated with coverage, and the benefits of purchasing a health insurance plan that covers such procedures.

How Much Does Cataract Surgery Cost in India?

There are different ways to treat cataracts in India. Thus, it is essential to discuss with your insurance provider — does health insurance covers cataract surgery — for any particular surgical procedure of your choice.

• The commonest type of cataract surgery is Phacoemulsification, which takes less than 30 minutes. Ophthalmologists make a small incision and use an ultrasonic probe to break the eye’s lens into fragments. The lens gets replaced with an intraocular lens or IOL through a corneal incision. This can cost anywhere between INR 22,000 to INR 60,000 or more.

• Ophthalmologists advise ECCE or Extracapsular Cataract Extraction for complex cataracts. It requires larger incisions to remove the cataract in one piece, and a patient requires sutures to seal the wound. The cost for ECCE ranges from INR 32,000 to INR 40,000.
• Intracapsular Cataract Surgery needs more extensive incisions, where your eye surgeon removes the lens and surrounding capsule and implants an IOL in front of the iris. This surgery costs between INR 32,000 to INR 39,000.
• FLACS, or Femtosecond Laser-assisted Cataract Surgery, is the most advanced method. The laser breaks the lens, performs anterior capsulotomy, and places the IOL. This surgery costs between INR 50,000 to INR 1,60,000.

What's the Waiting Period for Cataract Surgeries?

• Every medical insurance policy comes with a waiting periodduring which you are ineligible to receive the benefits of the cataract surgery covered by health insurance. You must essentially hold off on making any claims during this time.
• Policies that provide coverage for cataract surgeries, in particular, may have their unique waiting period that varies depending on the insurance provider. Usually, the waiting period for cataract surgeries falls between twelve to twenty-four months.

It is vital that you check your policy documentation with great care to avoid any ambiguity or confusion regarding the waiting period. Therefore, it is imperative that you familiarise yourself with the complexities of your policy and make a note of the waiting period associated with any condition you intend to seek treatment for.

Is Cataract Surgery Covered by Medical Insurance?

Yes, cataract surgery is covered by most comprehensive health insurance policies, but the extent of coverage is limited by certain factors. Here is a list of exclusions and inclusions:

Inclusions

• Surgical costs, such as fees for the surgeon and operating room charges.
• Hospitalisation charges, including room rent and nurse fees during the treatment.
• Pre and post-surgery care expenses, like charges for diagnostic tests, medical bills, and follow-up consultation
• Intraocular lens or basic IOL costs.

Exclusions

• Cosmetic upgrades, such as the use of premium lenses.
• Some policies have a cap amount, the cost beyond which is not covered during reimbursement.
• Treatment in non-network hospitals may not be covered.

Claim Process

Cashless Treatment: If you are admitted to a network hospital, the insurance provider will make a cashless payment directly to the hospital.

Reimbursement: In the case of a non-network hospital, you can submit bills later for reimbursement from your insurance provider.

Benefits of Health Insurance Covering Cataract Surgery

The benefits of a health insurance policy include financial support during and after the procedure, access to quality healthcare, and comprehensive coverage for the whole family.

The cost of cataract surgery is determined by several factors, such as the location of the hospital, the type of lens implanted, and the surgical procedure. Generally, the price ranges from INR 10,000 to INR 1,00,000, but if you undergo surgery at a leading hospital in a metro city or if your ophthalmologist suggests advanced procedures, the cost can go up to INR 60,000 for one eye. To save money on medical expenses, especially for ageing parents, purchasing a health insurance plan with an affordable premium is a good option. These plans can cover the costs of daycare treatments and post-surgery expenses, subject to the policy’s terms and conditions.

Some health insurance companies also offer plans with cataract coverage, which can help individuals save a significant amount of money. Researching and choosing a reputed health insurance company for the best coverage options is advisable.

Conclusion

Cataract surgery can restore vision and have a positive impact on the quality of life of an individual. While the process and costs may seem complex, having comprehensive health insurance provides you with the mental and financial security to undergo the surgery. Always read the policy documents carefully and consult the insurance provider before proceeding. With the right insurance plan, you can easily take a step closer to a better vision!

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.

Bariatric surgery is a viable option for people with morbid obesity who fail to lose weight through traditional methods. Policyholders should review their plan’s terms and conditions to ensure coverage and fulfil specific criteria for validating their bariatric surgery coverage. There are three types of bariatric surgeries, and patients should consult a medical professional to determine the most suitable option. Finally, the cost of bariatric surgery varies depending on various factors. You should consult healthcare professionals to determine the most affordable and effective option within your budget.

Does health insurance cover bariatric surgery?

Most health insurance policies include bariatric surgery as per the guidelines established by the Insurance Regulatory and Development Authority of India in 2019. However, checking the terms and conditions of the insurance that covers bariatric surgery is advisable to ensure coverage. Health insurance policies cover bariatric surgery only if a person meets certain conditions, such as being aged at least 18 years and having a BMI or body mass index of 40 or higher. If the BMI is between 35 and 40 and the patient has comorbidities such as diabetes, heart disease, or stroke, a policyholder will receive coverage for the surgery. Additionally, the patient must provide a doctor's prescription and relevant diagnostic test reports to claim coverage. Finally, patients should expect to wait for the coverage to begin, as most insurance for bariatric surgery has an initial waiting period of around 30 days. Individuals with pre-existing conditions may have to serve another waiting period of 2 to 4 years.

Types of bariatric surgery

There are three types of weight loss surgeries: Laparoscopic Sleeve Gastrectomy (LSG), Roux-en-Y Gastric Bypass, and Mini Gastric Bypass (MGB).

• Laparoscopic Sleeve Gastrectomy involves removing the outer margin of the stomach to restrict food intake, reducing the stomach to about 15% of its original size.

• Roux-en-Y Gastric Bypass involves:
• The process of partitioning the stomach into a smaller upper section and a larger lower section.
• Reattaching the small intestine to the pouch.
• Creating a bypass for food to absorb fewer calories and nutrients.

• Mini Gastric Bypass, also known as Single Anastomosis or Omega Loop gastric bypass, restricts food intake, causes malabsorption, and alters gut hormones responsible for appetite control.

• Unlike the standard Roux-en-Y Gastric Bypass, MGB involves only one anastomosis and can be performed in less time and with fewer early complications.

The various surgeries come with their own set of advantages and disadvantages; hence patients must seek guidance from a healthcare expert to decide on the most suitable choice.

