All Insurance Companies have their rules for medical check-up. Apollo Munich puts three conditions before an individual to undergo medical check-up. These are:-
If the sum assured is more than 5 Lakh
If you opt for Critical Illness Cover
If an insured is above the age of 45 years.
The medical check-up done at the time of policy issuance is valid for three years, if the policy is renewed every year in continuation and the sum assured remains same.
Wednesday, January 27, 2010
In the event of claim being already made, if I want to renew my policy for the second year, do I have to undergo medical check up again?
Apollo Munich promises to offer you hassle-free service and hence, it keeps you away from almost all health insurance-related hassles. Thus, there is no need of medical checkup again. Once done, it is valid for three years.
The claim made does not have any effect on policy renewal.
Hence, if you have raised a claim in first year since the policy commenced, you can renew it for the coming year without medical checkup or any change in your premium.
The claim made does not have any effect on policy renewal.
Hence, if you have raised a claim in first year since the policy commenced, you can renew it for the coming year without medical checkup or any change in your premium.
What is a Third Party Administrator (TPA)?
A Third Party Administrator (TPA) is an individual or an organization, which helps in processing of the insurance claims. These organizations or people are 'outsourced'. They take care of almost all works related to administration of reimbursement process and other services offered to the clients by the policy. A TPA works on behalf of Apollo Munich.
TPA is said to be the link between the Company and its clients.
TPA is said to be the link between the Company and its clients.
What is the procedure to be followed for a claim?
Apollo Munich has a customer-friendly but extremely professional claim process. They have a toll free help line where an individual can call and ask for assistance.
You will need to provide details about the incident due to which the reimbursement is required.
He/She needs to get his/her claim registered on call. An insured will get the registration number of his claim. Now, he/she needs to download the claim form from the site and send a duly filled form attached with the required document to the address mentioned on it.
Apollo Munich will start processing your claim as per its norms and would settle it within the specified number of days.
Apollo Munich Health Insurance Company
You will need to provide details about the incident due to which the reimbursement is required.
He/She needs to get his/her claim registered on call. An insured will get the registration number of his claim. Now, he/she needs to download the claim form from the site and send a duly filled form attached with the required document to the address mentioned on it.
Apollo Munich will start processing your claim as per its norms and would settle it within the specified number of days.
Apollo Munich Health Insurance Company
Would I have to fill the form again at the time of policy renewal?
No, there is no need of filling the form again at the time of policy renewal unless and until there are any changes to be made.
If there is any change in the name, address, contact details or any other information, a client needs to fill the 'Request Change' Form and in case of addition or deletion of any member, he/she needs to fill a 'Proposal' Form. The required changes will be made in the plan accordingly, in the specified number of days, as per the company's policies.
You can also increase the amount of sum assured at the time of policy renewal.
If there is any change in the name, address, contact details or any other information, a client needs to fill the 'Request Change' Form and in case of addition or deletion of any member, he/she needs to fill a 'Proposal' Form. The required changes will be made in the plan accordingly, in the specified number of days, as per the company's policies.
You can also increase the amount of sum assured at the time of policy renewal.
When do I have to take a medical check-up? What is the period for the medical check-up i.e., from the start date of the policy?
All Insurance Companies have their rules for medical check-up. Apollo Munich puts three conditions before an individual to undergo medical check-up. These are:-
If the sum assured is more than 5 Lakh
If you opt for Critical Illness Cover
If an insured is above the age of 45 years.
The medical check-up done at the time of policy issuance is valid for three years, if the policy is renewed every year in continuation and the sum assured remains same.
If the sum assured is more than 5 Lakh
If you opt for Critical Illness Cover
If an insured is above the age of 45 years.
The medical check-up done at the time of policy issuance is valid for three years, if the policy is renewed every year in continuation and the sum assured remains same.
What should I do If I want to insure more than 2 adults or 2 children?
A Family Floater Plan insures maximum of 2 adults and 4 children. So, if you want to have health cover for more than 2 adults, you can buy an individual plan for them. Four children are covered under Apollo Munich Easy Health Family Plan. In case of more than 4 children, you can buy a separate Health insurance Plan for them.
So, you need to plan your Family Health Insurance accordingly, so that all members get protected under health cover.
So, you need to plan your Family Health Insurance accordingly, so that all members get protected under health cover.
What should be done when one wishes to claim?
In times of emergency, the prime advantage of a mediclaim policy is that you can simply show the Apollo Munich Health Card in the network hospital at the time of hospitalization and avail the treatment required (as per the terms and conditions of the policy). It reduces the need to think twice about making use of any medical procedures.
When you wish to claim reimbursement using a policy, you need not drive yourself up the wall looking for somebody to help you! Just follow the steps below to claim reimbursement from Apollo Munich. Preferably contact the company or the TPA as soon as a need for the claim arises.
Contact Apollo Munich Health Insurance Company or the TPA (the toll-free number would be mentioned on the back of the health card issued with the policy).
Tell them all the details about the incident, including the doctor’s prescription (if any) and every other small detail related to the emergency (ambulance transportation, hospital name, expected duration of recovery, etc.)
You will need to present several documents in order to claim the reimbursement. These include the discharge summary, claim forms, original bills, a photocopy of the Apollo Munich Health Card and other documents as per the requirements of the selected policy. Apollo Munich's telephonic assistance or online assistance would be able to guide you through all the forms and 'proof of claim' required in order for the claim to be passed quickly and smoothly.
Once all the forms are duly filled and submitted at the Third-Party-Administrator (TPA), Apollo Munich will reimburse your money in specified number of working days in accordance to the terms and conditions of the policy opted for.
