 |
|
Frequently
Asked Questions On Subjects Covered Under Health Insurance And Scope Of
Service Provider 
Q.
What is MEDI-AIDAns."U MEDI-AID" is a
medical aid service provider scheme under which every member/cardholder of
UMSL can avail "HASSLEFREE hospitalization."
Q.
What are other benefits of MEDI_AID scheme ?
Ans.
The corporate clients can avail the following benefits if they avail
the U MEDI-AID scheme:
- Direct Debit (cashless) facility during hospitalization
- Planed Expenditure
- Gets group family floater policy which reduces expenditure on
premium
- No hassles of medical advance or loans to employees
- No manpower lost on healthcare of employees and follow-up of
claims
- No more pressure from employees on management.
- Full check on the Hospitalization expenses and control on
employees as well to misuse the facility.
- Network Hospitals extends discount facility to the members of
UMSL in course of treatment
- Low claim ratio helps the employer to pay lesser premium from
year to year on renewals
- Possible to cover maternity benefit for employees on payment 10%
additional premium
- Possible to cover existing disease on payment of 20% additional
premium
- Can get assistance for drafting Tailor made policy or improved
health Insurance products.
|
B. The Individual can avail following
benefits if they avail MEDI_AID scheme:
- Direct Debit (cashless) facility during hospitalization
- No hassles at the time of Hospitalization
- No need to carry huge cash for admission in the Hospital only
carry UMSL card and Authorization
- Network Hospitals extends discount facility to the members of
UMSL in course of treatment
- Easy to find a Doctor from UMSL website
- Can get discount on other medical services also
|
Q.
How U Medi-Aid works ?
A. Every member of UMSL
shall be provided with photo U MEDI AID ID card, Smart card which shall have
the information like Card no., Name of the holder, Employer code, Date of
birth, Sex of the member, date of issue of the card, photo of the member,
signature, Emergency service phone number. The policy number, amount
available under the policy for treatment and other information can be had
from our web site
www.umsltpa.com.
However in case the member is issued with the SMART CARD all data are
available in the chip contained in the card and can be read by the hospital
and in such case no pre-authorization is needed. The member has to carry his
ID card and Authorization letter from UMSL for admission in the Network
hospital. Authorization can be provided on line or by fax direct to the
hospital or the member can carry in person, as the client requires. The
Company shall provide round the clock support service cell to back up the
entire operation through its Toll Free no. 160011 3759. In case of EMERGENCY
hospitalization will be possible only on the strength of the UMSL ID card
and authorization can be given in the next 24 hours if required ( In case of
SMART CARD no authorization needed).
Q.
What is MEDI-CLAIM policy ?
Medi claim policy
provides cover for the hospitalization expenses and domiciliary
hospitalization expenses up to the amount it is indicated in the policy
incurred in India due to illness, decease or injury by any accident.
You
must remember that:
- The Hospitalization must be for a minimum period of 24 hours
except for certain treatments and it must not be for observation
only.
- The Hospital must be either a Registered Hospital/Nursing home
or where such registration is not prescribed by the Municipal rules
must be a Hospital/Nursing home with not less then 15 beds and it
must have 24 hour Nursing facility only then the Insurance premium
up to Rs. 10,000 is deductible under section 80D of the Income tax
while computing the Taxable Income.
|
Q.
Who can be covered under the policy ?
Ans. Any
person between the ages of 5 years to 80 years can be covered under the
medi-claim policy as per the prevailing rules. Children between the ages of
3 months to 5 years can also be covered along with the policy of their
parents.
Q.
What is the upper and lower limit of the coverage?
Ans. In a standard policy minimum policy can be for Rs.15,000 and
maximum can be for Rs.5,00,000 per individual but in the case of tailor made
policy there is no upper limit.
Q.
What Expenses will be covered under the policy?
Ans. All expenses related to the treatment of the patient reasonably
incurred during hospitalization or domiciliary hospitalization including :
Room rent and boarding expenses, Nursing expenses, fees paid to Surgeon,
Anesthetist, Physician, Consultants, and specialists cost of Anesthesia,
Blood, Oxygen, Operation, Radiology, Pacemaker, Artificial Limbs, Organs and
similar expenses for life saving and any other investigation.
Pre
Hospitalization expenses up to 30 days and post hospitalization expenses for
60 days related to the illness for which the hospitalization was recommended
shall also be allowed and covered under the policy. If no claim is made for
4 consecutive years the policyholder shall be allowed to have free full
medical check costing not over 1% of the average amount of the sum insured
in the last four years.
Q.
What is the cost of policy cover ?
Ans. The
government depending on the amount insured and the age group to which the
insured belong prescribes the premium rates. The detailed premium you can
have from the chart of premium shown in detailed section.
Q.
What is the procedure for claim ?