How much does bariatric surgery cost

The weight loss surgery cost can vary depending on various factors, such as a patient’s health conditions. Remember to ask the insurance provider, “is bariatric surgery covered by insurance” before choosing any type of surgery.

• The cost of weight loss surgery in major cities of India varies from Rs 1,36,000 to Rs 4,58,000.
• In Mumbai, the cost ranges from Rs 1,90,000 to Rs 3,58,000, while in Delhi, it ranges from Rs 2,30,000 to Rs. 4,58,000.
• In Bangalore, the cost is between Rs 2,20,000 and Rs 3,48,000, while in Kolkata, it is between Rs 2,36,000 and Rs 3,26,000.
• In Pune, the cost ranges from Rs 1,36,000 to Rs. 2,76,000, and in Hyderabad, it is between Rs 1,48,000 and Rs 2,66,000.

Imagine you have finally taken the step to secure your health and well-being by purchasing a health insurance policy. You feel relieved, knowing you have taken a proactive measure towards protecting yourself and your family. However, you soon realise that your policy comes with a waiting period for pre-existing illnesses. Suddenly, you feel a sense of uncertainty and wonder how this PED waiting period will affect you in the event of a medical emergency. So let’s talk about what exactly does waiting period in health insurance denotes, its duration, and factors to consider before finalising a policy and investing in it.

What are pre-existing illnesses?

Pre-existing illnesses are health conditions an individual already has before taking up a health insurance policy. These can range from chronic ailments like diabetes, heart disease, and asthma to terminal illnesses like cancer. Such illnesses get considered as pre-existing ailments if a person receives treatment for any ailment falling in this category before purchasing the insurance policy.

For instance, if a person has diabetes before taking up a health insurance policy, it will get considered a pre-existing illness. In case the policyholder needs medical treatment for diabetes, the insurer may not provide coverage or may provide it with certain restrictions and limitations.

Many insurance companies offer policies that cover pre-existing illnesses, but they may come at a higher premium or with various exclusions. One must exercise due diligence and carefully analyse the policy document, comprehending all the terms and conditions before making an informed decision. 

How much waiting period can there be for pre-existing illness?

Insurance companies determine the waiting period for pre-existing illnesses in health insurance policies. For instance, a healthcare policy you choose may have a 2-year waiting period for health insurance. In other words, you cannot make any claim for pre-existing illnesses or other ailments specified in the plan before the two-year period expires.

The waiting period for pre-existing illnesses in medical insurance policies may vary between insurance companies, but it generally falls within the 12-48 months bracket. The waiting period comprises the following parameters.

The waiting period for pre-existing diseases can vary depending on the disease type. Some diseases, such as hypertension or diabetes, are considered chronic conditions. Therefore, the waiting period for these diseases may be longer than other conditions.

The waiting period may also depend on the severity of the pre-existing condition. The waiting period may be more if the ailment is severe and requires significant medical treatment.

The policyholder’s age is also essential in determining the waiting period. The waiting period for pre-existing diseases is typically longer for older policyholders as they are more likely to have such health issues.

Important things to note about the health insurance waiting period

Here are some key aspects to note about health insurance waiting periods:

• Duration:

The waiting period for pre-existing illnesses generally ranges from two to four years, while the waiting period for specific treatments may be shorter.

• Coverage:

During the waiting period, a policyholder is ineligible for any benefits or coverage for the specific illness or treatment mentioned in the policy.

• Disclosure:

It is essential to disclose all pre-existing illnesses or medical conditions during policy purchase to avoid rejection of claims or cancellation of the plan.

• Renewal:

Waiting periods are usually applicable only for a specific period of the policy. A policyholder becomes eligible for the full benefits of the policy, including coverage for pre-existing illnesses, if he/she continues to renew the policy on time and completes the policy’s waiting period for specific ailments.

• Exclusions:

Certain policies may have permanent exclusions for pre-existing illnesses or specific treatments.

• Impact on premiums:

Policies with shorter or no waiting periods may have higher premiums than those with a more extended waiting period.

India has a high rate of accidents, which can result in huge financial expenses for the victim and his/her family. With the rising number of accidents on Indian roads and workplaces, it has become essential for individuals to have personal accident insurance. Let us start with getting into knowing what personal accident insurance meaning is.

Personal accident insurance provides monetary compensation in case an accident results in injury, disability, or death of a policyholder. This type of insurance can help individuals and their families cope with the financial impact of an accident and its aftermath.

Scroll down to learn in detail about personal accident policy.

What is Personal Accident Insurance?

These policies provide financial assistance against an accident resulting in injury, temporary or permanent disability, or even the demise of a policyholder. A personal accident insurance policy covers the insured person against accidents that occur while he or she is travelling, working, or participating in any other activities.

It is also important to know the features of the coverage that such plans offer. Some of the prime features of a personal accident insurance policy include coverage for medical expenses, accidental death, as well as permanent/temporary disability. Medical expenses coverage provides reimbursement for expenditures incurred as a result of an accident.

Personal injury protection insurance provides a lump sum payment to the nominee in the event of the insured person’s accidental death or permanent disability resulting from an accident. Temporary disability coverage provides a weekly or monthly benefit to the policyholder.

Benefits of Personal Accident Insurance

Understanding personal accident policy also requires being aware of the benefits it offers. The policy provides financial security to the insured person and his or her family from the adverse consequences that an accident can lead to. It offers much-needed peace of mind to the insured person and his/her family, knowing they will receive coverage against the financial impact of an accident.

Also, personal accident insurance policies are affordable, and the premium rates are reasonable. You can customise such plans based on your particular requirements. As per the Income Tax Act, a policyholder can avail of tax deductions for the premium paid towards a personal accident insurance policy under Section 80D.

Personal accident insurance policies do not require a medical examination for the policyholder to purchase the policy. One can also buy add-on covers, such as accidental hospitalisation rider, accidental death and dismemberment rider, etc., which provide additional coverage to the insured person.

Advantages of Buying Personal Accident Insurance

A personal accident policy provides a financial cushion to the insured and his/her family against accidents. The policy provides several benefits, such as financial security, peace of mind, affordability, customisation, tax benefits, worldwide coverage, and additional riders. Every individual should consider purchasing a personal accident insurance policy to ensure financial protection against accidents.

Apart from having a clear understanding of what is a personal accident policy, you must consider some factors before buying one. You must choose the coverage amount of a personal accident policy based on your particular needs and financial capabilities. It is essential to thoroughly read and identify the exclusions stated in the policy document. Some personal accident policies may have a waiting period before the insurance plan becomes effective. The waiting period may range from a few days to some weeks. Now that you have sufficient details about personal accident policy do a quick search and buy personal accident insurance at the earliest.

