What are the criteria for deciding on the best health cover?
Choosing a health cover for yourself must be done after careful analysis of your needs. In case you need a wide cover as also Income tax benefits the mediclaim policy with a family package cover could be a suitable option for you. You may also decide on the major ailments policy with annual, five and ten year cover options offering you a reasonable amount of premium savings.

Those going for a wide coverage as also long term cover about five or ten years can opt for the term hospitalisation policy. This gives benefits that are not available under the normal mediclaim policy. Another convenience this policy offers is the non-requirement of every year renewal of the policy. If you plan to go for a less costlier health cover with tax benefit and limited coverage you could choose the Jan Arogya cover. For those closer to retirement age the long-term retirement benefit plan would be the ideal cover. 

How do you decide whether a disease was a pre-existing one or not? 
While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. Such disclosures are important else at a later stage if discovered you could end up losing out terribly. At the time of insurance, you should be aware whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses. 

Who should the policy holder contact in the event of claim under Overseas Mediclaim Policy ? 
In the event of claim under Overseas Mediclaim Policy the policyholder can contact 
Mercury International Assistance and Claims Limited
P.O.Box 673, Brighton, 
Sussex, BNI 4, EZ, 
England. 

What compensation is provided under the Individual Personal Accident Policy? 
Under the Individual Personal Accident Policy: 

If the accident results in death, the full Capital Sum Insured must be paid to the Insured’s beneficiaries.
In the accident results in permanent disablement that involves the total loss of both eyes or two limbs or one eye and one limb, the full Capital Sum Insured is payable. 
In case the accident results in loss of one eye and one limb, then only 50 percent of the Capital Sum Insured will be paid.
In case the accident results in partial disablement of certain parts of the insured’s body, only a specified percentage of the Capital Sum Insured will be paid. 
In case there is disablement excluding injuries that are not visible or verifiable through medical tests like sprains, muscular spasms, etc ALL the benefits listed above have to be paid PLUS 1 percent of the Capital Sum Insured subject to a maximum of Rs.3000 per week over the Capital Sum Insured. However the total period of compensation will not exceed 104 weeks or 2 years approximately. 

Which discounts are available under the Group scheme for the Personal Accident Policy? 
There are chiefly two types of Group Schemes, first called Group A where an employer-employee relationship exists as in corporate firms, companies, etc. The second known as Group B is where an employer-employee relationship does NOT exist as in a club, association, club or any social institution.

Group discounts are applicable for groups of people not exceeding 500. The larger the group, the higher are the discounts given by the insurance company. 

 

101-300 people 15 percent of the total premium 301-500 people 25 percent of the total premium 501-1000 people 30 percent of the total premium 1001-5000 people 35 percent of the total premium 5001-50000 people 40 percent of the total premium > 50000 people 50 percent of the total premium

The benefits mentioned within the Group scheme are all those mentioned in the Personal Accident Policy except the Cumulative Bonus and the Education Fund. 

What are the different benefits that can be claimed under the Mediclaim insurance policy in event of hospitalisation?

Different heads of benefits under hospitalisation: 

Room boarding expenses by the hospital nursing home 
Nursing expenses 
Surgeon, anaesthetist, medical practitioner, consultants, specialist’s fees 
Anaesthesia, blood, oxygen, operation charge, surgical appliances, medicines and drugs, diagnostic material and x-rays, dialysis and chemotherapy, radiotherapy, pacemaker, artificial limbs and cost of organs and similar expenses 

All the above benefits are limited to the max sum insured.

The minimum period of hospitalisation should be for 24 hours. However for certain treatments this limit is not applicable when a package charges are levied for treatment by the hospital.

Who is entitled to an overseas mediclaim policy?
Anyone traveling abroad for business or pleasure or as student going for higher studies can qualify for an Overseas Mediclaim. Needless to say, this policy does not cover trips abroad for pre-planned medical treatment. 

What is the extent of liability under an overseas mediclaim policy?
For trips where the destination does NOT include the United States of America and its Northern neighbour, Canada, the extent of liability is limited to $50000. 

For trips where the destination does include the USA and Canada, the extent of liability can be as high as $100000. 

What is the procedure to be followed to apply for cover under an Overseas Mediclaim policy?
To acquire cover under an Overseas Mediclaim policy, the traveler must submit his

Visa details and its validity 
Country of visit 
Passport details 
Name and address of the sponsor, a certificate giving details of employment / studies and its duration 
Period of cover required 
Medical examination certificate as per the prescribed guideline
Income certificate of the sponsor in case of student 

What benefits can be made available to the insured under a Gramin Accident Insurance policy? 
Any individual aged between 10 to 70 years of age irrespective of his or her occupation can qualify for protection under the Gramin Accident insurance scheme. 

The benefits are subject to the level of the loss suffered by the insured individual. 

 

Death by accident Rs.10000/- Totally irrecoverable loss of use of both eyes or two limbs or one eye and one limb due to accident Rs.10000/- Total irrecoverable loss of use of one eye or one limb due to accident Rs.5000/- Permanent total disablement due to accident Rs.10000/-

What is the Premium Payable under the Gramin Accident insurance scheme?
The Premium Payable under the Gramin Accident scheme increases directly with the number of years that the cover is sought for. 

 

No of Years Single Gross Premium (In Rupees) 1 5/- 2 10/- 3 12.50/- 4 15.60/- 5 19/-

What are the benefits available to the insured under the Janata Personal Accident Policy? 
Under the Janata Personal Accident Policy, any individual between the age of 10 to 70 years of age irrespective of his occupation can qualify for protection against any untoward mishap.

 

Benefits Amount of indemnity Death due to accident Rs.25000 Loss of use of 2 limbs/sight in both eyes Rs.25000 Total and irrecoverable loss of use of one limb/sight in one eye due to accident Rs.12500 Permanent total disablement due to accident Rs.25000

What is the Premium Payable under the Janata Personal Accident scheme?
Under the Janata PAP scheme, the Premium Payable increases with the number of years that the cover is sought for.

 

No of Years Single Gross Premium (In Rupees) 1 15/- 2 28/- 3 40/- 4 51/- 5 57/-