health insurance basics- faqs

7/29/2019 Health Insurance Basics- FAQs

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Designed by Content team For Internal Circulation Only PolicyBazaar.com

Basics of Health InsuranceFrequently asked Questions

Why do I need health insurance?

Health insurance will protect you and your family against any financial risksarising due to a medical emergency. Buyinga proper health plan would help you in saving your hard earned savings and other assets.

What is Mediclaim insurance?

Mediclaim insurance consists of the reimbursement of hospitalisation and/or domiciliary hospitalisation expenses for

any illness/diseases or injury sustained by the insured individual. The policy takes care of medical expenses following

Hospitalisation/Domiciliary Hospitalisation of the insured in respect of the following situations: in case of sudden illness,

in case of an accident, in case of any surgery which is required in respect of any disease which has arisen during thepolicy period.

In contrast, there are fixed benefit hospitalization plans which serve as funding for medical emergencies without actual

bill settlement. They work with or without a mediclaim plan.

What does 'Hospital' mean with regards to mediclaim insurance policies?

Any institution established for the indoor care and treatment of sickness and/or injuries, which is duly registered and

supervised actively by a registered medical practitioner OR

If not registered with any authority, establishment with following criterias can be classified as a 'Hospital'.

At least 15 patient beds (10 beds if in rural area) with fully equipped operation theatre of its own if surgical procedures are carried out employing fully qualified nursing staff around the clock having fully qualified doctors in charge around the clock

HealthInsurance

Mediclaim

Comprehensive Senior Citizen Critical IllnessTop Up / Super

Top up

Hospitalization(Fixed benefit

plans)

Daily cash Critical Illness Surgery benefit


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What is meant by 'Hospitalisation'?

Hospitalization refers to admission in the hospital which is an in-patient activity (IPD).

Normally for insurance policies, any instance when and where the insured individual is hospitalized for a minimum

period of 24 hours can be termed as 'Hospitalization'.

There are other sections in the policy where same day discharge is also payable for specific treatment like dialysis

chemotherapy, radiotherapy, laser eye surgery, dental surgery, etc.

In contrast, OPD has consultations, diagnostic tests etc without getting admitted in the hospital.

What is 'Domiciliary Hospitalisation'?

"Domiciliary Hospitalisation' is any instance when and where the insured individual requires medical treatment at home

However, few criterias need to be met for it to be covered by insurance. These are:

Treatment should be for more than three days For illness / disease / injury that in the normal course would require hospitalization.

Also, conditions which must be fulfilled are:

1. Advised by Authorized Medical Practitioner2. Condition arose due to either lack of hospital accommodation or patients critical condition

Few conditions (explained below) are exempted from this ruling which majorly includes those arising because obreathing issues.

Are there any other restrictions on domiciliary hospitalisation benefits under Mediclaim ?

Under Mediclaim, the limit of compensation is low and for certain diseases like asthma, bronchitis, diabetes, epilepsy,

etc it is not available.

What is meant by Pre-hospitalisation and Post-hospitalisation expenses?

The expenses under these two sections are essentially related to the hospitalization involved here. It may includ

diagnostics, consultation, medicines etc. depending up on the relevance.

The relevant medical expenses incurred prior to hospitalization are known as 'Pre-hospitalization expenses(Usually 30 days prior)

Medical expenses incurred post discharge from the hospital is known as 'Post-hospitalization expenses.(Usuallytill 60 days )


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What are the different benefits that can be claimed under the Mediclaim insurance policy

in event of hospitalisation?

Usually below mentioned are the different heads of benefits covered under hospitalization:

Room boarding expenses by the hospital nursing home

Nursing expenses

Surgeon, anesthetist, medical practitioner, consultants, specialists fees Anesthesia, blood, oxygen, operation charge, surgical appliances Medicines and drugs Diagnostic material and x-rays Dialysis and chemotherapy, radiotherapy Pacemaker, artificial limbs and cost of organs and similar expenses

All the above benefits are limited to the maximum sum insured opted under the plan and may or may not have a specific

sub limit defined.

In general, the minimum period of hospitalization should be for 24 hours. However for certain treatments this limit is

not applicable when a package charges are levied for treatment by the hospital.

