Few Health Insurance related FAQs

What is AYUSH Treatment? Whether AYUSH Treatment is allowed in all Health Insurance Policies?
AYUSH Treatment refers to the medical and / or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems’. Whether or not AYUSH treatment is allowed in a Health Insurance Policy is subject to the product features offered by the insurers. The AYUSH treatment taken shall be covered as per the terms and conditions of the policy contract.

 

What is a Cashless facility? Whether cashless facilities are offered at all hospitals?
Cashless facility means a facility extended by the Insurer or Third Party Administrator (TPA) on behalf of the Insurer to the insured, where the payments for the costs of treatment undergone by the Insured in accordance with the policy terms and conditions, are directly made to the network provider by the Insurer to the extent preauthorization is approved. Cashless facility shall be offered only at Network Providers which have entered into an agreement with the insurer to extend such services.

 

Whether reimbursement of claim can be availed for treatment taken at any hospital.?
Reimbursement of a claim shall be allowed at any hospital or medical establishment subject to the terms and conditions of the policy contract. However such establishments must be licensed or registered as may be required by any Local, State or National Law as applicable.

 

How Cost of pre-insurance health checkup is treated by Life, General and Health Insurers?
The cost of any pre-insurance medical examination shall generally form part of the expenses allowed in arriving at the premium. However, in case of products with term of one year and less, if such cost is to be incurred by the insured, not less than 50% of such cost shall be borne by the insurer once the proposal is accepted, except in travel insurance policies.

 

What is Copayment?
Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured