Health Insurance
Total Cover
100% Claim Settlement
No
Documentation
Reasonable
Premium
Total Cover
100% Claim Settlement
No
Documentation
Reasonable
Premium
Our Proud Partners - Beemawala
Client Testimonials
3 weeks ago
They guided me through the intricacies of various insurance options, ensuring I fully understood each policy's coverage and benefits. Their transparency and willingness to address all my concerns instilled a sense of trust and confidence in their services.
5 months ago
Beemawala and team is a best Company for take any type of insurance. They support and take care of your claim . Thanks a lot for your support of my claims many times .
6 months ago
Really satisfied and happy with the progress in the process
Thank you for your service and your support
a year ago
Beemawala team provides professional services with best solution both at corporate and personal level. Always ready to answer any queries related to policy. I am very happy with the service.
a year ago
Shantanu is professional and very prompt in responding to my questions. I’m a repeated client and he’s been supportive throughout. I highly recommend his services. I wish him and his team good luck for future.
What is Health Insurance?
Health insurance is a financial arrangement that provides coverage for medical expenses and healthcare-related costs. It offers individuals and families a way to manage the financial burden that can arise from unexpected medical treatments, hospitalizations, surgeries, prescription medications, and other healthcare services. Health insurance plans can vary widely in terms of coverage, benefits, and costs. Generally, policyholders pay regular premiums to the insurance provider, and in return, the insurer covers or reimburses the insured for eligible medical expenses as per the terms of the policy. Health insurance helps individuals access timely medical care without worrying about the full financial impact of healthcare services.
Example Scenario: Accident took place on project Site Scenario: Mr. Rajesh runs a marketing company, and one day, while one of his employees was traveling for a business meeting, an accident took place on the road. The employee sustained serious injuries in the accident. How the Health Insurance Policy will help Mr. Rajesh:
1. Medical Expenses Coverage: The health insurance policy will cover the medical expenses incurred for the treatment of his injured employee. This includes hospitalization costs, doctor’s fees, diagnostic tests, surgeries, and prescribed medications.
2.Hospitalization Benefits: If the injured employee requires hospitalization, the insurance policy will cover the hospital room charges, nursing care, and other related expenses.
3.Cashless Treatment: With a cashless facility, Mr. Rajesh can ensure his employee receives immediate medical attention without worrying about arranging funds upfront. The insurance provider directly settles the medical bills with the hospital.
4. Reimbursement: If Mr. Rajesh pays for the medical expenses himself, the health insurance policy allows him to file for reimbursement, ensuring he doesn’t bear the entire financial burden.
5. Emergency Medical Services: In case the accident requires immediate medical attention or ambulance services, the health insurance policy might cover these emergency expenses.
6.Post-Hospitalization Care: The policy could also cover post-hospitalization expenses, which might include follow-up consultations, medications, and rehabilitation if necessary.
7. Financial Relief: By covering the medical expenses, the health insurance policy provides financial relief to Mr. Rajesh and his company. It prevents the unexpected medical costs from impacting his company’s financial stability.
8. Peace of Mind: Knowing that his employee’s medical needs are being taken care of, Mr. Rajesh can focus on his employee’s recovery and well-being without being overly concerned about the financial aspects.
Health insurance ensures that individuals and businesses are protected from the financial strains of medical emergencies. In this case, it helps Mr. Rajesh’s company fulfill its duty of care towards its employees while safeguarding its financial interests.
Coverages of Health Insurance policy
Hospitalization Expenses
Coverage for expenses related to hospital stays, room charges, nursing care, and intensive care unit (ICU) charges.
Medical Treatment
Coverage for medical treatments, including doctor’s consultations, diagnostic tests, surgeries, and medical procedures.
Day Care Procedures
Coverage for medical procedures that don’t require an overnight hospital stay, such as dialysis, chemotherapy, and cataract surgery.
Pre and Post Hospitalization
Coverage for medical expenses incurred before and after hospitalization, including doctor visits, medication, and diagnostic tests.