When you wish to claim reimbursement using a policy, you need not drive yourself up the wall looking for somebody to help you! Just follow the steps below to claim reimbursement from Apollo Munich. Preferably contact the company or the TPA as soon as a need for the claim arises.
Contact Apollo Munich Health Insurance Company or the TPA (the toll-free number would be mentioned on the back of the health card issued with the policy).
Tell them all the details about the incident, including the doctor’s prescription (if any) and every other small detail related to the emergency (ambulance transportation, hospital name, expected duration of recovery, etc.)
You will need to present several documents in order to claim the reimbursement. These include the discharge summary, claim forms, original bills, a photocopy of the Apollo Munich Health Card and other documents as per the requirements of the selected policy. Apollo Munich's telephonic assistance or online assistance would be able to guide you through all the forms and 'proof of claim' required in order for the claim to be passed quickly and smoothly.
Once all the forms are duly filled and submitted at the Third-Party-Administrator (TPA), Apollo Munich will reimburse your money in specified number of working days in accordance to the terms and conditions of the policy opted for.
What is Family Floater Plan?
A Family Floater Plan is a Health or Medical Insurance Plan that provides coverage to healthcare needs of all family members, which can include an insured, his/her spouse, his/her dependent parents and his/her dependent children.
Apollo Munich's Family Plans have been designed, looking into the curative and preventive needs of a family. These plans have several added facilities, which can be availed by an insured and his family. The coverage limit depends upon the following:-
Policy wording of the company.
Premium paid.
Variant opted, if any.
Apollo Munich's Family Plans have been designed, looking into the curative and preventive needs of a family. These plans have several added facilities, which can be availed by an insured and his family. The coverage limit depends upon the following:-
Policy wording of the company.
Premium paid.
Variant opted, if any.
Apollo Munich Health Insurance Company
What is the need of health insurance?
The increasing number of disease, escalating medical costs and changing life style have made it necessary for all individuals to get a health insurance cover for himself/herself and for his/her family. At any time of your life, you or any of your family members may become a victim of serious illness or an accident, which may cause a financial drain on you. Thus, in order to protect you financially during such situations, it is a must to have a health cover.
Health Insurance Plans give you coverage against the following:-
expensive doctor's visit
spiraling medical costs
medical care and checkup requirement
hospitalization and treatment possibility
Moreover, when you are protected, you can avail quality treatment in the network hospitals. So, in order to have financial security and quality treatment, get Apollo Munich Health Insurance Policy for yourself and for your family.
Health Insurance Plans give you coverage against the following:-
expensive doctor's visit
spiraling medical costs
medical care and checkup requirement
hospitalization and treatment possibility
Moreover, when you are protected, you can avail quality treatment in the network hospitals. So, in order to have financial security and quality treatment, get Apollo Munich Health Insurance Policy for yourself and for your family.
What is Pre-authorization?
Pre-authorization is the process used by Apollo Munich Health Insurance Company to review the proposed treatment and find out if the treatment is medically necessary or not. Pre-authorization is not a guarantee of benefits. It is just to check if the proposed procedure is medically necessary.
Pre-authorization is required if you avail treatment in any network hospital. In case of treatment in any non-network hospital, you will be at greater financial risks as the benefits payable might be reduced or the expenses would not be covered at all.
Pre-authorization is required if you avail treatment in any network hospital. In case of treatment in any non-network hospital, you will be at greater financial risks as the benefits payable might be reduced or the expenses would not be covered at all.
What is healthcare insurance card?
Healthcare insurance card is designed by Apollo Munich and issued to policyholders as a portable policy proof. It carries the basic information of the policyholder—his/her name, ID number, birth date, month and year of policy issue and expiry, the plan opted, etc. In addition, it also holds contact numbers of the TPA. You can call these numbers for queries, clarification and any other type of assistance.
The card helps you avail the facility of cashless hospitalization in network of hospitals. It helps you to undergo treatment, up to the sum assured, in any of the network hospitals and walk out without paying for any medical expenses. You only require calling TPA on the mentioned helpline number and taking the authorization. In this case, your entire expenses will be paid directly by the company.
The card helps you avail the facility of cashless hospitalization in network of hospitals. It helps you to undergo treatment, up to the sum assured, in any of the network hospitals and walk out without paying for any medical expenses. You only require calling TPA on the mentioned helpline number and taking the authorization. In this case, your entire expenses will be paid directly by the company.
What if I also have or intend to buy a medical policy of any other insurance company?
Yes, its absolutely a client's call. You can buy a policy from any other company, even if you have one from Apollo Munich and vice versa. But, you need to intimate the same to us and to the other concerned company.
Apollo Munich also gives you a 'Portability' offer, using which you can shift from some other Health Insurance Company to ours along with their accrued benefits.
Apollo Munich also gives you a 'Portability' offer, using which you can shift from some other Health Insurance Company to ours along with their accrued benefits.
What are the various options for payment of premium?
At Apollo Munich, the premium of the policy needs to be paid while buying the same. The mode of payment depends on the means of purchase of a product. The premium amount of Apollo Munich Health Insurances plans that have been bought online can be paid using credit cards, debit cards and cheques. Most popular credit cards accepted are VISA, MasterCard and American Express. ). If you purchase the policy through an agent or directly from the company, the mode of payment could be cheque, cash, and credit card.
At the time of renewal, you need to pay the premium amount through cheque, cash or credit card. An insured does not get any tax benefit under section 80(D) of the Income Tax Act.
