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In case the primary insured dies post hospitalization then the claimable health expenses would be reimbursed. If the primary insured is also eldest member in the family, then for the succeeding years after the death of primary insured the premium would be calculated on the basis of the age of next eldest member. For this to happen, the family should fill up change of request form provided by the insurer.
Please note that in case there were only two members covered under the policy then the family floater plan would be converted to an individual plan.
While choosing a health insurance policy there are a few things which you should be ready with are:
  • Number of members and relations to be covered- Because this will be the basis of buying policy.
  • Type of coverage – Individual, Family floater or group.
  • Sum insured or coverage amount – Ensure that you consider future expenses too.
  • Room rent – Check for the capping amount or criteria defined if applicable.
  • Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also check if the plan has co-pay feature.
  • Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital.
  • Policy wording – Most important thing to check before buying a policy. In case you are not sure about certain term or condition you can always contact the insurer for clarification.
If you already have a health insurance policy you can increase sum insured at the time of renewal.
No. As health insurance policy is designed to cover unforeseen medical expenses a normal health insurance policy does not cover maternity expenses. Coverage for maternity expenses is one of the additional features offered by some of the health insurance plans at a higher premium and waiting period.
Yes you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause you can cancel the policy and get a refund. Stamp duty, expenses on medical check-up and proportionate risk premium (the number of days that the insurance company was at a risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded.
*Note: For the refund to happen there should be no claim during the policy period.
Yes,a person can have more than one Health Policy.
There are four important types of exclusions in a Mediclaim policy they are:
  • Time related exclusions: e.g. Waiting period- general, specific ailments and pre-existing.
  • Non-medical expenses: e.g. Registration charges.
  • Illegal reasons: e.g. drugs, alcohol abuse, self-inflicted injuries.
  • Out-of-scope: e.g. Unproven medical procedures, HIV, adventure sports, etc.
The first or second year exclusions include list of diseases or ailments which have a waiting period. This may include ailments like Cataract, knee replacement, etc. (which are not pre-existing).
Yes. Some of the insurance companies have this concept of loyalty benefit under which they offer discount on renewal of policy from the same company.
Yes, your health insurance policy is very much applicable even if the hospitalization is less than 24 hours. This is known as Day Care Treatment. Here, 24 hours hospitalization is not required and you do have a scope of coverage too.
Day Care refers to any treatment or surgical procedure that is performed under general or local anesthesia in medical clinic/hospital or a day care centre requiring hospitalization for a period of less than 24 hours because of technological advancement.
However, remember that OPD (out-patient department) are not a part of the Day Care treatments. The claim procedure too is nothing different than a normal regular hospitalization.
The below treatments are covered under Day Care Treatment:
  • Appendectomy
  • Angiography
  • Chemotherapy
  • Colonoscopy
  • Eye Surgery
  • Radiotherapy
  • Lithotripsy
  • Hydrocele
  • Piles / Fistula
  • Prostate
  • Sinusitis
  • Liver aspiration
  • Dialysis
  • Sclerotherapy
  • Case 1: When you are hospitalized just before the policy expiry date and have intimated the insurance company about the same before policy lapses (where the policy lapses while you are still in hospital), the company will pay the benefit as per the plan, and its terms and conditions.
  • Case 2: If the policy lapses and you are hospitalized during the grace period, on intimation during the grace period about the hospitalization, the company will pay the coverage as per the plan, and its terms and conditions.