Ambulance Charges
Coverage for ambulance services required during medical emergencies or hospital transfers.
Cashless Hospitalization
Facility to avail cashless treatment at network hospitals, where the insurance company settles the bills directly with the hospital.
Emergency Medical Care
Coverage for emergency medical care needed due to accidents or sudden illnesses.
Maternity Expenses
Coverage for maternity-related medical expenses, including prenatal and postnatal care, delivery charges, and newborn care.
Organ Transplants
Coverage for medical expenses related to organ transplantation, including surgery and post-operative care.
Room Rent
Coverage for room rent charges during hospitalization, subject to policy terms and conditions.
Alternative Treatments
Some policies may offer coverage for alternative treatments like Ayurveda, Homeopathy, and Naturopathy.
Domiciliary Hospitalization
Coverage for medical treatments done at home due to the non-availability of a hospital room.
Critical Illness
Optional coverage for critical illnesses like cancer, heart attack, stroke, and kidney failure, providing a lump sum benefit upon diagnosis.
Ambulatory Care
Coverage for procedures that don’t require hospitalization, such as dental treatments, eye examinations, and vaccinations.
Health Check-ups
Some policies provide coverage for routine health check-ups and preventive screenings.
No Claim Bonus (NCB)
Reward for not making any claims during the policy term in the form of increased sum insured or reduced premium.
Add-on Riders
Additional coverages that can be added to the policy, such as accidental injury cover, maternity cover, and critical illness cover.
It’s important to note that the coverages can vary based on the type of health insurance policy, the insurance provider, and the chosen plan. Policyholders should carefully review the policy documents and terms to understand the specific coverages and exclusions applicable to their health insurance policy.
Additional Add-ons of Health Insurance Policy
Critical Illness Cover
Provides a lump-sum payout if the insured is diagnosed with a critical illness listed in the policy, helping to cover the high costs of specialized treatments.
Maternity Cover
Offers coverage for maternity-related expenses, including pre and postnatal care, delivery charges, and newborn care.
Personal Accident Cover
Provides coverage in case of accidental death, permanent total disability, or partial disability due to an accident.
Hospital Cash Benefit
Offers a daily cash allowance for each day of hospitalization, helping to cover incidental expenses.
Top-up or Super Top-up Cover
Provides additional coverage once the basic sum insured is exhausted, helpful in case of large medical bills.
Restore Benefit
Restores the sum insured amount if it gets exhausted during the policy year, providing coverage for subsequent hospitalizations.
Outpatient Department (OPD) Cover
Covers expenses incurred for OPD consultations, diagnostic tests, and medicines, even without hospitalization.
Wellness Programs
Offers preventive health check-ups, discounts on gym memberships, nutrition counseling, and other wellness-related benefits.
Dental Cover
Provides coverage for dental treatments and procedures, which are often not included in standard health insurance plans.
Alternative Treatment Cover
Covers expenses for alternative treatments like Ayurveda, Homeopathy, and Naturopathy.
Second Opinion Cover
Provides coverage for obtaining a second medical opinion from a different specialist before undergoing a major medical procedure.
Daily Hospital Cash
Offers a fixed daily cash benefit for each day of hospitalization, irrespective of the actual medical expenses.
Organ Donor Cover
Covers medical expenses related to organ transplantation for both the donor and recipient.
Ambulance Cover
Covers expenses for ambulance services required during emergencies or hospital transfers.
Global Coverage
Extends coverage to international medical treatments, useful for those who frequently travel abroad.
Accidental Death and Disability Benefit
Provides additional coverage for accidental death or disability on top of the base health insurance policy.
Daycare Procedures
Additional coverage for medical procedures that don’t require hospitalization for 24 hours, such as cataract surgery or chemotherapy.
Home Healthcare
Covers expenses for medical treatments and services provided at home due to the unavailability of hospital rooms.
Riders for Family Members
Allows adding family members like parents, spouse, and children under the same policy with additional coverage.
