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FAQ

Question: Are the new clinical and pathological tests covered by the Indian medical insurance policies? If no, then are they included in the mediclaim rules of the country?
Answers: Truthfully, there are few insurance companies who allow taking e-opinions. You suggestion is good and the insurance companies must consider this as well. According to us, the insurance companies should give permit for the clinical and pathological tests as they are intended to be conducted in the foreign country.

Question: Is there any 100% cashless mediclaim policies available?
Answer: Yes there are such policies available. In case of planned hospitalization, these policies are cashless. For instance, if you have met with an accident and admitted in the hospital in emergency. In that case, insurance company can contact the hospital and get the cashless hospitalization done for you.

Question: I'm covered under the Health First policy of Tata AIG. Do I need any other policy as well?
Answer: You health first policy predominantly covers the following:-

  • Cancer
  • Stroke
  • First Heart Attack
  • Coronary Bypass Surgery
  • Chronic Renal Failure
  • Major Organ Transplant
  • Aorta Surgery
  • Alzheimer's Disease
  • Benign Brain Tumor
  • Heart Valve Surgery Paralysis
  • Parkinson's Disease, and
  • Total Blindness

It won't cover your hospitalization which is happen due to other diseases. So you can certainly go for another policy from a non life insurance company. It will be in your interest.

Question: Which company should I approach if I need an insurance cover of Rs. 12,00,000?
Answer: Most of the companies cover for Rs. 5,00,000 where as Cholamandalam covers you for Rs. 10,00,000 under certain conditions. However, there is no company which can cover you for this exorbitant amount.

Question: Someone in knowledge had a medical insurance and he paid nothing when he got hospitalized. Which company is offering this kind of services?
Answer: Third Part Administrators are approved by the IRDA. They work on behalf of the insurance companies. The person who is in your knowledge and paid nothing must have enjoyed the cashless hospitalization services. In this case, the TPA contacts the hospital on behalf of the insurance companies and asks for all the bills that are related to the treatment of the insured person. TPA issues an ID card for the insured person and subsequently updates their data.

Question: Are all Third Party Administrators providing the same service?
Answer: IRDA authorises a TPA. The service the offer are similar but the charges they take varies from company to company. Some charge 6% of the premium for their services where as some companies' charge 10% of the same. Eventually, this cost is being paid by the insured people only.

Question: Are all insurance companies attached to only one TPA?
Answer: No it is not necessary. Insurance companies hire TPA in accordance to their needs and requirements. They can certainly have more than one TPA.

Question: If we have a group insurance taken from an insurance company, can we select one TPA for us from the 4 TPA's empanelled with the insurance company?
Answer: Initially, the insurance company will put forward a TPA to serve you. Subsequently, you can judge their services on the basis of their customer handling techniques, skills and the kind of reverts they do regarding your queries. And it is also suggested that as an aware customer, you must insist for this.

Question: A patient is treated for fever at home? Will the expenses suffered by the insurance company?
Answer: If your family doctor or any consultant doctor did the treatment then it won't be paid by the insurance company. But if the patient was hospitalized then all the expenses will suffered by the company.

Question: Due to an accident, a person got bandage and plaster. And within 3 hours he left for the home. Will the insurance company pay the expenses?
Answer: It won't be payable by the company because a patient have to be there in the hospital for atleast 24 hours.

Question: Is Maternity bill will also be paid by the insurance company?
Answer: It is basically subjected to the applicable conditions. In most of the policies, this facility is not included. However, you should read the terms and conditions of the policy and see whether the facility is available or not.

Question: If a lady is covered for Maternity and she is advised to get the ultrasound test done? Will the company pay for it?
Answer: No it won't be paid by the insurance company because 24 hours hospitalization condition doesn't met here.

Question: What do you mean by "Day Surgery"? Is it payable?
Answer: When a patient isn't kept in the hospital for the night and gets discharged after few hours, that treatment and surgery is known as Day Surgery. Every insurance company have its own list of day surgeries, so whether a particular surgery is payable or not, that depends on your insurance company.

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