Introuduction
Different types of health insurance schemes with different names, are introduced by insurers. Broadly speaking, all these schemes have certain common basic features. this chapter deals with these features of some major schemes availble in the market.
Mediclaim Policy (Individual)
1. the policy provides for reimbursement of Hospitalisation/ Domiciliary hospitalisation expenses for illness / disease suffered or accidental injury sustained during the policy period.
The policy pays for expenses incurred under the following heads:
a. Room, Boarding Expenses in the Hospital/ Nursing Homes
b. Nursing expenses
c. Surgeon,Anaesthetist, Medical Practitioner, Consultants, Specialist fees
d. anaesthesia, blood,oxygen,operation theatre charges, surgical appliances, medicines and drugs, Diagnostic materials, and x-ray, dialysis, chemotherapy, Radiotherapy, cost of pacemaker, Artificial limbs and cost of organs and similar expenses.
2. The liabilty in respect of all claims admitted during the period of insurance shall not exceed the sum insured for the person as mentioned in the schedule.
The company will pay through the party administrator named in the Schedule of the policy to the hospital/nursing home or the insured person reasonable and necessary expenses incurred in respect of medical/surgical treatment.
Reimbursement is allowed only when treatment is taken in a hospital or nursing home which satisfies the specified in the policy.
The criteria refer to registration with the local authorities or provision of number of in - patient beds, operation theatre and qualified doctors and nursing staff round the clock.
Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatment Dialysis, Chemotherapy, Radiotherapy, Eye Surgery,Dental Surgery, Lithotripsy, D&C , Tonsilectomy taken in the hospital/ Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit.
Relevant medical expenses incurred during period upto 30 days prior to and period of 60 days after hospitalisation are treated as part of the claim.
Different types of health insurance schemes with different names, are introduced by insurers. Broadly speaking, all these schemes have certain common basic features. this chapter deals with these features of some major schemes availble in the market.
Mediclaim Policy (Individual)
1. the policy provides for reimbursement of Hospitalisation/ Domiciliary hospitalisation expenses for illness / disease suffered or accidental injury sustained during the policy period.
The policy pays for expenses incurred under the following heads:
a. Room, Boarding Expenses in the Hospital/ Nursing Homes
b. Nursing expenses
c. Surgeon,Anaesthetist, Medical Practitioner, Consultants, Specialist fees
d. anaesthesia, blood,oxygen,operation theatre charges, surgical appliances, medicines and drugs, Diagnostic materials, and x-ray, dialysis, chemotherapy, Radiotherapy, cost of pacemaker, Artificial limbs and cost of organs and similar expenses.
2. The liabilty in respect of all claims admitted during the period of insurance shall not exceed the sum insured for the person as mentioned in the schedule.
The company will pay through the party administrator named in the Schedule of the policy to the hospital/nursing home or the insured person reasonable and necessary expenses incurred in respect of medical/surgical treatment.
Reimbursement is allowed only when treatment is taken in a hospital or nursing home which satisfies the specified in the policy.
The criteria refer to registration with the local authorities or provision of number of in - patient beds, operation theatre and qualified doctors and nursing staff round the clock.
Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatment Dialysis, Chemotherapy, Radiotherapy, Eye Surgery,Dental Surgery, Lithotripsy, D&C , Tonsilectomy taken in the hospital/ Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit.
Relevant medical expenses incurred during period upto 30 days prior to and period of 60 days after hospitalisation are treated as part of the claim.
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