At the time of renewal, you need to pay the premium amount through cheque, cash or credit card. An insured does not get any tax benefit under section 80(D) of the Income Tax Act.
Apollo Munich Health Insurance Company
What are the benefits of Healthcare Insurance Card?
The Healthcare Insurance Card acts as a portable policy proof for the insured. It contains the basic information regarding the person's identity, birth date, policy issue expiry date, etc.
Another benefit of the Healthcare Insurance Card is that it helps you to undergo treatment in network hospitals on a cashless basis. You do not have to worry about the arrangement of funds in times of exigency.
Thirdly, it confirms your eligibility to avail the benefits of the plan.
Hence, it is advisable to carry the Apollo Munich Health Card with you at all times.
Another benefit of the Healthcare Insurance Card is that it helps you to undergo treatment in network hospitals on a cashless basis. You do not have to worry about the arrangement of funds in times of exigency.
Thirdly, it confirms your eligibility to avail the benefits of the plan.
Hence, it is advisable to carry the Apollo Munich Health Card with you at all times.
What are network and non-network hospitals?
Network Hospitals—It is a group of Physician, Medical Service Providers, and hospitals that Apollo Munich Health Insurance Company has formed a contract with, in order to deliver good quality medical services to its members.
There is a list of network hospitals on the Company's website so that the insured can avail cashless treatment in these hospitals, when required.
Non-network Hospitals—Registered hospitals, other than network Hospitals come under Non-network Hospitals. The treatment undergone in these hospitals are not on a cashless basis. But, instead a reimbursement claim of the expenses incurred can be raised against the bills paid.
There is a list of network hospitals on the Company's website so that the insured can avail cashless treatment in these hospitals, when required.
Non-network Hospitals—Registered hospitals, other than network Hospitals come under Non-network Hospitals. The treatment undergone in these hospitals are not on a cashless basis. But, instead a reimbursement claim of the expenses incurred can be raised against the bills paid.
To file a claim successfully, what documents do I need?
Submitting all the required documents on time is crucial for non-rejection of the claim. Some of the common documents required for filling any claim at Apollo Munich are:
1.A signed and filled Claim Form.
2.A photocopy of the policy opted for (a copy of the Health Card may work in some cases).
3.Doctors prescriptions, bills and other hospitalization records.
4.Discharge summary
5.Original Bills
6.Proof of Id, age, etc. and any other documents that may be required according to the terms and conditions of the company and the policy.
But these requirements change depending on the company and the product you opt.
1.A signed and filled Claim Form.
2.A photocopy of the policy opted for (a copy of the Health Card may work in some cases).
3.Doctors prescriptions, bills and other hospitalization records.
4.Discharge summary
5.Original Bills
6.Proof of Id, age, etc. and any other documents that may be required according to the terms and conditions of the company and the policy.
But these requirements change depending on the company and the product you opt.
How do I select the appropriate cover amount?
Apollo Munich offers you various plans and variants, from which you can choose a plan that best suits your needs. All these plans are available with a wide coverage options.
Your appropriate cover amount depends upon the following factors:-
Your Age—Health risk increases with age. Hence, your age plays a major role in deciding the amount of insurance coverage, you require.
Your financial stability and life style—Give thought to your life style and financial stability before finalizing your plan. A healthier lifestyle determines a smaller risk factor and thus a smaller coverage.
Pre-Existing Disease—If you are suffering from any pre-existing disease, you are more prone to health risks and hence, require more coverage amount. The coverage of such illnesses are subject to the terms and conditions of the plan opted for.
Your appropriate cover amount depends upon the following factors:-
Your Age—Health risk increases with age. Hence, your age plays a major role in deciding the amount of insurance coverage, you require.
Your financial stability and life style—Give thought to your life style and financial stability before finalizing your plan. A healthier lifestyle determines a smaller risk factor and thus a smaller coverage.
Pre-Existing Disease—If you are suffering from any pre-existing disease, you are more prone to health risks and hence, require more coverage amount. The coverage of such illnesses are subject to the terms and conditions of the plan opted for.
Does the policy come into effect immediately after it is approved?
Yes, a policy issued by Apollo Munich comes into effect as soon as the policy has been approved by the company. However, any pre-existing disease is not covered for a minimum period of 3 years and dependent children are covered from the 91st day onwards, only if both parents are covered under the same- policy. Each policy coverage is subject to the rules and regulations laid down by the company.
Apollo Munich Health Insurance Company
Can I avail medical or premium reimbursements if my policy is rejected?
If any Apollo Munich policy is rejected, you cannot avail any of the medical reimbursements promised to you in the same, as the policy is still not issued, hence, you cannot avail benefits. However, you will be reimbursed the premium that you paid at the time of buying the policy, in case of online issuance. Apollo Munich basically refunds the premium amount in accordance to the Company’s rules and regulations.
Tuesday, January 26, 2010
Tele- marketing policy issuance procedure
Apollo Munich Heath Insurance Company has worked a lot in designing different ways to issue policy to the Indian citizens. The Company lays emphasis on the customer's comfort and convenience. Looking into this aspect, there are very simple and easy policy issuance procedures that are within reach of every individual.
Apollo Munich's plan can be purchased either by tele-marketing or through online. Tele-marketing methods include-
SMS helpline-- The Company's website contain the list of numbers and the letters to be typed in the definite format, which has proved to be the easiest way to get the policy. Just SMS us and we will look into your needs and shall revert you the same.
Contact Us-- You can visit the 'Contact Us' page and can fill the required formalities. The Company's representative will call you and shall guide you for the same.
