final modified insurance 2011

8/3/2019 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



MASTOIDECTOMY with TYMPANOPLASTY 33000

Surgery for varicose veins (including laser) 45000



Circumcision 7000

Fistulectomy 24000Fissurectomy + Sphincterotomy + Sentinal Pile 17000

Haemorrhoidectomy (excluding staples & trackers) 21000




Breast Lumpectomy 27000

Thyroidectomy - Total 24000

Inginal Hernioplasty (including Mesh) 27000


Phaco with Unifocal/ Foldable Lens 24000


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Total Knee Replacement (cost of Implant extra) 76000Total Hip Replacement (cost of Implant extra) 76000



TURP 42000


PCNL (percutaneous Nephrolithotripsy) 34000ESWL 22000





CABG 110000Acute gastro enteritis Management 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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MASTOIDECTOMY with TYMPANOPLASTY 64000

Surgery for varicose veins (including laser) 84500



Circumcision 13000

Fistulectomy 45500

Fissurectomy + Sphincterotomy + Sentinal Pile 33000Haemorrhoidectomy (excluding staples & trackers) 39000




Breast Lumpectomy 52000

Thyroidectomy - Total 45000Inginal Hernioplasty (including Mesh) 50000


Phaco with Unifocal/ Foldable Lens

35000 (per

eye)



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Total Knee Replacement (cost of Implant extra) 125000Total Hip Replacement (cost of Implant extra) 125000



TURP 85000


PCNL (percutaneous Nephrolithotripsy) 65000ESWL 35000





CABG 200000Acute gastro enteritis Management 25000




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

final modified insurance 2011

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