Author: Vinod N

HDFC ERGO has launched Optima Wellbeing, a new OPD subscription Add on plan, in Pune. This plan offers cashless OPD services and discounts of up to 50% on diagnostics and medicines.

You must have seen advertisements from insurance companies boasting claim settlement ratios of 98-99%. By sheer statistics, it appears that every insurance company is customer-friendly and settles all claims from policyholders. However, choosing a health insurance policy based solely on claim settlement ratio can be confusing and challenging. In this article, I will discuss whether this is a reliable metric for purchasing health insurance. What is Claim Settlement Ratio? First, let’s clarify what a claim settlement ratio is with an example. Suppose an insurance company receives 1,000 claims in a year. If it settles 900 of these claims and 100…

This standard definition which you can find in every health insurance policy, implies that the insurance company will not cover the total cost of treatment if it exceeds the average cost for similar treatments in that region and the type of hospital. Instead, the insurance will pay up to the average cost of treatment for that particular disease in that city and type of hospital.

If you have tried to buy health insurance you might have come across terms like “Restoration of sum insured” or seen ads promoting 2x or 3x, cover etc. But what do these terms really mean? In this article, I have discussed in detail: I will try to explain this term with a practical example. Suppose Rohit, who has a health insurance policy with a cover limit of 5 lakh. Unfortunately, Rohit is diagnosed with fatty liver disease and uses up his entire coverage limit during his hospitalization at Apollo Hospital, Delhi from December 1, 2024, to December 10, 2024. However,…

In simple terms co-payment in Health insurance is the percentage of claim amount that a policyholder has to bear. Insurance regulator IRDA has defined co payment in insurance in Master Circular on Standardization of Health Insurance Products dated 22nd July, 2020 as: “Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.” Not all health insurance policies include a co-payment clause, but it is important to understand its implications. For example, if your health insurance has…

The Insurance Regulatory and Development Authority of India (IRDA) on March 20, 2024 through its circular “Insurance Products Regulations, 2024”  has introduced changes regarding pre-existing diseases and the moratorium period in health insurance policies. In this article, I have discussed- Pre- existing disease(s) Before the current changes, IRDA’s Master Circular on Standardization of Health Insurance Products, dated July 22, 2020, defined pre-existing diseases as – “Pre-existing disease means any condition, ailment, injury or disease:a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or b) For which medical advice or treatment was recommended by,…

Does your health insurance policy cover home dialysis? Dialysis is often recommended for patients with chronic kidney diseases, where the kidneys have sustained irreparable damage. The only way left to replicate the functions of the kidney in such cases is through dialysis. Generally, Health insurance policies cover expenses related to chronic kidney diseases, including dialysis and, even the cost of a kidney transplant, if the kidney disease develops during the policy period. There are two methods through which kidney dialysis can be performed: 1. Hemodialysis – This type of dialysis is performed at a hospital as a day…

Star Health Insurance Company’s comprehensive health insurance and family health Optima policies stand out as top-selling insurance products in the Indian market. The similarities between these two policies creates a lot of confusion among customers, making it challenging for them to decide which policy to choose. I have emphasized the difference in coverage between these policies, as well as comparing their premiums. Since the post is extensive and thorough, it demands patience to read through. Sum insured options Comprehensive health insurance policy offers more sum insured options ranging from 5 lakh to 1 Cr, while Family health optima has maximum…

Choosing the right health insurance terms is crucial because you’re making a long-term commitment. You’ll be paying premiums for years, so understanding vital terms ensures your coverage truly suits your needs when you eventually need it. The term “hospital room rent limit” in health insurance policies may seem straightforward, but its scope extends beyond solely covering room charges. Insurance Regulatory and Development Authority of India (IRDA), defines room rent in its Master Circular on Standardization of Health Insurance Products dated 22July 2020, as “Room Rent means the amount charged by a hospital towards Room and Boarding expenses and shall include…

Physiotherapy is recommended by doctors for various conditions related to muscles, bones, joints, ligaments, and tendons. This includes conditions like arthritis, back pain, sprains, and strains. Physiotherapy helps patients recover and regain mobility after surgeries, such as joint replacements or orthopedic procedures. Apart form these physiotherapy is also prescribed in various other cases like sports injury, neurological disorders, chronic pain management, rehabilitation after accident. It helps in improving muscle movement, coordination and regaining strength. Physiotherapy prescription types Physiotherapy can be prescribed by doctor in 2 conditions: Condition 1: Post hospitalisation This comes under post surgery rehabilitation part of treatment. Where…