Mediclaim after 60 years is crucial as it provides financial support during medical emergencies, which is common in this age group. With age, the risk of developing chronic diseases and health complications increases, which requires continuous medical attention and medication. The cost of medical treatments has also increased significantly in recent years, making it even more important to have health insurance. Without a mediclaim policy after 60 years, the burden of medical expenses can quickly drain the savings of senior citizens and affect their financial stability, making it essential to have robust health insurance coverage.

Need of a Mediclaim Policy After 60 Years

With age, the risk of developing chronic diseases, such as heart disease, hypertension, and diabetes, increases. These medical conditions require continuous medical intervention, which can be expensive. Therefore, having a mediclaim policy after 60 years is crucial to ensure that you do not have to bear the financial burden of these medical expenses.

Also, financial capacity may get somewhat restricted in old age. After retirement, there is a significant drop in income, and one has to rely on his/her savings to manage expenses. In such circumstances, medical emergencies can quickly drain your savings. A mediclaim policy for those over 60 years provides financial support during such emergencies and ensures that their savings remain intact.

Furthermore, with the advancement in medical technology and increasing demand for quality healthcare, medical treatment costs have risen significantly in recent years. This makes it even more necessary to have a mediclaim policy that covers your healthcare expenses.

Things to Consider While Buying a Mediclaim Policy for 60+

When buying a mediclaim policy after you reach 60, choosing a coverage amount sufficient to cover all your medical expenses is essential. As you age, medical expenses tend to increase, so opting for a policy with higher coverage is crucial. It is important to note that some mediclaim policies come with co-payments and deductibles, meaning you will have to shell out a specific percentage of the medical expenses yourself. Therefore, checking the co-payment and deductible clauses before buying a mediclaim policy is crucial.

Most mediclaim policies have a waiting period of 2-4 years for pre-existing ailments. Therefore, choosing a policy that covers pre-existing conditions or has a shorter waiting period is important. Next, it is crucial to check the network hospitals of the insurer offering the mediclaim policy before buying it. This will ensure you can avail of cashless hospitalisation at the nearest network hospital without worrying about medical expenses.

Do consider the premium as the amount for mediclaim after 60 years tends to increase with age. Therefore, comparing the premiums of different policies before buying one is essential.  

In conclusion, mediclaim after 60 years is essential for senior citizens as it provides financial support during medical emergencies. Remember to consider the coverage amount, co-payments, deductibles, waiting period for pre-existing ailments, network hospitals, and premiums. By considering all these aspects, you can pick a policy that suits your medical requirements and budget.

The loss of a tooth, whether due to injury, decay or age, can significantly impact one’s quality of life. It can affect one’s confidence, ability to eat and speak, and overall well-being. Fortunately, a dental implant has emerged as a reliable and practical remedy for a missing tooth. Yet, opting for dental implants can be pricey, and not everyone can afford it. Many people in India are unaware that they may have options to help offset the cost of dental implants. This article delves into various methods to help cover dental treatment costs.

Are dental implants covered by health insurance?

Typically, standard health insurance plans exclude coverage for dental treatments. The patient must bear any expenses for dental procedures that aim to improve facial appearance. Health insurance providers will only cover dental procedures that are medically necessary and recommended by a certified medical practitioner. In cases where a condition has the potential to become life-threatening if left untreated, health insurance will also provide coverage for dental treatment.

Several insurers have recently started providing dental insurance as an add-on. This additional coverage offers protection for oral check-ups, root canal procedures, extractions, preventive treatment, and filings. On the other hand, dental insurance usually excludes cosmetic treatments like dentures, prostheses, jaw alignment, and orthodontics.

Dental treatment can involve costly procedures. Hence it is extremely important to go through the policy wording to comprehend the exclusions of your healthcare plan. If you have a doubt and require clarification about the exclusions and limitations of your medical policy, you must reach out to your insurance provider. You can talk to the insurer’s customer care department or visit the nearest branch of the insurance provider. It would be wise to have all your queries answered before you invest in the policy.

When does insurance cover dental implants?

Insurance coverage for dental implants is typically contingent upon specific circumstances:

• Accidental Dental Injury: If teeth are damaged or lost due to an accident, certain health insurance policies may cover the cost of necessary dental procedures, including implants, especially if hospitalisation is involved.
• Comprehensive Health Plans with Dental Riders: Some insurers offer comprehensive health insurance plans that include optional dental riders, which may cover a portion of the costs associated with dental implants.

How to get dental implants covered by medical insurance?

You can cover dental-related treatment costs in the following ways.

• Dental Cover:

Purchase a dental insurance rider to supplement your health insurance coverage and deal with dental issues.

• Government Schemes:

The Government of India offers several schemes that provide eligible individuals with free or subsidised dental treatment.

• Payment Plans:

Many dental clinics in India offer payment plans that allow patients to pay for treatment in instalments over time. This can be a good option for those who cannot afford to pay for such treatments upfront.

• Medical Crowdfunding:

This is becoming an increasingly popular way to raise funds for medical expenses, including dental treatment. Multiple platforms in India allow individuals to create fundraising campaigns and share them on social media to raise money for dental treatment. One must bear in mind that such platforms do not cater to people looking for cosmetic enhancements.

• Dental Colleges:

Many dental colleges offer treatment at a reduced cost compared to private clinics. Dental students conduct various procedures and offer treatment under the supervision of experienced dentists. This can be a good option for those who cannot afford private dental treatment.

Things to remember when buying dental insurance

When selecting a health insurance policy with dental coverage, consider the following:

• Coverage Scope: If you are relying on a health insurance policy for family, verify whether the policy covers only basic dental procedures or extends to major treatments like implants.
• Waiting Periods: Be aware of any waiting periods before dental benefits become active.
• Sub-Limits and Co-Payments: Understand any sub-limits on dental procedures and whether co-payments are required, which could affect out-of-pocket expenses.
• Network of Dental Providers: Check if the insurance plan has a network of dental practitioners, which can facilitate cashless treatments and potentially lower costs.
• Exclusions: Carefully read the policy's fine print to identify any exclusions, such as cosmetic dental procedures, to avoid unexpected expenses.