Toll-free Number-- The Company's toll-free number is stated on-*- the home page of its website. You can call at the number and get the required assistance.
In all the above three modes, the agent will visit you to collect the document and fulfill other formalities.
Apollo Munich's plan can be purchased either by tele-marketing or through online. Tele-marketing methods include-
SMS helpline-- The Company's website contain the list of numbers and the letters to be typed in the definite format, which has proved to be the easiest way to get the policy. Just SMS us and we will look into your needs and shall revert you the same.
Contact Us-- You can visit the 'Contact Us' page and can fill the required formalities. The Company's representative will call you and shall guide you for the same.
Toll-free Number-- The Company's toll-free number is stated on-*- the home page of its website. You can call at the number and get the required assistance.
In all the above three modes, the agent will visit you to collect the document and fulfill other formalities.
Disability Insurance
Disability Insurance is an insurance that insures the beneficiary against the risk arising from a disability, caused due to an unexpected event. It may be short- term disability insurance or long-term disability insurance, depending upon the extent of injuries incurred.
Disability Insurance is said to be a part of the Accident Insurance. The amount of compensation to be made depends upon the terms and conditions of the plan opted. Different Health Insurance Companies offer different percentage of the sum assured as disability insurance.
Enlisted below are some important variables that should be considered while raising disability claim.
What is the waiting period before the start of claim?
How much money will be paid?
Till what time this payment will continue?
Was the disability caused during the course of job-related works?
Was the disability predictable or unpredictable?
What if beneficiary is partially or completely disabled?
What other insurance policies will pay claim for this event?
Disability Insurance is said to be a part of the Accident Insurance. The amount of compensation to be made depends upon the terms and conditions of the plan opted. Different Health Insurance Companies offer different percentage of the sum assured as disability insurance.
Enlisted below are some important variables that should be considered while raising disability claim.
What is the waiting period before the start of claim?
How much money will be paid?
Till what time this payment will continue?
Was the disability caused during the course of job-related works?
Was the disability predictable or unpredictable?
What if beneficiary is partially or completely disabled?
What other insurance policies will pay claim for this event?
Health insurance in case of pre-existing diseases
All Health Insurance Companies have their own policy wordings to provide coverage for pre-existing disease, depending upon the exclusion time or the waiting period of the disease. The required cover may be provided after the insured has availed continuous coverage for 1 year, 2 year or 3 years, depending upon the underwriting clauses of the company.
Every insurer has certain exclusion time, which may vary from 6 months to 24 months. During this time, there is no insurance coverage provided to an insured, but after this specific time period, he/she is financially and medically protected.
Every insurer has certain exclusion time, which may vary from 6 months to 24 months. During this time, there is no insurance coverage provided to an insured, but after this specific time period, he/she is financially and medically protected.
Health Maintenance Organization (HMO)
Health Maintenance Organization plans are well known to focus on prevention and wellness. When you opt for a HMO plan, you require to take most of your care from a primary care physician, who is well aware of your health picture. In case of these plans, you take most of your medical care from network providers, except in emergency. HMO plans do not have any deductible, but instead have flat co-payments.
When you opt for HMO plan, you have select a primary care physician, who will be responsible for your care. He may be your family doctor, pediatrician, gynecologists or general physician. If you become ill, you primary doctor will look into your treatment unless it is emergency. He/She will give you a referral if he/she needs a specialist. It is only with this referral, your HMO will provide you due coverage.
In case of an admission to a hospital, you need to have pre-certification from your insurer, unless it is an emergency. If it is emergency, one of your family member, you doctor or your hospital need to contact your insurer within certain time period, so that the medical expenses for the same could be covered.
When you opt for HMO plan, you have select a primary care physician, who will be responsible for your care. He may be your family doctor, pediatrician, gynecologists or general physician. If you become ill, you primary doctor will look into your treatment unless it is emergency. He/She will give you a referral if he/she needs a specialist. It is only with this referral, your HMO will provide you due coverage.
In case of an admission to a hospital, you need to have pre-certification from your insurer, unless it is an emergency. If it is emergency, one of your family member, you doctor or your hospital need to contact your insurer within certain time period, so that the medical expenses for the same could be covered.
Health Saving Accounts
Health saving Account is the major medical policies with a large deductibles and low premiums. It is an excellent way to control your monthly payments and at the same time save on your future costs, if any.
The amount saved in these accounts may vary from year-to-year, thus allow you to save on investment earnings. The money withdrawn from these accounts for medical expenses is tax and penalty free. This money can be used for health and medical care solutions.
The amount saved in these accounts may vary from year-to-year, thus allow you to save on investment earnings. The money withdrawn from these accounts for medical expenses is tax and penalty free. This money can be used for health and medical care solutions.
How do you get health insurance?
Majority of employees get the health insurance through their employer or the organization they work for. These plans are known as Group insurance plans. The people who do not have an access to these plans need to buy an individual health insurance plan or family health insurance plan to provide coverage to themselves or to their families respectively.
Group insurance plan
If you are a member of some organization or an employee, your employer might provide you this health insurance plan. These plans can be customized to suit requirement of both employer and employee. In this case, the part of premium or the entire premium amount is paid by the employer. Thus, it is an easily affordable plan.
When you get group health insurance through membership of an organization, you get a benefit of being the member of a large organization. You have to pay for less premium amount than an individual or a family plan.
Individual or family health insurance plan
If your employer does not provide you with a group insurance plan or you are self employed, you need to purchase an individual or a family health insurance plan directly from a health insurance company.
