final modified insurance 2011
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Health InsuranceAwareness on
Aga Khan Health Service, India
Regional Board for Western India
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Mawlana Hazar Imams Guidance
Hazar Imam wants His jamat to
have financial access to quality
health care.
Every Individual should have
adequate Insurance to cover all
medical expenses.
Your Insurance coverage should beenough to cover all expenses for
quality health care.
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Today getting treated for illnesses is getting very
costly. It is beyond a common mans resources to
pay for the hospitalization of one self or thedependents.
Our lifestyle is such that all of a sudden, a hail &
hearty person is diagnosed for Angiography or heart
bypass surgery for which the expenses incurred isanywhere between Rs.2 lacs to Rs.5 lacs.
Diabetes & Blood Pressure have become as
common as a common cold.
Due to this, it has become absolutely necessary for
each one of us to get a HEALTH INSURANCEcommonly known as MEDICLAIM INSURANCE
POLICY.
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Insurance Adequacy
In todays scenario, do you think that
coverage of Rs.1.00 Lac to Rs.2 Lacs is
ADEQUATE ?
The answer is a BIG NO?
Than, what sum would be adequate
according to you in the present scenario ofrising costs of medical expenses and
diseases
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Recommended Coverage Depending in the city you stay.
Class & hospital in which you desire to take
treatment.
Depending on the families medical history.
Expenses cap: The companies have started fixing
the maximum amount payable in case of different
illnesses, irrespective of the Sum Insured.
Companies have also put a cap on the room,
boarding and nursing expenses admissible to the
insured not exceeding to 1% of the sum insured,
e.g. a person having policy of Rs 50,000/- would
be eligible for a room, boarding and nursing
expenses not more than Rs 500/- per day.
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Early Insurance
It is advisable to take an insurance policy
at an early age so that you get benefit of
no-claim bonus.
An individual should also take maximum
coverage before the age of 40 yrs to avoid
medical checkups.
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Important Pointers in Health Insurance
You must read the policy exclusions & the limitations in various coversproperly before buying a Health Insurance plan because you should know
what all your policy includes & excludes.
You should have the list of network hospitals covered by your insurance
company as this will help you to get cashless & hassle-free claims.
You must know that the medical expenses incurred within the first 30
days of buying the health insurance plan are not covered, unless the
injury has occurred out of an accident.
You must disclose all the Pre-Existing diseases to the insurer before
buying the health plan as the insurer doesnt cover them, now a days
General Insurers have started covering these diseases normally after 3-4
years varying from company to company.
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Understand your policy
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Understand your policy
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Document List for Submission
1. Copy of the original medical policy.
2. Letter informing the insurance company about
hospitalization.
3. Completely, correctly and signed filled claim form.
4. All original prescriptions and bills from the Doctor for
medicines as well as diagnostic tests.
5. Hospital Discharge card.
6. Death Summary Report in case of Hospital Death.
7. Summary sheet of the documents submitted.
8. Additional documents suggested by the agent if any.
9. Always keep a photocopy of all the documents submitted
to the insurance company and if possible get it duly
attested by your treating doctor.
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Document List for Submission
10.D
eath Certificate (T
his certificate is issued by thelocal Municipal Authority or any local authority).
11. Death Summary (As the patient has died & then
shifted from hospital, there is no Discharge Certificate
issued for such cases. In lieu ofDischarge Card, a
Death Summery is issued indicating the patient
condition & cause of death at hospital. This is MUST
for cases involving death at hospital).
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Ensure
Intimation to the TPA/Insurance
company within 24 hours of
hospitalization.
Reimbursement claims MUST be
submitted within 7 days from the date of
discharge from Hospital.
Bills related to post hospitalization
expenses can be submitted as second
claim within 67 days of discharge from
hospital.
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Important Considerations:-
Planned surgeries, if can wait, try to post pone them at the
end of your policy year.
Understand your policy thoroughly do not depend onagents, ensure you know all the requirements for claims.
Ensure to collect all the required documents at the time of
discharge from hospitals.
Children are vulnerable and also need to be insured
adequately.