Day Care treatments are an exception to this condition as well.

Are the tests prescribed by the doctor reimbursed under Mediclaim?

All charges incurred at the hospital or nursing home primarily for diagnostic purposes such as X-rays, blood analysis,

ECG, etc will be reimbursed only if they are consistent with or incidental to the diagnosis and treatment of the ailment

for which the policyholder has been hospitalised and not otherwise. Also, the time frame needs to be in the purview of

pre/ post hospitalization.

Can treatment be taken at any hospital or at a particular hospital under Mediclaim?

Under Mediclaim, treatment at all the hospitals / nursing homes registered with local authorities is allowed. In case

there is no registration with the local authority the hospital should have at least 15 in-patient beds, a fully operational

operation theatre, qualified nursing staff and doctor in charge. Only if these conditions are satisfied can the person go to

his or her hospital of choice.

However, there is network hospital chain where the claim might be passed cashless.


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What is a Health Card?

A health card is a card that comes along with the Health Policy. Similar to an Identity card, the card entitles you to avail

cashless hospitalization facility at any of the network hospitals.

A typical health card mentions the contact details and the contact numbers of the TPA (on the backside). These numbersshould be contacted in case of a medical emergency, for queries, clarifications and for seeking any kind of assistance.

Moreover, the health card needs to be displayed at the time of admission into the hospital.

It can be with photograph or without one. If not included, the health card is valid with a photo identity proof.

What if I want to renew my health insurance policy after one year?

The insurer sends a renewal notice informing of the expiry of your health policy via courier.

However the Company is under no obligation to send renewal notice and its absence thereof shall not tantamount to

deficiency in services. Hence Customer has the prime responsibility to renew his policy.

Policybazaar customers are contacted by our own renewal team as well. A customer also can call us at our toll free

number or write to us at [email protected] for such requests.

Thus we serve to bridge the gap there. The customer has the option to choose the same insurer or switch to another by

opting Insurance portability.

What do you mean by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless

Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. It is

settled by the insurer as the health card is shown by the insured at the network hospital.

What is the maximum number of claims allowed over a year?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital.

Under Cashless Hospitalization the patient does not have to settle the hospitalization expenses at the time of discharge

from hospital. It is a direct settlement by the insurer after authorization has been established with registration and

display of the health card by the insured at the network hospital.


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Can I get any Tax Benefits with Health Insurance?

As per Section 80D of the Income Tax Act, any amount of health insurance premium paid up to Rs. 15,000 would be

allowed as deduction from the total income for income tax calculation purposes. This amounts to cover for self, spouse

and children. A person is eligible for a deduction of another Rs. 15,000 for covering parents.

The limit is extended to a higher amount of up to Rs 20,000 for senior citizens.

Thus, a maximum of Rs. 35,000 can be considered for deduction from taxable amount under section 80 D covering

health insurance.

In case the proposer intends to cover his parents under medical insurance, is he/she

eligible for a deduction of another Rs.15,000 under section 80D?

Yes, the cover for parents is in addition to the self/family cover. In case the age of parent to be covered is above 60

years, the deduction available is increased up to Rs.20,000 under section 80D.

What is the Family Floater Plan?

One single policy takes care of the hospitalisation expenses of your entire family. Family Floater Health Plan takes care

of all the medical expenses during sudden illness, surgeries and accidents.

It is like using a party pack chips for all in the party. The one, who needs it, can use it without the compulsion of finishing

individual packets.

Is a medical check up necessary before buying a Health policy?

Most of the insurers do not mandate a pre-policy check up for younger age group and for a low cover.

This becomes compulsory for a new policy above a certain age and cover amount and the criteria differs from one

insurer to the other.

It also becomes mandatory for customers who are not enjoying good health even if they have not reached the age limit.

Good health is checked by a set of questions which typically includes (but not limited to) past illnesses/ hospitalization

and Body Mass Index.

My wife and children are residing at Mysore while I am here in Bangalore. Can I cover all of

us in one policy?