Different insurance companies provide different insurance coverage limit, different features and different benefits. Moreover, you have to pay for the premium amount yourself. Therefore, search and buy a plan that suits best to your needs and budget.
Group insurance plan
If you are a member of some organization or an employee, your employer might provide you this health insurance plan. These plans can be customized to suit requirement of both employer and employee. In this case, the part of premium or the entire premium amount is paid by the employer. Thus, it is an easily affordable plan.
When you get group health insurance through membership of an organization, you get a benefit of being the member of a large organization. You have to pay for less premium amount than an individual or a family plan.
Individual or family health insurance plan
If your employer does not provide you with a group insurance plan or you are self employed, you need to purchase an individual or a family health insurance plan directly from a health insurance company.
Different insurance companies provide different insurance coverage limit, different features and different benefits. Moreover, you have to pay for the premium amount yourself. Therefore, search and buy a plan that suits best to your needs and budget.
How does medicare coverage works?
Medicare coverage is for the “outpatient prospective payment system” to pay for the services offered or covered under the medicare plan.
Benefits of medicare system:
It provide coverage to outpatient services received in hospital or community
It reduces your out-of-pocket costs over time, thus, helps in saving money. Depending upon the services you get, your out-of-pocket costs may vary with time.
It determines how much you pay and how much your medicare pays for outpatient services.
These medicare services, you get with health insurance plan, can be received in any of the network hospital. The extent of these services may vary with the plan, you opt for. The ratio of amount you pay and the amount paid by medicare services vary with the plan.
Benefits of medicare system:
It provide coverage to outpatient services received in hospital or community
It reduces your out-of-pocket costs over time, thus, helps in saving money. Depending upon the services you get, your out-of-pocket costs may vary with time.
It determines how much you pay and how much your medicare pays for outpatient services.
These medicare services, you get with health insurance plan, can be received in any of the network hospital. The extent of these services may vary with the plan, you opt for. The ratio of amount you pay and the amount paid by medicare services vary with the plan.
Indemnity Insurances
Indemnity insurance gives you flexibility to choose doctors and hospitals. Usually, you can choose your own health practitioner and can change it at any time. But these plans come with extra costs, depending upon the policy wordings of the plan selected.
Terms to learn while choosing an indemnity health insurance plan
Deductibles-- It is amount that an insured should pay every year before the company pays for benefits. There are different types of deductibles, which might be included by companies in their plans. So, go through the policy wordings carefully and learn about this term before finalizing the plan.
Co-payment-- it is the payment made after deductible. It is the percentage you pay of the remaining charges after deductible. Once the doctor receives the payment from the Insurance Company, he will charge you for the difference. While with some doctors, you might have to pay the entire bill and then claim the insurance company for reimbursement.
Indemnity plans have out-of-pocket maximum, which means if an expenses reach to a certain amount, the over an above fees of the covered benefits will entirely be paid by the company.
The indemnity plan may vary from company-to-company. In some case, it does not cover preventive services. Hence, go through the terms and conditions of the plan carefully to know about it thoroughly.
Terms to learn while choosing an indemnity health insurance plan
Deductibles-- It is amount that an insured should pay every year before the company pays for benefits. There are different types of deductibles, which might be included by companies in their plans. So, go through the policy wordings carefully and learn about this term before finalizing the plan.
Co-payment-- it is the payment made after deductible. It is the percentage you pay of the remaining charges after deductible. Once the doctor receives the payment from the Insurance Company, he will charge you for the difference. While with some doctors, you might have to pay the entire bill and then claim the insurance company for reimbursement.
Indemnity plans have out-of-pocket maximum, which means if an expenses reach to a certain amount, the over an above fees of the covered benefits will entirely be paid by the company.
The indemnity plan may vary from company-to-company. In some case, it does not cover preventive services. Hence, go through the terms and conditions of the plan carefully to know about it thoroughly.
Managed care plans
Managed care plans are the plans with wide range of heath services. Here, the patient takes advantage of the network providers and thus, costs less than indemnity plans.
In case of managed care plans, you have not to fill any forms or raise claims, as your payments are settled by the insurance company. You may have to co-pay, which vary from company-to-company.
These plans have lower out-of-pocket expenses till you get the treatment in network providers.
There are three type of managed care plans. These are:
1.POS-Point of Service Plan
2.HMO-Health Maintenance Organization Plan
3.PPO- Preferred Provider Organization Plan
In case of managed care plans, you have not to fill any forms or raise claims, as your payments are settled by the insurance company. You may have to co-pay, which vary from company-to-company.
These plans have lower out-of-pocket expenses till you get the treatment in network providers.
There are three type of managed care plans. These are:
1.POS-Point of Service Plan
2.HMO-Health Maintenance Organization Plan
3.PPO- Preferred Provider Organization Plan
Point of Service (POS) Plan
A POS (Point of Service) is a managed healthcare plan that offers more flexibilities than HMO. This plan is sometime known as hybrid healthcare plan as it contains aspects of both HMO and PPS plans.
This plan is designed to provide effective and efficient patient service at a low cost. In POS healthcare plan, patient first visit network of preferred providers and then, on referral may seek other provider, if deemed necessary.
A primary physician may refer to other physician or a specialist, which may or may not be from the network of preferred provider. If patient visits specialist without the referral of primary physician,he does not get the coverage from the health insurance provider. Such patients have to bear the cost themselves.
POS plan is bit expensive than HMO plan due to restrictive network and less number of options associated with the later.