Conclusion

While obtaining coverage for dental implants through health insurance in India can seem challenging, it is not as complicated as it looks. By properly researching and selecting comprehensive health insurance policies that include dental benefits, understanding policy specifics and maintaining thorough documentation, individuals can enhance their chances of receiving financial assistance for dental implant procedures. Prioritising oral health and aligning it with suitable health insurance coverage is a smart strategy for managing dental care expenses effectively.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

As a health insurance policyholder, you are familiar with the protection and peace of mind that comes with healthcare coverage. However, policyholders who maintain good health and avoid filing claims can earn an additional benefit — the No Claim Bonus. This incentive serves as a means to motivate policyholders to prioritise their health and take preventive measures to avoid illness or injury. While the No Claim Bonus is another technical term in the context of health insurance, comprehending its workings can bring significant advantages. Let’s talk about how does no-claim bonus works in health insurance and how, as a policyholder, you can avail yourself of its advantages.

What is a no claim bonus in health insurance?

A No Claim Bonus (NCB) in a health insurance policy is a reward given by insurance companies to policyholders who do not file a claim during the policy term. This reward can be an increased sum insured without any additional premium or a discount on renewal premium, depending on the policy. It acts as a motivation for individuals to maintain good health and avoid unnecessary claims. NCB applies to both individual and health insurance policy for family plans.

Different types of no claim bonus

To understand how NCB in health insurance works, comprehending its type is crucial.

• Cumulative bonus:

Insurers provide an additional percentage of the sum insured for every claim-free policy year. For each year you do not claim on your health insurance policy, your sum insured grows by a certain percentage up to a pre-specified limit.

For instance, let’s say your health insurance policy has a sum insured of Rs 3,00,000 and a cumulative bonus of 10%. You refrain from filing any claims on your health insurance policy during the initial year. As a result, your sum insured will increase by 10% to Rs 3,30,000 in the second year. If you still don’t make any claims in the second year, your sum insured will increase by another 10% to Rs 3,60,000 in the third year, and so on. This can be a substantial advantage, raising your coverage without any additional premium payments.

• Discount on premium:

The discount on premium NCB works as follows. Let's say your health insurance policy includes this benefit, and you don't make any claims in a policy year. In that case, the insurer will offer you a discount on the premium for the following year. This discount can progressively increase with each subsequent claim-free year, reducing the cost of your health insurance policy’s premium while incentivising you to maintain a healthy lifestyle.

Features of no-claim bonus in health insurance

The main components of a no-claim bonus in health insurance policy are:

• Reward for staying claim-free: This encourages policyholders to avoid small or unnecessary claims.
• Applicable on renewals: NCB is added only at the time of renewal of the policy after a claim-free year.
• Varies by insurer: The percentage increase or discount and the maximum limit differ from one insurer to another.
• Carried forward: The bonus continues to accumulate for every claim-free year, up to a certain cap.
• Available on family policies: Even a health insurance policy for family can avail of NCB benefits.

Benefits of no claim bonus (NCB) in health insurance

Here are some of the advantages of NCB in health insurance:

• Premium discount:

One of the primary benefits of NCB is that you may receive a discount on the premium for the following policy year. This discount can increase with every consecutive claim-free year.

• Increased coverage:

NCB may also increase your sum insured without incurring extra premiums. This increase in the sum insured can be helpful in the event of a medical crisis that necessitates a higher level of coverage.

• Guaranteed renewal:

A no-claim bonus also ensures that your policy remains valid and renewable as long as you continue making timely premium payments.

How does no claim bonus work in health insurance?

Let us understand NCB through this example:

Suppose you purchase a health insurance policy with a sum insured of ₹5 lakhs, and your insurer offers a 10% cumulative NCB. If you do not raise any claim during the first year, your insured sum at renewal will increase to ₹5.5 lakhs at no extra cost. If you continue to remain claim-free, the sum insured can go up to ₹6 lakhs, ₹6.5 lakhs, and so on (depending on the cap set by the insurer).

However, if you make a claim during any year, your accumulated bonus may either be reduced or lapse entirely, depending on the terms of your policy.

Conclusion

No Claim Bonus is a useful feature in any health insurance policy, rewarding you for staying healthy and not making any claims. Whether you are considering individual coverage or a health insurance policy for family, understanding and using NCB smartly can offer enhanced benefits at a lower cost. Always read the policy documents carefully to know how NCB applies to your plan, and use it as a tool to maximise your coverage and savings.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

While health insurance for HIV patients in India has improved in recent years, it remains limited. Insurance providers offer some benefits, including in-hospital care, but accessing healthcare services can still be a challenge for those living with HIV. A comprehensive approach is needed to address these challenges and ensure HIV-positive patients receive the care and support necessary to maintain their health and well-being. Living with HIV can significantly impact a person’s health, weakening the immune system and leaving him/her vulnerable to illnesses. As a result, insurance companies often hesitate to provide health coverage to individuals living with HIV, which further increases the challenges they face.

What is HIV?

HIV, a short form of Human Immunodeficiency Virus, is a virus that is known to target the CD4-T cells in the body, which are responsible for helping us fight infections and diseases. When HIV reduces the number of these cells, immunity weakens and people become more prone to infections and certain cancers. If not detected on time and treated with care, HIV poses the threat of progressing into AIDS or acquired immunodeficiency syndrome, which, simply put, is an advanced stage of HIV infection.

Does health insurance cover HIV-positive patients?

Disability rights groups have long recognised the need for insurance coverage for people with disabilities, including those living with HIV/AIDS. However, progress has been slow in this area, and these individuals have often faced discrimination when it comes to accessing healthcare.

Fortunately, recent developments in India have brought about a positive change. Following the Delhi High Court direction, the IRDAI has mandated private insurers create policies specifically catering to vulnerable groups, including health insurance covering HIV treatment.

This initiative aims to ensure everyone has access to appropriate and quality healthcare, regardless of their medical history and represents a significant step forward for enforcing rights in India.

Are there any health insurance plans available for HIV+ patients?

In India, health insurance coverage for HIV-positive patients is generally limited, with most insurance companies refusing to issue healthcare plans. However, a few insurance providers offer benefits to HIV-positive patients, which can significantly relieve those living with the condition.

• One of the benefits available via medical insurance for HIV patients is in-hospital care, which covers all expenses related to in-patient care. This includes physician fees, nursing charges, surgery costs, and diagnostic tests. This ensures that individuals can receive comprehensive medical treatment for their condition without facing financial constraints.
• Some insurers provide pre- and post-hospital care, which covers healthcare expenses before and after hospitalisation.
• Emergency ambulance services are also available for transportation to and from the hospital, ensuring patients receive prompt medical attention in an emergency.

Some HIV positive health insurance providers offer coverage for daycare treatment, i.e., treatment at a daycare facility or hospitalisation for less than 24 hours.

