Tuesday, August 7, 2012
WHAT IS IT?
It is an online surgical benefit health Insurance policy that paysyou a defined lump sum against a surgical procedure.
WHAT DO YOU GET?
The policy covets upto 849surgical proceduresunderfive defined categories Surgeries that are not defined are bunched upin category 6.The entire sum assured is paid against surgeriesthat fall under category one, such as heart bypass and knee jointreplacement. For lowercategories, the sum assuredgoesdownaccordingly.
You can make a claim for more than one surgery in a year subject to the sum assured For Instance, if person makes a claimagainst cataract whichis a category four surgery (the maximumlimit for category four surgeries is Rs. 60,000 under the gold plan which has a sum assured ofRs.3 Laks every year - he can make another claim for the balance 2.4 Lakh during the same year.
It can be taken individually or for the entire familybut it doesn’t work like afloater policy and eachmember can claim up to the sum assured every year.
The policy is cashless. Soifyou incurred sayRs. 20,000 for a cataractoperation (for which thedefined benefit is Rs.60, 000) In the example above, the insurer will pay Rs.20,000 directly to the hospital and remaining Rs.40,000 will be paid to you.
This policy also has an in-built hospital cash benefit that can be claimed against hospitalization expenses. You can claim this benefit for 60 days a year.
WATCH OUT FOR
The term for the policy is 15 Years and is renewable uptill 100 years of age.You are entitled to a sum assured of either Rs.3 Lakhunder the Gold Plan or Rs.5 Lakh under the Platinum plan every year. But this does not mean that you can make a claim up to Rs. 3Lakh each year. The maximum limit under the policy is five times the original sum assured. So in 15 years, you can’t claim more than Rs. 15 Lakh under the Gold Plan.
Also, the premium isfixed only for three years. The insurer will
review its claims experience accordinglyvis-à-vis the policy and not individual claims and alter the premium accordingly. The policy does not cover pre-existing ailments at the time of buying the policy.
MINT MONEY TAKE
being an online plan, the premium plans are lower. For example, a family of three – Husband (35 Years), wife (30years), and child below 18 years of age – will pay a premium of around Rs.9,900 per annum. The other advantage is that it covers most surgeries. However, remember that it is a defined benefit plan and like most other defined benefit plans; its primary purpose is to act as an income source. Take this policy as an add-on to your basic health insurance policy that can be used to settle your bills.