There are certain points that should be considered while choosing a plan. Your needs, your health, the benefits offered etc play a major role.
This plan is designed to provide effective and efficient patient service at a low cost. In POS healthcare plan, patient first visit network of preferred providers and then, on referral may seek other provider, if deemed necessary.
A primary physician may refer to other physician or a specialist, which may or may not be from the network of preferred provider. If patient visits specialist without the referral of primary physician,he does not get the coverage from the health insurance provider. Such patients have to bear the cost themselves.
POS plan is bit expensive than HMO plan due to restrictive network and less number of options associated with the later.
There are certain points that should be considered while choosing a plan. Your needs, your health, the benefits offered etc play a major role.
PPO (Preferred Provider Organization)
PPO health insurance plan lies between HMO and pure fee-for service plan. A PPO is a managed care plan, where you get the degree of choice regarding which provider to use. It s similar to HMO in the aspect that you have to pay a certain premium amount and in return health insurance company provides you the basic medical benefits.
In PPO plan, it is not necessary to visit a primary physician and moreover, visit to a specialist does not require any referral. But, instead if you need a healthcare from outside, you need to pay higher co-payment.
Pros of availing PPO plan
Out-of-pocket cost is limited
Healthcare cost remains low, when staying within network.
You can consult any specialist either inside or outside of the network.
Primary care physician is not a prerequisite.
Cons of availing PPO plan
Cost of treatment outside network is expensive
In case of treatment in non-network of hospitals, you have to complete paperwork.
Co-payments are higher.
In PPO plan, it is not necessary to visit a primary physician and moreover, visit to a specialist does not require any referral. But, instead if you need a healthcare from outside, you need to pay higher co-payment.
Pros of availing PPO plan
Out-of-pocket cost is limited
Healthcare cost remains low, when staying within network.
You can consult any specialist either inside or outside of the network.
Primary care physician is not a prerequisite.
Cons of availing PPO plan
Cost of treatment outside network is expensive
In case of treatment in non-network of hospitals, you have to complete paperwork.
Co-payments are higher.
Supplemental Insurance
Supplemental insurance benefits are benefits that pays on occurrence of specific event. These are the benefits that an insured can avail either on hospitalization or on suffering from critical illness.
Hospitalization coverage
Health Insurance Companies provide hospitalization coverage for the enlisted diseases. These health plans have different coverage limits with regard to pre-hospitalization and post-hospitalization, subject to terms and conditions.
Health plans, Accident plans, Travel plans, Medical plans etc. all provide hospitalization coverage in different situations, depending upon the cause of hospitalization.
An insured can avail the facility of cashless hospitalization, which allow you to get medical treatment, up to the sum insured, for free in any of the network hospital. In case of treatment in non-network hospital, you can claim for the reimbursement of the expenses incurred.
Critical Illness Cover
Critical Illness Cover aims to insure you against the risk of serious illness. All health insurance companies have their own terms and conditions and thus, provide coverage to different diseases.
Hospitalization coverage
Health Insurance Companies provide hospitalization coverage for the enlisted diseases. These health plans have different coverage limits with regard to pre-hospitalization and post-hospitalization, subject to terms and conditions.
Health plans, Accident plans, Travel plans, Medical plans etc. all provide hospitalization coverage in different situations, depending upon the cause of hospitalization.
An insured can avail the facility of cashless hospitalization, which allow you to get medical treatment, up to the sum insured, for free in any of the network hospital. In case of treatment in non-network hospital, you can claim for the reimbursement of the expenses incurred.
Critical Illness Cover
Critical Illness Cover aims to insure you against the risk of serious illness. All health insurance companies have their own terms and conditions and thus, provide coverage to different diseases.
What happens if you have your health insurance through your employer and you leave your job?
If you are working with some organization, you might have been provided Group Health Insurance plan by your employer. But the associated benefits can be availed, only till you are on rolls. The day you leave you job, the policy gets terminated and you cannot avail any more benefit.
Hence, it is better to have an Individual or Family Health Insurance Plan along with Corporate Health Insurance Plan so that you can avail pre-policy benefits after the certain time period, as mentioned in underwriting clauses of the Company.
Hence, it is better to have an Individual or Family Health Insurance Plan along with Corporate Health Insurance Plan so that you can avail pre-policy benefits after the certain time period, as mentioned in underwriting clauses of the Company.
What is Consumer directed Coverage?
Consumer directed health coverage plan helps individuals and families to have greater control over their healthcare needs. It has some of the major aspects, which includes:-
When and how they access care?
How much they spend on healthcare services?
What type of care they receive?
Different health insurance plans have different coverage limits and different aspects.
The major type of consumer directed coverage are:-
Flexible spending arrangement
Health saving accounts with High deductible health plans
Archer medical saving account
Health reimbursement arrangement
When and how they access care?
How much they spend on healthcare services?
What type of care they receive?
Different health insurance plans have different coverage limits and different aspects.
The major type of consumer directed coverage are:-
Flexible spending arrangement
Health saving accounts with High deductible health plans
Archer medical saving account
Health reimbursement arrangement
What type of health insurance is right for you?
Everyone should know about his health needs and should opt for a plan accordingly. It is must for every individual to know about the right type of health insurance plan for you. To reach to a conclusion, the following parameters should be compared:-
Premium
Benefits/Coverage
Out-of-Pocket costs (Deductibles, Co-payment)
Access to doctors, hospitals and other medical providers
Access to emergency care
Exclusions and limitations
If you get the plan from your employer side, you need to check the following points:-
What kind of services are covered by the Plan?
How are the benefits paid?