Inclusions & exclusions of health insurance for HIV patients

There are certain services covered by a health insurance policy for HIV patients, while there are a few things not covered by the policy:

Inclusions:

• In-patient hospitalisation: This covers expenses related to hospital stays for treatments or surgeries.
• Day-care procedures: Expenses for treatments that do not require prolonged hospitalisation.
• Pre- and post-hospitalisation expenses: Medical costs incurred before and after hospitalisation, typically within a specified period.
• Ambulance charges: Costs associated with emergency transportation to the hospital.

Exclusions:

• Pre-existing conditions: Some policies may have waiting periods before covering pre-existing conditions, including HIV.
• Cosmetic treatments: Procedures not medically necessary.
• Alternative treatments: Expenses related to non-allopathic treatments may not be covered.

Benefits of buying health insurance for HIV patients

Battling HIV is not an easy path; however, health insurance policy provides the following benefits that make it a little easier-

• Financial protection: It lightens the financial burden of medical treatments and hospitalisations.
• Access to quality healthcare: This ensures timely and appropriate medical interventions without financial constraints.
• Peace of mind: Knowing that medical expenses are covered allows individuals to focus on their health and well-being.
• Comprehensive coverage: Many policies offer additional benefits like coverage for critical illnesses, providing a broader safety net.

Conclusion

An individual health insurance policy is a useful option for anyone struggling with HIV, as it allows them to pay for costly yet essential hospital treatments, medicines and checkups. With changing medical regulations and more inclusive policies, getting suitable health insurance coverage has become more accessible. Still, it is essential to research and compare available options, understand policy terms and choose a plan that aligns with the particular requirements of the patient and their case to make sure that no expenses are spared and an individual’s physical and financial health remains unstrained.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

ICICI Lombard Health Insurance Cashless Network Hospital List in Akluj, Maharashtra

Explore ICICI Lombard’s health insurance plans :

• Family Health Insurance
• Personal Accident Insurance 
• Top Up Health Insurance
• Arogya Sanjeevani Policy
• Senior Citizen Health Insurance
• Parents Health Insurance
• Children Health Insurance

which offers people much needed financial backup during any medical emergencies.

ICICI Lombard Health Insurance Cashless Network Hospital List in Akola, Maharashtra

Explore ICICI Lombard’s health insurance plans :

• Family Health Insurance
• Personal Accident Insurance 
• Top Up Health Insurance
• Arogya Sanjeevani Policy
• Senior Citizen Health Insurance
• Parents Health Insurance
• Children Health Insurance

which offers people much needed financial backup during any medical emergencies.

ICICI Lombard Health Insurance Cashless Network Hospital List in Ahmednagar, Maharashtra

Explore ICICI Lombard’s health insurance plans:

• Family Health Insurance
• Personal Accident Insurance 
• Top Up Health Insurance
• Arogya Sanjeevani Policy
• Senior Citizen Health Insurance
• Parents Health Insurance
• Children Health Insurance

which offers people much needed financial backup during any medical emergencies.

We all know that life is unpredictable, and it’s essential to remain prepared for any unexpected events that might come our way. One such event that can cause a financial and emotional burden is a medical emergency. In such cases, having health insurance is crucial. One may not be aware that there is a particular type of healthcare card that can enhance the entire process of accessing medical treatment. It is known as a cashless health card.

What is a cashless health card?

A cashless health card is a convenient and hassle-free way to receive medical treatment without worrying about expenses. It is a card issued by an insurance company that allows policyholders to get cashless treatment at network hospitals. Generally, the cashless health card comprises critical information such as the policyholder’s personal details, insurance policy number, and the insurer’s customer care team contact information.

With a health insurance card, the policyholder does not have to shell out payments upfront for medical treatment at a network hospital. In this case, the hospital does not give the bill to the policyholder but instead sends it directly to the insurance provider for payment settlement.

Cashless health card benefits

• Hassle-free access to medical treatment:

With a cashless health card, a policyholder can avail of medical treatment at any network hospital without worrying about making upfront payments. The card serves as a payment mode, and the policyholder can receive treatment without any hassle.

• Quick settlement of claims:

The settlement of claims is quick and hassle-free with a cashless health card. The policyholder does not have to worry about submitting multiple documents or waiting for reimbursement of the expenses incurred on medical treatment.

• Comprehensive coverage:

Medical insurance cards offer exhaustive financial protection for various medical expenses, including hospitalisation, surgeries, diagnostic tests, and other medical procedures.

• Peace of mind:

The cashless health card provides policyholders with a sense of security and peace of mind, knowing they will get covered in the event of a medical emergency. It offers a sense of assurance that is crucial during illness or medical emergencies.

How to get a cashless health card?

• Choose a medical plan:

The first step is to select a health insurance plan that offers a cashless health card. One can do this by researching various health insurance plans and their benefits.

• Submit documents:

After choosing a health insurance plan, the policyholder needs to submit the required documents, such as documents showing proof of age, identity, address, and medical history, to the insurance company.

• Pay premium:

The policyholder must pay the insurance premium through various online modes of payment.

• Receive health card:

Once the policy is issued, the policyholder will receive a cashless health card with the policy documents

• Activate the card:

Policyholders need to activate the card before using it. One can do this by contacting the insurance company’s customer care or following the activation process mentioned on the card.

• Use the card:

After activation, the policyholder can use the cashless health card to avail of medical services at a network hospital.

Healthcare costs are on the rise, and critical illnesses, such as cancer, paralysis, heart disease etc., are becoming increasingly common. Treating these critical illnesses requires prolonged medical intervention or involves a high cost to get quality health care or both. Such illnesses not only affect the individual but also significantly impact his/her family’s finances. Therefore, it is important to buy critical illness insurance for family members to ensure they receive adequate financial support during times of crisis.

What is critical illness insurance?

Critical illness refers to a severe and life-threatening medical condition that can have a significant impact on a patient’s health, lifestyle, and finances. Examples of critical illnesses include kidney failure, heart attack, cancer, stroke, and major organ transplant.

Critical illness insurance for the family provides financial coverage to the policyholder and his/her family against critical illnesses covered by the policy. This type of insurance pays a lump sum amount to the policyholder and the person’s family upon diagnosis, which one can use for medical expenses, loss of income, or any other expenditures that may arise due to the critical illness. It provides financial stability during a difficult time, allowing the person to focus on recovery without worrying about the economic burden of the illness.