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Yes, you can cover the entire family under one policy. Your health insurance policy is in force across India. You must

check whether there are any network hospitals near to your as well as your family's place of residence. You must check

if your insurer has a network hospital close to you or where the rest of your family resides. Network Hospitals are the

hospitals that have tied up with the TPA (Third Party Administrator) for cashless settlement for expenses incurred there.

If there are no network hospitals at the place of your residence, you could opt for reimbursement mode of settlement.

I am a Foreign Citizen? Can I take a health policy for my child who is continuing furtherstudies in India?

Yes. The scope of coverage however, shall be restricted to treatment taken in hospitals in India during the policy period.

Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?

Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc as long they are associated with the patients

stay in the hospital for at least 24 hours. Any diagnostic tests which do not lead to treatment or which have been

prescribed as Outpatient are generally not covered.

Does any health policy cover expenses on outpatient treatment also?

Normally Health policies cover only expenses incurred as Inpatient. So unless and until specified, a health insurance

policy does not cover for expenses incurred as out patient.

Some health insurers covers reimbursement of expenses incurred as Outpatient subject to terms and conditions of the

policy.

Examples:

1. Apollo Munich Health Insurance - Maxima (Sum Insured 3 Lakhs for mediclaim and OPD features)2. Star Health Insurance- Health Gain policy (Sum Insured 1-5 lakhs with OPD benefit varying)

Does any health policy cover the treatment for diseases Im currently suffering from/

which occurred in past also?

Normally health plans exclude treatment of any pre-existing diseases / conditions. Mostly the treatment of any such pre

existing disease/ condition is covered after 48 months of continuous renewals with the health insurer.

Also, an insurer might choose not to cover for the illness and complications arising because of it permanently. In such a

case, the applicant is informed at the time of policy purchase and they have the option of rejecting the same.

Can a take a health insurance policy for my child who is 3 yrs old?

Depending on the insurer/ policy, children can be covered individually or with either or both the parents.


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Can I avail this policy if I am not an Indian National but living in India?

Yes, foreigners living in India can be covered under a health insurance policy. However, the coverage would be restricted

to India.

Also, they should be able to produce proofs of a longer visit with reason supporting it. Typically, it can be work relatedwherein one can produce Visa and work appointment letter to get the policy.

What do you mean by Network /Non-network Hospitalization?

A Hospital, which has an agreement with the particular insurer (or TPA) chosen for providing Cashless treatment, is

referred to as a 'Network Hospital'. Cashless facility can be provided ONLY at the network hospitals.

Non-network hospitals are those with whom the insurer / TPA does not have any agreement and any policyholder

seeking treatment in these hospitals will have to pay for the treatment and later claim as per reimbursement procedure

Cashless can be denied even in cases where the hospitalization was in network hospitals; and later they can be

reimbursed for if the reason for decline has been solved. These cases arise in the event of lack of documentation or

some other issues where instant approval could not be provided. Denial of cashless treatment does not mean denial of

claim.

How does one obtain the Authorization letter?

The Network Hospital can intimate health insurer/TPA and fax the Pre authorization form to health insurer/TPA. Theform is already available with the Hospital or they can download it from the website. Insurer doctors will scrutinize the

request and send an authorization letter or regret letter with reasons supporting the stand.

Can a request for Authorization for cashless be declined?

Yes, a request for authorization for cashless access may be declined in following cases:

Inadequate/vague/wrong information is provided The ailment/ disease for which hospitalization is required is not covered by the scope of the insurance policy The person does not have adequate insured amount left to cover the hospitalization costs

Additionally, these cases may also arise in the event of lack of documentation or some other issues where instan

approval could not be provided.

Denial of cashless treatment does not mean denial of claim.


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How does hospitalisation for Planned Hospitalisation work?

1. The request for Pre- Authorization form for planned treatment has to be signed by the customer and sent byHospital

2. This request must reach the health insurer at least 2-5 days before hospitalization (depending on the insurer)3. The authorization will be addressed and faxed to the hospital. Any change in the date of hospitalization, Hospital, nature of illness or surgeon who is going to perform the

procedure will make the authorization invalid. A fresh authorization will have to be taken.

The authorization is valid only for Network Hospitals.

How does one get Reimbursements in case of treatment in non- network hospitals?

Cashless Hospitalization is a feature available only in Network Hospitals.