Do you need to submit the claims?
When do you need approval beforehand to make sure that you get coverage for care?
What steps do you require to take to get the care you and your family require?
In addition to it, you shall learn various ways to take advantage of the benefits, so that you can avail them at right time.
Above all, you need to decide whether you require an indemnity plan or a managed care plan. The basic difference between the both is the coverage of hospitals. Indemnity plans provide non-network hospitals coverage. Managed care plans provide network hospital coverage.
Premium
Benefits/Coverage
Out-of-Pocket costs (Deductibles, Co-payment)
Access to doctors, hospitals and other medical providers
Access to emergency care
Exclusions and limitations
If you get the plan from your employer side, you need to check the following points:-
What kind of services are covered by the Plan?
How are the benefits paid?
Do you need to submit the claims?
When do you need approval beforehand to make sure that you get coverage for care?
What steps do you require to take to get the care you and your family require?
In addition to it, you shall learn various ways to take advantage of the benefits, so that you can avail them at right time.
Above all, you need to decide whether you require an indemnity plan or a managed care plan. The basic difference between the both is the coverage of hospitals. Indemnity plans provide non-network hospitals coverage. Managed care plans provide network hospital coverage.
Why do you need Health Insurance?
As medical care advances, the cost of treatment also increases. The aim of health insurance is to pay for your care. It protects you and your family against unforeseen incident, which can cause financial drain. Secondly, if you have health insurance, there are more chances that you will get routine and preventive care.
The most common reason for which you need health insurance is that you cannot predict what your medical bills will be. It may vary from time to time. It might be low at one time of your life, but at the other time, it may go too high. If you have health insurance plan, you would be relieved that you are protected for most of these costs.
Additionally, there is a link between quality care and health insurance. If you are covered under health insurance policy, you can avail for the quality treatment without any tension of arrangement of funds. Market survey and research show that individuals with insurance plans are more likely to go for routine check-ups and get the care, they need.
Hence, it is advisable to get a health insurance plan today and secure your tomorrow.
The most common reason for which you need health insurance is that you cannot predict what your medical bills will be. It may vary from time to time. It might be low at one time of your life, but at the other time, it may go too high. If you have health insurance plan, you would be relieved that you are protected for most of these costs.
Additionally, there is a link between quality care and health insurance. If you are covered under health insurance policy, you can avail for the quality treatment without any tension of arrangement of funds. Market survey and research show that individuals with insurance plans are more likely to go for routine check-ups and get the care, they need.
Hence, it is advisable to get a health insurance plan today and secure your tomorrow.
Friday, January 22, 2010
Why should I take Family Floater Health Plan if I already have health insurance from my employer?
If you are working with some organization that provides you health cover under a corporate or a group plan, it is always advisable to have a Family Floater Health Plan from Apollo Munich in addition to a group plan so that you can take advantage of the health cover for a longer period of time.
The Group Health Insurance Plan, from your employer, terminates as soon as you leave the job. So, in order to have long term health benefits, you should have a Family Floater Plan that provides coverage to you and your family members, which can include your spouse, your dependent children and your dependent parents, under a single plan.
The Group Health Insurance Plan, from your employer, terminates as soon as you leave the job. So, in order to have long term health benefits, you should have a Family Floater Plan that provides coverage to you and your family members, which can include your spouse, your dependent children and your dependent parents, under a single plan.
What is Claim Reimbursement?
Claim reimbursement is the claim raised for the money spent on medical treatment in non-network hospital. If you undergo treatment in a non-network hospital, you have to pay for the bills yourself, which can later be claimed from the insurer.
Every company has its own terms and conditions to submit claims. Apollo Munich also has its own rules and regulations according to which the claim will be settled. For instance, the non-network hospital, where you underwent treatment should be a registered hospital. You require to submit relevant documents and discharge details while raising a claim. Similarly, it is a must that your claim should satisfy underwriting clauses so that your money can be successfully reimbursed.
Every company has its own terms and conditions to submit claims. Apollo Munich also has its own rules and regulations according to which the claim will be settled. For instance, the non-network hospital, where you underwent treatment should be a registered hospital. You require to submit relevant documents and discharge details while raising a claim. Similarly, it is a must that your claim should satisfy underwriting clauses so that your money can be successfully reimbursed.
What is cashless hospitalization?
Cashless hospitalization is the service provided by Apollo Munich, wherein an insured does not have to run around for the collection of cash for medical services. Instead, an insured can go to any of the network hospital and can undergo treatment for free. The medical bills in this case are settled by the insurance company.
Depending upon the terms and conditions of the company, you might require TPA approval before admittance to hospital. It is advisable to always carry your Healthcare Insurance Card along with you.
Depending upon the terms and conditions of the company, you might require TPA approval before admittance to hospital. It is advisable to always carry your Healthcare Insurance Card along with you.
What does the term 'service provider' refer to?
A service provider is simply a company or an individual who provides 'service' to others. In terms of insurance, the term 'service provider' refers to the company/agency through which you are covered or insured. Apollo Munich is one of India's fastest growing and most reliable insurance service providers. They provide services like hospital networking, reimbursement of hospitalization charges, etc. (in accordance with the terms and conditions of the policy)
Apollo Munich, the insurance service provider, can be contacted when you wish to claim or renew the policy you have purchased. All policies, opted for by the client, are governed by the rules and regulations set by the service provider, i.e., Apollo Munich.
Apollo Munich, the insurance service provider, can be contacted when you wish to claim or renew the policy you have purchased. All policies, opted for by the client, are governed by the rules and regulations set by the service provider, i.e., Apollo Munich.