Key features of critical illness insurance plans for family

When considering a critical illness health insurance plan for your family, it is essential to understand its distinctive features:

• Comprehensive Coverage: These plans cover a range of severe illnesses, ensuring that multiple family members are protected under a single policy. They can be used in addition to pre-existing health insurance for senior citizen to avoid any strain caused by sudden and severe health issues.
• Lump Sum Benefit: Upon diagnosis of a covered illness, the policyholder receives a one-time lump sum payment, providing immediate financial relief.
• Flexible Usage: The received amount can be utilised for various purposes, including medical treatments, rehabilitation or even daily household expenses.
• Affordable Premiums: Opting for a family plan often results in cost savings compared to individual policies for each member.
• Tax Benefits: Premiums paid towards critical illness insurance are eligible for tax deductions under Section 80D of the Income Tax Act, offering additional financial advantages.

Benefits of critical illness insurance plans

Some significant advantages of critical illness insurance for the family are listed below.

• Financial Security: Critical illness insurance provides financial security to the policyholder and the person’s family during medical emergencies resulting from such ailments. The policyholder can use the lump sum amount paid by the insurer to cover loss of income, medical expenses, or any other expenditures associated with the treatment.
• Coverage for Multiple Illnesses: Policies offering critical illness insurance provide coverage for a range of critical illnesses, such as stroke, cancer, kidney failure, and heart disease. The policyholder can choose a policy that covers the specific illnesses that he/she might have the risk of developing.
• Tax Benefits: Under the ITA or Income Tax Act, the premium you pay towards critical illness insurance becomes eligible for tax deductions.
• No Claim Bonus: If the policyholder refrains from making any claim during the policy period, he or she can receive a no-claim bonus. The insurer can offer this in the form of a higher sum insured or a reduced premium.
• Peace of Mind: Having critical illness insurance provides policyholders and their families peace of mind, knowing they will receive coverage financially in case of a critical illness.
• Quick Disbursal of Funds: Critical illness insurance pays a lump sum upfront to a policyholder, which the person can utilise for any expenses related to the illness.

Types of critical illnesses covered

Critical illness insurance covers a range of severe medical conditions, including:

• Cancer of specified severity
• First heart attack (of specified severity)
• Open-chest coronary artery bypass graft surgery
• Stroke resulting in permanent symptoms
• Permanent paralysis of limbs
• Kidney failure requiring regular dialysis
• Major organ/bone marrow transplant
• Open heart replacement or repair of heart valves

Factors to be considered while opting for critical illness insurance

While choosing a critical illness cover for the family, consider the following factors:

• Coverage: Choose a policy that covers the maximum number of critical illnesses and provides comprehensive coverage.
• Sum Insured: Buy critical illness insurance that offers an adequate sum insured to cover the medical expenses and other costs for the patient’s treatment.
• Premium: Compare the premium of different policies and go for one that extends the best coverage but at a reasonable premium.
• Waiting Period: Check the policy’s waiting period; pick one with a lesser waiting period.
• Claim Settlement Ratio: Check the company’s claim settlement ratio before investing in the policy. A higher claim settlement ratio shows the company is reliable and efficient in settling claims.
• Exclusions: Carefully read the policy documents to understand the exclusions and limitations. Choose a policy that has fewer exclusions and provides comprehensive coverage.
• Network Hospitals: Check the insurance provider’s list of network hospitals. Select a policy that covers a vast network of hospitals.

Conclusion

Before buying a critical illness health insurance plan, explore different insurance companies and their critical illness policies online. Make a comparison in terms of the coverage, premium, waiting period, and claim settlement ratio of different policies offered by various insurers. Make sure to opt for a policy that provides comprehensive coverage at a reasonably priced premium.

Filling out the application form with accurate details and providing all the required documents is necessary. Pay the premium online using Internet banking or your debit/credit card.

Critical illness cover for the family can provide peace of mind and financial support during a medical crisis. It is a valuable investment for those looking to safeguard their family members from unforeseen financial troubles.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

Cancer insurance coverage is a safety net that provides financial protection and support to those affected by the unpredictable and often expensive cancer treatment.

When a person is diagnosed with cancer, their world turns upside down. The physical and psychological toll can be overwhelming, and the last thing they need is to worry about the financial implications of cancer treatment. Cancer treatment insurance coverage can help alleviate this burden by providing coverage for medical and related expenses. With this coverage, patients can focus on their health and well-being during the cancer treatment journey without worrying about the associated costs. In this post, let’s discuss the advantages of cancer treatment insurance coverage and how it can be a valuable asset for anyone dealing with this challenging disease.

What is Cancer Insurance Coverage?

Cancer insurance coverage assures policyholders that they will not have to bear the financial burden of treatment alone, allowing them to focus on their health and well-being.

Suppose, Mr X, a 30-year-old family man, buys this medical coverage with Rs 15,00,000 sum insured. The policy period is 20 years. When X reaches the age of 40, he develops a cancerous tumour which is in its initial stage. Since he has insurance coverage, he will receive the sum insured amount as per the percentage specified in his policy. But at this point, the coverage amount reduces.

After the passage of a few years, the tumour reaches an acute stage, prompting the insurer to disburse the remaining sum insured, and the coverage ends. Notably, the payout from the policy is contingent upon the stage of cancer identified.

What Does Cancer Insurance cover?

Typically, cancer insurance covers the following:

• Overall comprehensive coverage
• Regular checkups
• Pre-hospitalisation charges
• Post-hospitalistion charges

While knowing about the coverage of a cancer policy, you should also understand what it doesn’t cover. Here are the details of what the policy doesn’t cover:

• Pre-existing ailments related to cancer
• Cancers due to sexually-transmitted diseases like AIDS, HIV
• Cancers that may have progressed due to congenital diseases
• Cancers that progress from overuse of drugs or alcohol
• Cancers that progress from different sources of pollution (chemical, biological sources, etc.)

Benefits of Cancer Treatment Insurance Coverage

Cancer treatment insurance coverage can be highly beneficial. It can cover the cost of medical treatment and related expenses. 

Here are the benefits of the coverage:

• Top-quality care: By investing in cancer treatment insurance, individuals can secure access to high-quality medical services, including cutting-edge technologies and top-notch medical practitioners.

• Reduced financial burden: Seeking insurance coverage for cancer treatment can be a strategic move as it can help alleviate the financial stress that accompanies medical care. Such coverage can mitigate or even eliminate the expenses that arise from cancer treatment, reducing the out-of-pocket burden on patients and their families.