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Jagruti Policy Highlights
The entire family is covered under Family floater Policy
1+5 family members
Pre-existing diseases covered
Pre & Post Hospitalization expenses for 30 days and 60 daysrespectively from date of illness are covered
No health check-up required
Room, Boarding and Nursing expenses are covered but
limited to 1% of sum insured Ceilings on Diseases
Minimum hospitalization of 24 hrs
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 100,000
Tonsillectomy / Adenoidectomy / Adenotonsillectomy 13000
FESS + Septoplasty 25000
MASTOIDECTOMY with TYMPANOPLASTY 24000Surgery for varicose veins (including laser) 30000
Appendicectomy - Laproscopic 20000
Cholecystectomy - Laproscopic 30000
Circumcision 3000
Fistulectomy 15000Fissurectomy + Sphincterotomy + Sentinal Pile 12000
Haemorrhoidectomy (excluding staples & trackers) 12000
Perianal Abscess 8000
Pilonidal Sinus 6000
Radical Mastectomy Modified 40000
Breast Lumpectomy 15000Thyroidectomy - Total 15000
Inginal Hernioplasty (including Mesh) 16000
Hysterectomy (laproscopic) 25000
Phaco with Unifocal/ Foldable Lens (Per Eye) 13000
Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) 10000
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 100,000
Arthroscopic Surgery 30000
Total Knee Replacement (cost of Implant extra) 60000
Total Hip Replacement (cost of Implant extra) 60000
Fracture Neck Femur (cost of implant extra) 60000
Laminectomy / Discectomy / Stabilzation of Spinal Cord 45000
TURP 30000
Hydrocelectomy 15000
PCNL (percutaneous Nephrolithotripsy) 25000
ESWL 15000
Haemo Dialysis (per sitting) 1500
Coronary Angiogram (incuding Dye) 10000
Angioplasty - PTCA (excluding stent) 50000
Valve Replacement 80000
CABG 80000
Acute gastro enteritis Management 8000
LRTI Management 15000
Urinary Tract Infection Management 8000
Therapeutic D & C 10000
Management of Fever due to unknown etiology or Malaria or Typhoid
(approx stay 3 -4 days without ICU requirement, without complications)12000
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 2,00,000
Tonsillectomy / Adenoidectomy / Adenotonsillectomy 21000
FESS + Septoplasty 40000
MASTOIDECTOMY with TYMPANOPLASTY 33000
Surgery for varicose veins (including laser) 45000
Appendicectomy - Laproscopic 34000
Cholecystectomy - Laproscopic 47000
Circumcision 7000
Fistulectomy 24000Fissurectomy + Sphincterotomy + Sentinal Pile 17000
Haemorrhoidectomy (excluding staples & trackers) 21000
Perianal Abscess 13000
Pilonidal Sinus 10000
Radical Mastectomy Modified 62000
Breast Lumpectomy 27000
Thyroidectomy - Total 24000
Inginal Hernioplasty (including Mesh) 27000
Hysterectomy (laproscopic) 38000
Phaco with Unifocal/ Foldable Lens 24000
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 2,00,000
Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) 24000
Arthroscopic Surgery 45000
Total Knee Replacement (cost of Implant extra) 76000Total Hip Replacement (cost of Implant extra) 76000
Fracture Neck Femur (cost of implant extra) 66000
Laminectomy / Discectomy / Stabilzation of Spinal Cord 62000
TURP 42000
Hydrocelectomy 24000
PCNL (percutaneous Nephrolithotripsy) 34000ESWL 22000
Haemo Dialysis (per sitting) 2000
Coronary Angiogram (incuding Dye) 13000
Angioplasty - PTCA (excluding stent) 66000
Valve Replacement 110000
CABG 110000Acute gastro enteritis Management 14000
LRTI Management 21000
Urinary Tract Infection Management 18000
Therapeutic D & C 14000
Management of Fever due to unknown etiology or Malaria or Typhoid
(approx stay 3 -4 days without ICU requirement, without complications) 19000
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 5,00,000
Tonsillectomy / Adenoidectomy / Adenotonsillectomy 39000
FESS + Septoplasty 72000
MASTOIDECTOMY with TYMPANOPLASTY 64000
Surgery for varicose veins (including laser) 84500
Appendicectomy - Laproscopic 65000
Cholecystectomy - Laproscopic 100000
Circumcision 13000
Fistulectomy 45500
Fissurectomy + Sphincterotomy + Sentinal Pile 33000Haemorrhoidectomy (excluding staples & trackers) 39000
Perianal Abscess 25000
Pilonidal Sinus 20000
Radical Mastectomy Modified 117000
Breast Lumpectomy 52000
Thyroidectomy - Total 45000Inginal Hernioplasty (including Mesh) 50000
Hysterectomy (laproscopic) 73000
Phaco with Unifocal/ Foldable Lens
35000 (per
eye)
Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) 49500
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AILMENTWISE CAPPING SUBLIMITS (Rs) SI 5,00,000
Arthroscopic Surgery 84500
Total Knee Replacement (cost of Implant extra) 125000Total Hip Replacement (cost of Implant extra) 125000
Fracture Neck Femur (cost of implant extra) 115000
Laminectomy / Discectomy / Stabilzation of Spinal Cord 117000
TURP 85000
Hydrocelectomy 45500
PCNL (percutaneous Nephrolithotripsy) 65000ESWL 35000
Haemo Dialysis (per sitting) 2000
Coronary Angiogram (incuding Dye) 20000
Angioplasty - PTCA (excluding stent) 80000
Valve Replacement 200000
CABG 200000Acute gastro enteritis Management 25000
LRTI Management 35000
Urinary Tract Infection Management 26000
Therapeutic D & C 24000
Management of Fever due to unknown etiology or Malaria or Typhoid (approx
stay 3 -4 days without ICU requirement, without complications)
35000
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Renewal of the policy
MOST IMPORTANT: THERE IS NO GRACE PERIOD FOR
RENEWAL OF THIS POLICY. PLEASEDONTWAIT FOR THE
LASTDATEOR SOMEBODYTO REMINDYOU. DEPOSITTHE
PREMIUM AT LEAST 30 DAYS IN ADVANCE ANDENSURETHAT
THE CHEQUE IS DULY CLEARED FROM YOUR A/C BEFORE
THEDUEDATE. OTHERWISE, ITWILL BETREATED AS A
FRESH POLICY AS FAR AS PREEXISITING DISEASES ARECONCERENED, WHICH IS MAJOR LOSS.
Remember, the longer the policy has been in force
without a break, the lesser is the probability of a claim
being rejected.
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Thank You