Coverage Clarity! Understand the complex world of insurance in simple way.
You may have been diligently paying your health insurance premiums for years, feeling secure that your financial worries in case of an illness are covered. But one day, you fall sick, require hospitalization, and file a claim, only to face rejection. The reasons could be something like “hospitalization was not medically necessary” or some other … Read more
A pacemaker battery generally lasts 5–6 years, but sometimes it might need replacement earlier. Now, the big question: does health insurance cover this cost? Let me explain in simple terms, so there’s no confusion. If you are still with the same insurance company that covered your pacemaker surgery, getting claim of of pacemaker battery replacement … Read more
When purchasing a health insurance policy, the first preference is often to look for plans that have no restrictions or limits in coverage. But is it truly possible to buy a health insurance policy without sub limits? With many insurers marketing ₹1 crore health insurance plans at so-called affordable premiums, one might assume these plans … Read more
GIPSA stands for the General Insurance Public Sector Association, a group of four public sector general insurance companies. These companies are National Insurance, Oriental Insurance, United India Insurance, and New India Assurance. These insurers have empaneled a number of hospitals across India, referred to as the Preferred Provider Network (PPN). Apart from the PPN package rates for surgical procedures, hospitals also agree to offer discounts on their cash rates (treatment costs for patients without insurance) to policyholders of these insurance companies.
It is always better to disclose all information related to your medical conditions and lifestyle upfront to the insurance company before buying a health insurance policy. Otherwise, you may end up paying premiums for years only to have your claim rejected or your policy canceled in the future.
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 … Read more
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 … Read more
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 … Read more
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 … Read more