One may preferably choose to get admitted in a network hospitals which helps in no cash arrangement affair. However,

it might not be a luxury always and fe might prefer their trusted hospitals.

In cases where treatment in a Non Network hospital, Health insurer will reimburse reasonable expenses supported by

the bills subject to the policy taken by the policyholder.

Health insurer should be contacted either in advance or within 24 hours from the time of admission with details of

Health insurer id card number Nature of illness, Name & address of the Hospital/ Nursing Home/ Clinic, Room Number etc.

The claim will be registered by Customer Care and a claim number will be provided to the Policy holder.

Claim form will be sent to the Policy holder address.

This claim form must be filled fully and sent to Health insurers office along with the following documents in original.

1. Main Hospital Bill with Receipt for payment along with the break up.2. Doctors prescription and medicine bills.3. Discharge summary sheet from the hospital.4. Investigation reports along with the X Ray film5. Other relevant details and documents connected to hospitalization.

Note: Only expenses relating to hospitalization will be reimbursed as per the policy taken. All non-medical expenses/

convenience charges will not be reimbursed.


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How do Top-up covers work?

Top-up covers work on the deductible sum insured concept. Deductible amount means the amount which you have to

pay first so as to trigger the top-up cover. You can pay this deductible amount from your existing/base health insurance

policy, or out of your own pocket.

A top cover may be advantageous to buy for following reasons:

Increase in hospitalization expenses over the period of time Increase in the frequency for serious hospitalizations Additional cover over and above the existing cover Reasonable premiums as compared to the covered sum insured Waiting periods and exclusions are as per the base policy (generally but not always)

Though the base policy is a requirement in many, there are standalone top-up cover available for purchase as well. For

these one does not have to have any base policy. In this case, as suggested earlier, the deductible amount will have to

be paid from your pocket and all the standard waiting periods and exclusions would apply for this as it would for a

regular policy.

Standard waiting periods:

First 30 days waiting period Waiting periods for pre-existing diseases Waiting period for specified treatments/ illnesses/ surgeries

Standard exclusion:

Pregnancy and child birth HIV, AIDS Plastic or cosmetic surgery External equipment or aid Dental or eye related treatments (unless due to accidents) Hospitalization for diagnostic purpose only

The exclusive and exhaustive lists of each can be read in the policy wordings.

It should be ascertained that when you purchase a top-up cover the deductible amount should match your base policy

sum insured otherwise the difference would have to be borne by you.

Caution: Top up policy requires the deductible amount to be surpassed in each and every claim. For example, if the

deductible mount is 2 lakhs then the top up becomes payable only when the amount exceeds 2 lakhs every time (except

for same illness withing a time frame).


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Super top up policies are recommended to bypass this.

What are the criteria for deciding on the best health cover?

Choosing a health cover for yourself must be done after careful analysis of your needs.

In case you need a wide cover as also Income tax benefits the mediclaim policy with a family package cover could be a

suitable option for you. A simple option is to contact Policybazaar advisor to help with the requirement fulfilling.

Following things should be kept in mind while selecting the features and the cover extent (amount)

1. Lifestyle

Occupation Income City Food style

2. Life-stage

Single/ Married With/ without kids Age Recent Marriage

3. Health conditions

Healthy Past illnesses Hereditary conditions Risky Lifestyle Recent hospitalizations

Please know that this is just an indicative list.

How do you decide whether a disease was a pre-existing one or not?

There are many ways. The most common and obvious ones have been mentioned:

1. At the time of policy purchase: Proposal form serves as disclosures which the customer needs to make in goodfaith. There are columns capturing this information which should be provided as per the knowledge.

Diseases occurred in past and for those one is undergoing any treatment classify in this category. The insurers refer suc

health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses.

2. At the time of claim: Insurers refer to the proposal form for disclosures made. They also need all the medicaldocuments related to the diagnosis and the history of illness which should coincide. Failure might result in denia

of claim.


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Under mediclaim, is the limit of insurance per sickness or annual?

Under mediclaim, the amount of insurance is the limit until which the insurance company will pay during any policy

period. They are annual limits for all sicknesses / accident during a year. Depending on the insurer, there might be

disease specific limits as well.