• Coverage for all stages of cancer: Cancer treatment insurance can offer comprehensive coverage, spanning from the initial diagnosis to the follow-up care. With this coverage, policyholders can receive a lump sum payout allocated to different stages of cancer treatment, with a portion dedicated to the early-stage treatment and the remainder available for advanced-stage care.

• Flexibility: Having insurance coverage can offer the freedom to select the optimal treatment approach that aligns with individual requirements and personal preferences.

• Home care: With cancer treatment insurance, policyholders may be eligible for coverage of expenses related to in-home care, including services provided by nursing or personal care professionals.

• Coverage for transportation: Frequent visits to the doctor are often necessary during cancer treatment, which can result in significant expenses. If you have insurance coverage, it usually covers the transportation costs that arise from your cancer treatment.

• Dealing with mental health: The emotional impact of cancer can be challenging to manage. However, with cancer treatment insurance, one may obtain coverage for mental health services with lump sum payouts, such as counselling or therapy, to support their well-being during treatment.

Conclusion

A critical illness like cancer can cause a huge setback physically, emotionally, and financially. Having proper health insurance coverage can relieve a lot of burden. Hence, when choosing a cancer coverage policy, you should check the coverage in detail, including the inclusions and exclusions. Getting a good cancer treatment insurance policy is a great investment which will benefit you in distressing times.

Also Read:

• Insurance Plan With Cancer Coverage
• Cancer Health Insurance Policy
• What is the Waiting Period for Cancer Insurance?
• Critical Illnesses & Treatment Costs in India

As one lies on a hospital bed encircled by a team of medical professionals, the person’s thoughts revolve around the looming fear of accumulating medical bills. And this is the last thing an individual in such a state requires. That is where the 10 lakh health insurance comes in as a safety net, ready to catch individuals when they fall. With coverage of up to Rs. 10 lakhs, it provides the financial backing required to receive the best medical care possible.

What is a 10 lakhs medical insurance?

A 10 lakh health insurance policy extends coverage for medical expenses up to Rs. 10 lakhs. In other words, if you suffer from an illness or injury and incur medical-related costs, your health insurance policy will cover up to Rs. 10 lakhs of those expenses.

For example, suppose you have a 10 lakh health insurance policy. You need to undergo surgery that costs Rs 5 lakh. Your health insurance policy will cover the entire surgery cost, up to Rs 5 lakhs. If you have any additional medical expenses, such as post-surgery care or follow-up doctor visits, your health insurance policy will cover them as well, up to the policy limit of Rs 10 lakh.

How does the 10 lakhs health insurance plan work?

A 10-lakh health insurance policy functions through its features designed for well-rounded support for healthcare:

• Comprehensive coverage

These healthcare policies provide a substantial coverage amount that can help you meet various medical expenses, including hospitalisation, surgery, and critical illnesses.

• Protection against rising healthcare costs

Medical inflation in India is on the rise, and healthcare costs are increasing rapidly. A 10 lakh health insurance policy can adequately protect against these rising costs.

• Peace of mind

When you secure a 10 lakh health insurance policy, you can be confident that you and your family will have financial security during medical emergencies.

• Access to quality healthcare

Such policies can give you access to quality healthcare facilities and hospitals, which can help you receive timely and proper medical treatment.

How to purchase 10 lakhs health insurance online from ICICI Lombard?

Buying a ₹10 lakh health insurance policy online from ICICI Lombard is simple:

1. Visit the official ICICI Lombard website and navigate to the health insurance section.
2. Enter your details such as name, age, gender, and coverage type (individual or family).
3. Choose the sum insured as ₹10 lakhs and select any additional riders or features you may need.
4. Compare plans if multiple options are available.
5. Proceed to payment after reviewing your premium and benefits.
6. Submit the necessary documents, and once approved, your digital policy will be issued instantly.

Online purchase often comes with added benefits like premium discounts, faster processing, and easy documentation.

Benefits of 10 lakh health insurance policy

Key benefits of 10 lakh health insurance are:

• No Claim Bonus

A Mediclaim policy for Rs. 10 lakhs offers a no-claim bonus to those who refrain from submitting any claims during the policy tenure. The earned incentive can be a premium discount or an increase in the sum insured.

• Cashless hospitalisation

A 10 lakh health insurance policy offers cashless hospitalisation, which means the policyholder doesn’t have to pay for any medical expenses upfront. The policyholder can receive medical care at any network hospital in or outside his/her city without spending any cash.

• Tax benefits

A 10 lakh health insurance plan offers tax advantages under the Income Tax Act’s Section 80D. Policyholders can lower their taxable earnings by up to Rs. 25,000 on the amount spent towards medical insurance policies.

Inclusions and exclusions of 10 lakh health insurance

The coverage of 10 lakh health insurance includes:

• Hospitalisation expenses

A 10 lakh health insurance policy provides coverage for hospitalisation expenses, including room rent, ICU charges, and surgical fees. This policy covers pre- and post-hospitalisation medical care expenses for up to the given sum insured.

• Coverage for critical illness

These healthcare policies cover cancer, heart attack, kidney failure, and other ailments if you supplement your primary healthcare policy with a critical illness rider.

• Covers ambulance charges

A health insurance 10 lakh policy may extend coverage for ambulance charges that include transportation to the hospital in the event of an emergency.

• Coverage for daycare procedures

As a policyholder, you will receive coverage for expenses related to daycare procedures, including dialysis, chemotherapy, and other medical treatments.

• Alternative treatment coverage

Such policies extend coverage for alternative medical care, such as Ayurveda, Homeopathy,  , and others.

• Coverage for pre-existing diseases

A 10 lakh health insurance policy extends coverage for pre-existing diseases, including diabetes, hypertension, and others.

A few things are excluded from this health insurance policy, such as:

• Cosmetic and dental procedures
• Injuries due to self-harm or substance abuse
• Non-medical expenses (gloves, syringes, etc.)
• Experimental treatments

Factors determining the premium on 10 lakhs health insurance plan

Several factors affect the premium of your ₹10 lakh health insurance policy:

• Age of the insured: Higher age generally means higher premiums.
• Number of members: A family health insurance plan for more members costs more than an individual policy.
• Medical history: Pre-existing conditions can increase premiums or lead to waiting periods.
• Lifestyle habits: Smokers or individuals with risky lifestyles may face higher rates.
• Geographical location: Premiums can vary based on the city or zone you live in.
• Riders/Add-ons: Adding features like critical illness cover, maternity benefits or room rent waivers can increase the premium.