Ans. The
underwriter means the Insurer must be informed immediately on
hospitalization. After introduction of the TPA, pre-authorization must be
taken from the TPA before hospitalization until it is an emergency where
authorization is taken from the TPA by the hospital within 24 hours from the
date of hospitalization. On getting the information the Insurer or the TPA
as the case may be will send its Doctor to the hospital to discuss the
treatment suggested to the patient with the Doctor attending on the patient.
This will also help the patient before hand if any treatment taken is not
covered under the policy. All relevant prescription, investigation reports,
bill of the pharmacist for the medicine purchased room rent of the hospital,
should be collected and must be submitted to the TPA/Insurance Company in
original to process the claim. 30 days pre-hospitalization and 60 days post
hospitalization bill for the medicine relating to the disease for which
hospitalization was necessary should also be submitted to the insurance
company for reimbursement.
Q.
Whether all sicknesses are covered under the policy ?
Ans. No there are certain illness which are not covered under the
policy and for such ailment no claim is paid, The following shall be
excluded from claim payments: Within 30 days from the date of first policy
no claim shall be payable for any ailment except cost of treatment due to an
accident. Any existing disease on the day of the policy weather known or no
shall not be covered. Diseases like Cataract, prostratic hypertrophy, hernia
etc. are not covered during first year of the policy. Medical expenses on
maternity related hospitalization, Voluntary medical termination of
pregnancy during first 12 weeks, Spectacles, contact lenses and hearing
aids, dental treatment or surgery of any kind unless requiring
hospitalization, any expenses related to HTLBIII or LAV or any
derivatives/variants, AIDS, Naturopathy treatment shall not be covered.
Q.
Can a medi-claim policy for Critical diseases like cancer be taken?
Ans. Yes there is a policy for critical disease which
covers the following six critical sickness and for which a separate policy
can be taken can be taken:
- Renal Failure
- Stroke Coronary
- Bypass Surgery
- Organ Transplant
- Cancer
- Multiple Sclerosis
|
Q.
Is there any age limit for such policy?
Ans.
Yes the Policy for Critical Sickness can be purchased for the
beneficiaries between 20 years to 65 years of Age Group.
Q.
Who will insure the risk for such sickness?
Ans.
All the Nationalized Insurance companies can issue the Insurance for
critical Sickness.
Q.
What will be covered under this policy?
Ans.
All expenses relating to any of the Critical Sickness shall be covered under
this policy including all expenses of Hospitalization, All checkups, Tests,
Pre-hospitalization treatment, Cost, Chemotherapy, Radiotherapy,
Post-Hospitalization Expenses etc.
Q.
Can there be separate policy for Cancer only?
Ans.
Yes there can be a separate for treatment of Cancer
Q.
What is the age limit for this policy?
Ans.
Indian citizen up to the age of 70 years can purchase this policy.
Q.
Who will Issue this policy?
Ans. New India
Assurance Co. Ltd. Issues the policy in collaboration with Indian Cancer
Society.
Q.
What expenses shall be covered under this policy?
Ans. Reimbursement of the allopathic treatment relating to Cancer up
to rs.50,000/- to meet cost of diagnosis, biopsy, surgery, Chemotherapy,
radiotherapy, hospitalization for self and spouse is payable under this
policy.
Q.
What is Bhavishya Arogya?
Ans. This is
the Health Insurance Policy, which a working member can purchase during his
working period of life for Future sickness after retirement.
Q.
How the premium shall be paid on this policy?
Ans.
The choice is of the Buyer. He can pay the premium in one Go or in
installments during working period
Q.
What happens if the person dies before retirement?.
Ans. The Premium paid can be refunded on the request of his/her legal
heir as per the rules of the Insurance companies.
Q.
Is there any Income tax rebate on such premium?
Ans. R. Yes Under Section 80D of the Income Tax Act 1961 the deduction
shall be allowed for the premium paid.
Q.
What is UTI's senior Citizen Plan?
Ans. UTI
under its Senior citizen's Unit Plan issues a Policy to cover the future
medical expenses for self and spouse and the premium can be paid during the
Earning Period of the Insured. The Expenses under this policy shall be only
for Hospitalization in India.
Q.
Is there any Age limit for this plan?
Ans.
Yes any Individual between the age of 18 to 54 can join this Plan
Q.
Can the Insured go to any Hospital at the time of need?
Ans. No, UTI has a list of 184 tied-up Hospitals in 54 cities across
the country with whom they have tied-up especially for this Plan where
treatment can be availed by the insured.
Q.
What is the premium of this Policy ?
Ans.
The UTI offers UNITS for this plan and the person willing to Join this
plan can join by purchasing the units issued under this scheme. The minimum
Number of Units required to be purchase based on the age of the person at
the time of purchase.
Q.
Who manages this Policy ?
Ans. The Policy is
managed by UTI with arrangements with New India Assurance Company Limited.