What happens when the limit of insurance is exhausted under Mediclaim?

Under mediclaim, future expenses are not covered during the same policy period however when the policy is renewed,

the limit of insurance starts afresh.

Few insurers also provide facilities of restoration of Sum Insured/ Recharge facility within the policy period. This allows

the cover amount to be increased in cases of new illnesses or accidents. The regulations/ specifications vary as per the

plan.

Can my whole family be covered under a single Mediclaim policy?

Yes, under Family Floater Mediclaim policies, where the spouse (husband/wife), children and/or dependant parents may

be covered under same policy.

What are the factors which determine the premium payable under Mediclaim?

Under Mediclaim, the age of the eldest member and the amount of cover are the primary factors that decide the

premium. Age of other insured members also play a role.

Few other factors may be:

Location Floater / Individual cover

Who will receive the claim amount under Mediclaim if the policyholder dies during the

time of treatment?

Under Mediclaim, the claim amount is paid to the nominee of the policyholder. The amount is only to settle the bills of

the particular treatment and not to compensate for any other loss.

Accidental policies may have claim payments arising out of death claims to a limit.

In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate

from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the

court for disbursement to the next legal heirs of the deceased.


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Why opt for a Top-up Cover?

The simplest reason for buying a top-up cover is that your health insurance policy may not always be sufficient when it

comes to large medical expenses. Let us take the example of Aditi:

Aditi is a young corporate professional. She has health insurance for Rs.3 lakh. One day, she is diagnosed with a serious

illness and is hospitalized for treatment. Within 5 months, her health insurance policy has been exhausted due to the

treatment being very expensive. Luckily for Aditi, she had taken a top-up cover of Rs.10 lakh, with a deductible of Rs.3

lakh. So her medical bills continue to be paid without any trouble.

Top-up covers are also useful if you are a senior citizen, or approaching that age. As you grow older, getting an increase

is the sum insured of your base policy will be difficult and expensive. The premium rates will be very high and there will

be numerous medical tests to undergo as well. In these cases, having a top-up cover means that you can stick with your

base policy, while letting the top-up cover take care of any extra expenses that arise.

Can the Mediclaim the insurance contract be cancelled midway?

The policy can be cancelled at any time during the course of its operation. However, no claim should have been made up

to the cancellation request date.

In such cases, the insurance company will refund the premium paid (on the basis of the table provided below). This

might have variations from insurer to insurer and should be checked in the policy document of the plan finally

purchased.

Date of cancellation Amount to be refunded

Within 1 month Quarter of the annual rate

Within 3 months Half of the annual rate

After 6 months No refund

Note: The policy may also be cancelled at any time by the insurance company by giving the insured person 30 days

notice through a registered letter sent to the last known address of such person.

This holds true for most of the insurers, however few of them have the provision of free look period or a different setup

for cancellation fees.

In such circumstances, the insurance company has to refund the premium pro-rata for the un-expired period of

insurance.

I am young and healthy. Do I really need health insurance?

Yes. You will need insurance. Even if you're young, healthy and haven't had to see a doctor in years, you will need

coverage against unexpected events like accidents or an emergency. While your health insurance coverage may/may no

(depending on the policy taken) pay for things that aren't too costly like routine doctor's visits, the main reason to have


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coverage is to have protection against the large treatment expenses of serious illness or injury.

No one knows when a medical emergency might strike. It is best to buy health insurance, to save money when an

emergency strikes.

Is Health Insurance the same as Life Insurance?

No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely

death/or if something happens to you. The payout is made only post the death of the person insured or at the maturity

of the policy. Health Insurance protects you against ill health/diseases by covering the expenses you might incur (for

treatment, diagnosis etc.) in case you are affected by disease or injury. There is no payout made at maturity. Health

insurance also needs to be renewed annually.

My employer provides me with health insurance coverage. Is it advisable to take another

policy on my own?

It is strongly advised to have health insurance on your own as well because of reasons of continuity. Firstly, if you change

your job, you might not necessarily get health insurance from your new employer. In any case you will be exposed to

health costs in the transition period between jobs.

