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07-19-13 8:39pm
SUBJ1
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07-19-13 8:46pm
SUBJ1
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グッチ 長財布 What Is An Individual Mediclaim Policy? The most common and easy to understand mediclaim policy is the individual health policy. We are provided hospitalization expenses up to the amount we insure ourselves commonly known as the sum assured. The premium of the policy may range from INR 1500 To INR 3000 for a policy cover ranging from INR 1 Lakh to INR 2 Lakhs. What Is A Family Floater Policy? A Family Floater policy is a higher variant of the individual mediclaim policy. The assured sum covers an entire family. This means that the policy floats among the family members. Each family member comes under this policy. The premium paid for the family floater is lesser than if each individual member had taken up a health policy. Let us consider Mr Mohan a 35 year old IT Executive takes up a family floater policy for a sum insured of INR 10 Lakhs. Mr Mohan’s father had a heart ailment hospitalization of which cost INR 6 Lakhs. 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Premium for the sum insured of 5-10 Lakhs is around INR 30,000 - INR 50000 with a varying degree of medical tests. Premiums are around 1 Lakh for a sum insured of INR 15-20 Lakhs. The premium is calculated based on the eldest family member’s age. •If you are taking a family floater covering your father and mother who are suffering from diabetes and hypertension and you want to take a health cover for INR 6 Lakhs, you have a premium in the range of INR 30000 to INR 35000.It might go up to INR 45000 for a sum insured of 10 Lakhs. Premiums Charged For An Individual Mediclaim Policy: •Let us consider an individual who is around 38 years of age and takes a health cover of INR 4-5 Lakhs .He suffers from Asthma which is a pre existing disease.The premium for this is INR 10000-12000. •For a young healthy individual of an age group of 25-30 years premium for the health cover of INR 1-2 Lakhs is in a range of INR 1500-3000. What Is A Critical Illness Rider? •Critical illness rider is a customized policy which covers the high costs incurred during a critical illness. These diseases can be cancer, stroke, heart attack and coronary bypass treatment and organ failure. Not all health insurers offer critical illness riders but those that do specify which diseases are covered. This policy complements and adds value to the existing health policy .This policy provides a lump sum when required and financial aid when we need it the most. What Is The Role Of A Third Party Administrator In Health Insurance? •These are basically outsourced by the health insurance companies. They function as an intermediary between the hospitals where patients or policy holders undergo treatment and the insurance company . These companies are licensed by the IRDA and have telecom facilities with phone numbers starting from 1600 which are toll free. •A Computer Database having all the details of policy holders. •Medical specialists to assess whether health care is needed or not, assessing hospitalization treatment and passing of the claim bills. •They coordinate with hospitals with respect to treatment of patients, settling of medical bills on behalf of the insurance company. •When a patient is ill he is not able to help himself. His relatives and family members admit him to the hospital and then have to apprise the TPA of the situation over phone or in writing. You have to specify the name of the policy holder, Policy No, ID Number, Name of the Doctor sent for treatment, Hospital where the patient is hospitalized, reason for hospitalization, Copy of the prescription of the Doctor. •All of this needs to be faxed so that the TPA can make a real time decision. •If the hospital where the hospitalization of the patient is going on is on the approved list then the hospital conducts treatment and sends the bills to the Third Party Agent. This is a case of cashless treatment. •If the hospital is not on the approved list , the treatment is conducted at the hospital. The patient pays the medical bills himself .Once the treatment is over the bills are sent for approval to the TPA’s. Once approved the amount spent by the patient is refunded by the TPA. •Under the 5% concept the policy holder pays 5% of the hospital bills and the rest of the amount is paid by the TPA. 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07-19-13 8:52pm
SUBJ1
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inharpind
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07-19-13 8:57pm
SUBJ1
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vmgreia
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