Conclusion

A 10-lakh health insurance policy is a smart way to protect yourself and your family against rising medical costs. If you are buying it as an individual or as part of a family health insurance plan, the substantial coverage amount will make sure that you have peace of mind and financial protection during emergencies. With easy online purchase options through insurers like ICICI Lombard and comprehensive benefits, this plan is an ideal choice for modern Indian households aiming for quality healthcare without compromise.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

• Women who meet certain conditions are eligible for maternity benefits, including leave and payment during this period. These conditions are:
• being pregnant for the first time
• already have one or two children
• taking in a child who is under three months old
• having a child through a surrogate
• or recovering from a miscarriage, abortion, or tubectomy operation

Nevertheless, in order to qualify for perks, it is necessary to have been employed by a company for at least 80 days within the preceding 12 months prior to your childbirth.

• Men or people who identify with other genders do not have the option to seek benefits. However, some public sector employees receive paternity leave benefits.
• The ACT applies to various establishments, such as
• factories
• mines
• government establishments
• shops or establishments with at least 10 employees
• any other establishment or class of establishments that the State may notify
• It does not differentiate between permanent, temporary, or contractual employees; denying worker benefits is against the law.
• Women engaged on a casual basis are entitled to maternity leave benefits. However, a female employee cannot avail of any maternity benefits after the expiration of the contractual period.

Employers who fail to pay maternity benefits or dismiss an employee during their maternity leave may be imprisoned and asked to pay a fine.

The claim settlement ratio (CSR) of the insurance company is one of the most important factors to be considered when investing in an insurance product. A good CSR is an assurance of your claim being honoured in the time of your need.

What is a claim settlement ratio in health insurance?

Simply put, the claim settlement ratio is the percentage of claims that an insurance company settles against the number of claims it has received. Every year, insurance companies declare their claim settlement ratio. This ratio is calculated annually based on the number of claims received and settled during a particular fiscal year. This is inclusive of life insurance claims as well as other insurance products such as the claim settlement ratio of travel insurance and health insurance claim settlement ratio.

You can find the CSR of all the registered insured companies on the official website of the Insurance Regulatory and Development Authority of India (IRDAI).

Importance of a claim settlement ratio in health insurance

The claim settlement ratio shows the credibility of the insurance company. The higher the CSR, the higher the credibility of the insurance company. It means a higher chance of your claim being settled without any hassles. There is no point in investing in an insurance product if you cannot trust your insurer to support you when you need to utilise your policy. A trustworthy insurer honours your claim if you have done everything on your part honestly. You must choose an insurer with a credible track record of settling the claims of its policyholders.

Health insurance claim settlement process

Understanding the claim settlement process can help policyholders navigate their claims more effectively:

1. Claim intimation: Notify the insurer about the hospitalisation or medical treatment promptly.
2. Documentation: Submit all necessary documents, including claim forms, medical reports, and bills.
3. Claim processing: The insurer reviews the submitted documents to verify the claim's validity.
4. Approval and settlement: Upon approval, the insurer disburses the claim amount as per the policy terms.

Submission of documents timely can expedite the settlement process, ensuring swift financial support during medical emergencies.

How to check health insurance claim settlement ratio?

Suppose you are about to buy a health insurance policy and you are checking the health insurance claim settlement ratio of your preferred insurer. Here are the things that you must assess before buying the insurance product:

• High CSR:
• Make sure that the company you are planning to buy insurance from has a high claim settlement ratio. A high CSR implies a higher chance of your claim being settled.
• Claim settlement process should be easy:
• Check the claim settlement process of the insurance provider. Go to their website or talk to their representative to know the details of the process. In the hour of need, you do not want to be engrossed in a tedious long claim settlement process.
• Claim settlement process should be quick:
• Check the average time taken by the insurance company to settle the claim. If it is a long time-consuming process, chances are high that it may cause you financial and mental stress when you least want it.
• CSR of the last five years:
• Look beyond the immediately preceding financial year and check the CSR of the last five years. This will tell if your preferred insurer has been settling claims consistently.
• Financial statements of the insurance company:
• Sometimes, knowing the CSR history of the insurance provider is not enough. It can be so that they have managed to maintain a high CSR until now. So, go for a financially-healthy insurance company. For example, ICICI Lombard’s claim settlement ratio is not only good, but its financial statements are also positive, making it a trustworthy and credible insurance company.

Conclusion

When picking a health insurance plan, especially a critical illness insurance, the claim settlement ratio (CSR) is important to check. It shows how well an insurer handles claims and pays policyholders on time. A higher CSR means you have a better chance of getting financial help when you need it most. It is also smart to look at factors like how many claims get rejected or are still pending. Checking these components can help you choose a health insurance policy that gives you proper coverage, peace of mind, and quick support during medical emergencies.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

Like any other market, the insurance market also runs on the dynamics of demand and supply. People need insurance companies to offer them insurance products that protect them from various financial losses. At the same time, the insurance providers are also required to meet the expectations of their customers—the policyholders. The most crucial expectation that people have from these insurance providers is that their claim will be settled easily, that is, they would be reimbursed with the insured sum as and when needed.

Principles of claim settlement

In their pursuit to meet the insurance market demands, the suppliers or the insurance providers must adhere to a certain set of principles surrounding claim settlement. There are primarily three major pillars of claim settlement:

Verification of the loss

It is the responsibility of the insurance provider to verify the claim. They must ensure that the authentic claims do not get rejected or delayed, and the inauthentic ones do not make it to the final claim disbursal. This involves estimating correctly the instance of loss and corroborating the same with the policy coverage.

Prompt payment

The second principle for settling a claim is to clear the claim amount at the earliest—that is as soon as the information collection and verification are completed. Once the claim is found to be valid, the payment of the insured sum should not be delayed by any means.

Assistance to the insured

The insurance company must provide systematic and consistent assistance to the policyholder during claim settlement. While the need for insurance is widely understood, its processing is still a long shot for many policyholders. It is the responsibility of the insurance provider to ensure that their customer has access to correct information about the claim settlement process.

Some key points for policyholders

While insurance providers are expected to stick to the principles mentioned above, insurance buyers are suggested to take note of certain factors surrounding claim settlement. These are:

• Before buying an insurance policy, you should research well to ensure that the company you opt for is credible. Always check the claim settlement ratio of your preferred company. The higher the claim settlement ratio, the better the chances of your claim being settled without any hassles.
• You can find the claim settlement ratio of all the IRDA-registered companies on the IRDA Claim Settlement Ratio 2022
• Say, you zero in on an insurance provider with a high claim settlement ratio. But, that is not enough. You should also check the overall financial health of the company.