Secondly, the track record that you have built in health insurance at your old employer will not transfer to the new

company policy. Covering pre existing diseases might be a problem. In most policies pre-existing diseases are covered

only from the 5th year onwards.

Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided

group health insurance policy.

Are Maternity/Pregnancy related expenses covered under Health Insurance plans?

No. Maternity/Pregnancy related expenses are not covered in a Health Insurance plan. However, employer provided

group insurance plans often cover maternity related expenses.

What are the minimum and maximum policy durations?

Health insurance policies are general insurance policies usually issued for a period of 1 year only. However, some

companies also issue a two year policy. At the end of your insurance period you must renew your policy.

What is coverage amount?

Coverage amount is the maximum amount payable in the event of a claim. It is also known as sum insured and sum

assured. The premium of the policy is dependent on the coverage amount chosen by you.


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Are naturopathy and homeopathy treatments covered under a health policy?

Naturopathy and Homeopathy treatments are not covered under a standard health policy. The coverage is available only

for allopathic treatments in recognized hospitals and nursing homes.

Who is a Third Party Administrator?A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development

Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of

services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely

settlement.

What do you mean by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under CashlessHospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. The

settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This is for your

convenience.

However, prior approval is required from the TPA before the patient is admitted into the hospital. In case of emergency

hospitalization, approval can be obtained post-admission. Please note that this facility is available only at the network

hospitals of the TPA.

Can I buy more than one Health Insurance policy?

Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay rateable proportion

of the loss.

For example, a customer has Health Insurance from Insurer A for coverage of Rs. 1 lakh and Health Insurance from

Insurer B for coverage of Rs. 1 lakh. In case of a claim of Rs. 1.5 lakh each policy will pay in the ratio of 50:50 up to the

sum assured.

Are there any waiting periods when my expenses will not be settled, in case of acontingency?

When you get a new health insurance policy, there will be a 30 day waiting period starting from the policy start date,

during which period any hospitalization charges will not be payable. However, this is not applicable to any emergency

hospitalization occurring due to an accident.

This 30 day waiting period is not applicable when the policy is renewed.


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What happens to the policy coverage after a claim is filed?

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement.

For Example: In January you start a policy with a coverage of Rs 5 Lakh for the year. In April, you make a claim of Rs 2

lakh. The coverage available to you for the May to December will be the balance of Rs.3 lakh.

Can I avail this policy if I am not an Indian National but living in India?

Yes, foreigners living in India can be covered under a health insurance policy. However, the coverage would be restricted

to India.

Is mediclaim the same as health insurance?

Yes, it is the same in the broader terminology. However, health insurance is the umbrella term which includes surgical

coverage plan, fixed benefit plans etc as well.

What is the difference between Health Insurance & Critical Illness policies or Critical

Illness Riders in insurance?

A Health Insurance policy is a reimbursement of the medical expenses.

Critical illness insurance is a benefit policy. Under a benefit policy upon the occurrence of an event, the insurance

company pays the policyholder a lump sum amount. Under a Critical Illness policy, if the insured is diagnosed with any

critical illness as specified in the policy, he insurance company will pay the policyholder a lumpsum amount. Whether

the client spends the amount received on the medical treatment or not depends on the client's own discretion.

What happens when I cancel the policy?

If you cancel the policy, your cover will cease to exist from the date of cancellation of policy. Additionally, your premium

should be refunded to you on short period cancellation rates. You will find these in the policy terms and conditions in

the policy document.

Can I seek treatment at home and be reimbursed for it under health insurance?

Most policies offer the benefit of treatment at home:

a) When the condition of the patient is such that he cannot be moved to the hospital or

b) When there is no bed available in any of the hospitals and only if it is like the treatment given at the hospital / nursing

home which is reimbursable under the policy. This is called domiciliary hospitalization and is subject to certain

restrictions both in terms of the amount which is reimbursable as well as the disease coverage.


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What do you mean by coverage amount? Is there is a minimum or maximum limit?

Coverage amount is the extent to which the insurance company will reimburse you for the medical expenses incurred by

you. Usually, mediclaim policies start with a low coverage amount of Rs 25,000 and go to a maximum of Rs 5, 00,000.

(There are also high value insurance policies especially for critical illness available from some providers)

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