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| Know
Your Policy |
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In
the modern era with the advent of improved
diagnostic facilities and growing advancement
of medical science, medical services
have become very expensive. One need
not hesitate to avail of the best of
the treatment and when one is covered
under a mediclaim policy. |
| Hospitalisation
for illness, disease or accident, whether
including surgery or not, imposes a
heavy financial burden on individuals,
families, employers and welfare bodies.
This is where medical insurance comes
in handy. |
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| Mediclaim
insurance policies provide reimbursement of
hospitalisation expenses, which include boarding
costs, nursing costs and fees of professionals
such as a surgeon, anaesthetist, medical practitioner,
consultant and specialist. It also grants
reimbursement of expenses incurred on account
of procedures like anaesthesia, blood, oxygen,
operation theatre charges, surgical appliances,
medicines and drugs, diagnostic material,
X-ray, dialysis, chemotherapy, radiotherapy,
cost of pacemaker, artificial limbs, cost
of organs and similar expenses. The amount
of money available for reimbursement depends
on the amount that the insured person was
insured for. |
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| Mediclaim
or Hospitalisation Benefit Insurance Policy |
| (A
general idea for understanding the cover is
given, but not exhaustive in nature) |
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| Provides
cover for medical expenses following hospitalization
from sudden illness or accident |
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| Extends
Cover to pre-hospitalisation and post-hospitalisation
for periods of 30 days and 60 days respectively
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| Domiciliary
hospitalisation is also covered (Pl. look
for details given below) |
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| Benefits |
- Reimbursement of medical expenses
- Discount in insurance premium on family
package; so also cumulative bonus and
health check-up. In case of family package
cover, a single member can avail of the
entire policy limits under floater cover
- Pre-existing diseases not covered
- Premium upto a maximum of Rs.10,000
is totally exempt from income tax
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| Domiciliary
hospitalisation |
- A patient is allowed to be treated at
home when he is not in a fit condition
to be moved to the hospital or where there
is no accommodation in the specialist
hospital provided,
- The treatment was for a period not less
than 3 days
- The sub limits of sum insured towards
domiciliary hospitalisation are furnished
in the sum insured and premium schedules
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| Exclusions |
- If any illness contracted within 30
days from the commencement of risk is
not covered except in case of an accident
- Any pre-existing diseases, Dental treatment,
congenital diseases. etc.
- Treatment for cataracts, benign prostatic
Hypertrophy, Hydrocele, Congenital internal
diseases, Fistula in anus, Piles, Sinusitis
and such related disorders for 1st year
of policy
- All the expenses incurred in respect
of any treatment relating to pregnancy
or childbirth
- Routine medical, eye and ear examinations,
cost of spectacles, Cosmetic, aesthetic,
obesity related treatment
- Directly or indirectly connected with
war, riot, strike, terrorism, nuclear
weapons induced hospitalization
- Intentional self-injury, AIDS, Alcohol
or Drug Abuse.
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| Please
look for the covers offered by various Indian
Insurance companies to have an idea. A general
idea is given below for approaching the subject. |
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| Suitability |
- Any one in the age group of 5 to 80
years can take the policy. Children in
the age below the age of 5 years can also
be covered from the age of 3 months onwards
provided one or both of the parents are
covered concurrently. Higher limits are
permitted if the policy is in renewal
for the preceding three years. Suitable
for persons of any nationality but treatment
should be availed of within the country
and the claim is paid in Indian currency
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| Requirements |
- A completed proposal form.
- If the proposer is having a medical
history like "diabetes" or "hyper-tension",
a separate questionnaire is to be completed
by family physician
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| We
serve all the persons covered by the health
policies under the TPA Services of "Gokulam
TPA". The following links to the websites
of insurance companies' will provide you detailed
information on insurance policies offered
by them. |
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| New
India Assurance Company Ltd. |
| National
Insurance Company Ltd. |
| Oriental
Insurance Company Ltd. |
| United
India Insurance Company Ltd. |
| Reliance
General Insurance Company Ltd. |
| ICICI
Lombard General Insurance Company Ltd. |
| Cholamandalam
Mitsui General Insurance Company Ltd. |
| Royal
Sundaram Alliance Insurance Company Ltd. |
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