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CRITICAL ILLNESS FAQS

  • What is the difference between Critical illness insurance and normal health insurance ?
    In a critical illness policy you are covered for certain mentioned critical illnesses only. Some of coverage's are Kidney disease, brain tumor, and major organ transplant and many more depending on the companies. If you have normal health insurance you will definitely get covered for critical illness but in critical illness you won't get coverage for normal disease like malaria, typhoid.

    For e.g. If your age is 25 and you buy normal health insurance from any XYZ company and let say its premium is Rs. 3000 for cover of 3 lacs but if you buy critical illness policy for 3 lacs the premium would be less because considering your age the changes of you getting a critical illness is lesser than any normal disease.

    Similarly for old age person the premium for critical illness insurance will be more than normal health insurance because chances of getting that critical disease are more at older age. One other option would be to avail critical illness rider in term plan itself.
  • What is the benefit of critical illness policy?
    So as you grow older it is advisable to have another critical illness policy along with normal health insurance. So those at old age when undergo major operation or transplant, this critical illness policy can be used and for minor disease normal health insurance is used.

    The reason for this is e.g. if you have normal health insurance of 5 lacs and you undergo tumor surgery with other complications and the expenses are around 4 lacs and after sometime you get hospitalized because of ill-health then you have nothing left in your health insurance.
  • What is Domiciliary Hospitalization?
    Domiciliary Hospitalization means medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a Hospital/Nursing Home but actually taken whilst confined at home in India under any of the following circumstances, namely:

    i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home
    ii) The patient cannot be removed to Hospital/Nursing Home for lack of accommodation therein

    For smooth claim process, just take care that all your documents are in place and to be on a safer side have a report from your family doctor, stating that this person cannot move to nursing home/hospital due to such and such reasons.

    It just provides the proof and makes the process simpler. Note that every company does not offer this facility, you should check your policy document.
  • Why is Critical illness Insurance important?
    All of us should buy Critical insurance and for all members of our family, according to our needs. Buying critical illness insurance protects us from the sudden, unexpected costs of hospitalization which would otherwise make a major dent into household savings or even lead to indebtedness.

    Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advances, new procedures and more effective medicines that have also driven up the costs of healthcare.

    While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.
  • What kinds of Critical illness Insurance plans are available?
    A Critical Illness benefit policy provides a fixed lumpsum amount to the insured in case of diagnosis of a specified illness or on undergoing a specified procedure. This amount is helpful in mitigating various direct and indirect financial consequences of a critical illness. Usually, once this lump sum is paid, the plan ceases to remain in force.

    There are also other types of products, which offer lumpsum payment on undergoing a specified surgery (Surgical Cash Benefit), and others catering to the needs of specified target audience like senior citizens.
  • Can I transfer my policy from one insurance company to another without losing the renewal benefits?
    Yes. The Insurance Regulatory and Development Authority (IRDA) has issued a circular making it effective from 1st October, 2011, which directs the insurance companies to allow portability from one insurance company to another and from one plan to another, without making the insured to lose the renewal credits for pre-existing conditions, enjoyed in the previous policy.

    However, this credit will be limited to the Sum Insured (including Bonus) under previous policy. For details, you may check with the insurance company.
  • What is 'Any one illness'?
    'Any one illness' would mean the continuous period of illness, including relapse within a certain number of days as specified in the policy. Usually this is 45 days.
  • What is the maximum number of claims allowed over a year?
    Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However the sum insured is the maximum limit under the policy.
  • What do you mean by Family Floater Policy?
    Family Floater is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured.

    Quite often Family floater plans are better than buying separate individual policies. Family Floater plans takes care of all the medical expenses during sudden illness, surgeries and accidents.
  • What are the advantages of sticking to one Health Insurance company for a long time?
    The plus point of sticking with one company is that if someone is suffering from any pre-existing disease at the time of commencement of policy, those complications will be covered after 4 years.

    Until portability is introduced in India, this is the single biggest advantage to stick with one company for long. Another advantage is that when you have a continued policy from any insurance company, after few years you get bonus or discount in premium.

    For example: Suppose you have a policy of 3 lacs and you are with the same insurer for past 4 years you can get a bonus of 50% i.e. you pay premium for 3 lac only but you get coverage of 4.5 lacs. Similarly some companies don't offer bonus but they offer discount in premium i.e. for coverage amount of 3 lacs you pay lesser premium than actual amount.

    So if you don't have any serious problems with the insurance company then it is better to stick to one company.
  • Can NRI's take Critical illness insurance? Can they travel to India for treatment and claim? What about emergency situations?
    Yes NRI's can take Critical illness insurance in India. They can definitely travel to India for treatment and can claim it. however they will have to show their residence proof, ITR and a few other documents. If they don't have those documents, then they are not eligible to get insured in India.The cost of treatment in India is different and cheaper than countries like USA, UK and other European countries.

    The premium amount computed depends on Indian conditions and parameters. So if a NRI has health insurance form Indian company, that person would be paying premium as per India actuaries and obviously cost of treatment in his residing country would be higher than India.

    For e.g. If a person get dengue and he is very critical and requires urgent hospitalization, the cost of treatment in India would come up to 1-2 lacs (and this is on higher side.) The same treatment would cost around 10-15 thousand dollars in US so this burns a hole in insurance companies' pocket. So for treatment the person has to come to India and they don't offer compensation for treatment there.
  • How to claim successfully in case of emergency and planned hospitalization?
    The most basic fundamental for a smooth claim process is keeping all your documents up to date. If you have a past history of illness, make sure that you submit those documents too, because the TPA department will come to know whether it's a pre-existing disease or not.

    While submitting your documents make sure that all the documents are proper and there is no missing document pertaining to your illness. This will just give a chance to TPAs to make excuses and you will have to run for your money. It's worth noting that in case of planned hospitalization, if you inform your mediclaim company in advance and take prior authorization, everything will be settled by the mediclaim company or TPA, without the policyholder been required to submit any document.
  • If there are no loading charges, can premium still change on renewal?
    This is a very big question with very easy answer..If you check the premium structure of any of the mediclaim company, either there premium is increasing every year or they have premium slab for different age groups; something like for age 30-35 premium is 4200 and from age 36-40 its 6700.

    So under this second policy, when the policy holder moves from age 35 to 36, his premium suddenly jumps by Rs 2500 and this is not loading. So yes, premium can/will increase irrespective of loading after certain age.
  • During the course of my treatment, can I change the hospitals?
    Yes it is possible to shift to another hospital for reasons of requirement, of better medical procedure.

    However, this will be evaluated by the TPA on the merits of the case and as per policy terms and conditions. Note that it would be prudent if you check the network hospital list and go to the best hospital in the beginning itself rather than changing midway.
  • What are the situations under which one may be denied cashless hospitalization?
    1. If there is any doubt in the coverage of treatment of present ailment under the Policy if the information sent to TPA is insufficient to confirm coverage
    2. If the ailment/condition is not being covered under the policy.
    3. If the request for pre - authorization is not received by TPA in time. In such a situation, the Insured can take the treatment, pay for the treatment to the hospital and after discharge, send the claim to TPA for processing.
    4. In case the hospital in not on the panel of the company or the disease/illness is pre-existing and not covered for 4 years.
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