What do I do if my health card is lost?
If your Apollo Munich Health Card is lost, you should dial up the toll-free number 1800-102-033 and get your ticket locked. Our representative will provide you further assistance in lodging your request for the issuance of a duplicate card. You will be able to get a new card within the specified time period, as per the rules and regulations of the Company.
Thus, if your card gets lost, immediately contact us so that we can generate you a new card at the earliest and you are not deprived of the benefits for long.
Thus, if your card gets lost, immediately contact us so that we can generate you a new card at the earliest and you are not deprived of the benefits for long.
In the event of claim being already made, if I want to renew my policy for the second year, do I have to undergo medical check up again?
Apollo Munich promises to offer you hassle-free service and hence, it keeps you away from almost all health insurance-related hassles. Thus, there is no need of medical checkup again. Once done, it is valid for three years.
The claim made does not have any effect on policy renewal.
Hence, if you have raised a claim in first year since the policy commenced, you can renew it for the coming year without medical checkup or any change in your premium.
The claim made does not have any effect on policy renewal.
Hence, if you have raised a claim in first year since the policy commenced, you can renew it for the coming year without medical checkup or any change in your premium.
How does a Health Card function in case of policy renewal?
Health Card is a proof of purchasing a policy. It holds a unique policy number. At the time of renewal, your policy is renewed on the basis of the policy number stated on the card and then, after renewal, a new card is issued so that an insured can avail the associated facilities and benefits for extended time duration.
Thus, Apollo Munich issues you a new card at the time of renewal. An expired card has no more significance with regard to cashless treatment after policy renewal.
Thus, Apollo Munich issues you a new card at the time of renewal. An expired card has no more significance with regard to cashless treatment after policy renewal.
Does a higher cover mean preferential treatment in case of hospitalization & claim?
No, a higher cover does not mean preferential treatment. Apollo Munich does not differentiate among its clients on the basis of coverage limit.
Each client gets quality treatment in our network hospitals, regardless of the plan opted and coverage limit. The coverage limit is a maximum amount that a Health Insurance Company can pay to its beneficiaries. It is related to the cost of treatment paid but not to the quality of treatment.
Each client gets quality treatment in our network hospitals, regardless of the plan opted and coverage limit. The coverage limit is a maximum amount that a Health Insurance Company can pay to its beneficiaries. It is related to the cost of treatment paid but not to the quality of treatment.
Does a higher cover guarantee better protection?
Yes, higher cover guarantees better protection as it offers you an option to go for better treatment without worrying about the money required or the medical costs. When a higher sum is insured to an individual, he/she gets more financial freedom to undergo treatment.
It is helpful in situations when you have to pay for high medical expenses. If you have a higher cover, you are more relieved of your medical costs.
It is helpful in situations when you have to pay for high medical expenses. If you have a higher cover, you are more relieved of your medical costs.
Do Apollo Munich cover Pre-existing diseases?
Yes, Apollo Munich provides coverage for Pre-existing diseases under all its Health products, but terms and conditions may vary with each product.
For instance, in Easy Health Plan, Pre-Existing Disease (within 36 months prior to commencement of first policy with us) are covered only if you get continuous coverage under the same plan for three years. A waiting period of 1 year may apply, if you:
i) are insured continuously and without interruption for at least 2 years under another Indian insurer’s individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital;
ii) establishes to our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
Likewise, Pre-Existing disease coverage varies with the products. Hence, Maxima and insure Health have different Pre-existing conditions, depending upon the Company's norms.
For instance, in Easy Health Plan, Pre-Existing Disease (within 36 months prior to commencement of first policy with us) are covered only if you get continuous coverage under the same plan for three years. A waiting period of 1 year may apply, if you:
i) are insured continuously and without interruption for at least 2 years under another Indian insurer’s individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital;
ii) establishes to our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
Likewise, Pre-Existing disease coverage varies with the products. Hence, Maxima and insure Health have different Pre-existing conditions, depending upon the Company's norms.
Can I have an Insurance cover higher than Rs 3 Lakh for individual or Rs 4 Lakh for others?
Yes, Apollo Munich gives you an Insurance Cover higher than 3 Lakh for individuals and 4 Lakh for others. Our Easy Health Plan is available in three variants, each with a different range of benefits. Easy Health Individual Health Insurance Plan provides coverage from 1 Lakh to 10 Lakh while Easy Health Family Health Insurance Plan provides coverage from 2 Lakh to 10 Lakh, depending upon the variant and benefits opted.
Similarly, Personal Accident and Easy Travel Plan have different coverage limit, depending upon the situation and policy's underwriting clause.
Similarly, Personal Accident and Easy Travel Plan have different coverage limit, depending upon the situation and policy's underwriting clause.
Are all policyholders eligible for a Health Card?
Yes, all policyholders of Apollo Munich are eligible for a healthcare insurance card and can carry them along with them as a proof of the plan purchased.
It carries the information regarding the person's identity along with the basic details that might be required before undergoing treatment on a cashless basis. But, the ID number mentioned on a healthcare insurance card is unique, thus, it cannot be used for any other policy or in non-network hospital.
The information mentioned on Apollo Munich Cards is very specific to the insured.
It carries the information regarding the person's identity along with the basic details that might be required before undergoing treatment on a cashless basis. But, the ID number mentioned on a healthcare insurance card is unique, thus, it cannot be used for any other policy or in non-network hospital.
The information mentioned on Apollo Munich Cards is very specific to the insured.
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