Factors Determining the Premium of Health Insurance Policy
Age of Members
The age of the insured members is considered as younger members generally pose a lower risk of accidents, leading to relatively lower premiums.
City
Some Compnay charge the premium on the basis of city big city like mumbai , delhi , kolkatta , cheenai . they ahve higher premium as the treatment is costly as comapre to tire 2 & TIRE-3 CITIES
Coverage Limit
The sum insured or coverage limit chosen by the insured group impacts the premium. Higher coverage limits will lead to higher premiums.
Add-ons
If the insured group opts for additional add-ons or riders to enhance the policy coverage, it will affect the overall premium cost.
Policy Term
The duration of the policy, whether it is a one-year term or a longer period, impacts the premium calculation.
Medical History
The medical history of the insured members, if considered for coverage, may influence the premium amount.
Major Differences Between Health insurance policy and Critical Illness Insurance
| Aspect | Health Insurance | Critical Illness Insurance |
|---|---|---|
Coverage Type | Provides coverage for a range of medical expenses and treatments. | Offers coverage for specific critical illnesses mentioned in the policy. |
Coverage Purpose
| General healthcare and medical expenses. | Financial protection against high treatment costs of critical illnesses. |
Claims Payout
| Covers various medical treatments and hospitalization expenses. | Pays a lump sum amount upon diagnosis of a covered critical illness. |
Scope | Broader coverage for medical procedures, hospitalization, etc. | Specific coverage for critical illnesses like cancer, heart attack, etc. |
Policy Duration
| Typically offers annual or multi-year coverage options. | Usually renewable annually or as per policy terms. |
Premium Cost | Premiums vary based on factors like age, health, coverage amount. | Premiums can be higher due to the specialized coverage provided. |
Benefit Usage | Can be used for various healthcare needs, not just critical illnesses. | Intended to cover financial impact of specific critical illnesses. |
Claim Process | Requires medical bills and documentation for reimbursement. | Requires medical diagnosis confirming critical illness for payout. |
Additional Riders | Offers riders for added coverage like maternity, dental, etc. | Limited additional riders as the focus is on critical illness coverage. |
Survival Period Requirement | No survival period requirement, benefits can be claimed for medical treatments. | Requires survival for a defined period (usually 30 days) after diagnosis. |
Payout Purpose | Flexible usage for various medical expenses and treatments. | Intended to cover costs that arise due to the critical illness. |
How to Settle Health Insurance Policy
Notify the Insurer
Inform your health insurance company as soon as possible about the hospitalization or medical treatment. This can often be done through a toll-free helpline or online portal.
Submit Documents
Provide all necessary documents to the insurer, including the claim form, medical bills, prescriptions, diagnostic reports, discharge summary, and any other relevant records.
Medical Review
The insurer will review the documents to assess the claim’s validity and coverage as per the policy terms.
Cashless or Reimbursement
If you’re availing cashless treatment at a network hospital, the insurer will directly settle the bills with the hospital. If you’re opting for reimbursement, you’ll need to pay the bills initially and then claim the expenses from the insurer.
Claim Processing
The insurer will process the claim based on the policy terms, coverage, and your medical records.
Approval & Payment
Once approved, the insurer will either directly pay the hospital (for cashless) or reimburse you (for reimbursement) as per the policy coverage.
Claim Settlement Time
The settlement time can vary, but insurers strive to process claims within a reasonable period, often within a few weeks.
Follow-Up
If there are any discrepancies or additional information required, the insurer will communicate with you. Stay in touch to ensure a smooth claim settlement process.
Claim Rejection or Dispute
In case of claim rejection or dispute, you can appeal to the insurer’s grievance cell and provide any necessary clarifications or documentation.
Stay Informed
Familiarize yourself with the policy’s terms, exclusions, and claim procedures to make the process smoother.
Remember, each insurer might have specific guidelines and requirements. Always consult your insurance policy documents and insurer’s guidelines for accurate and updated information on claim settlement procedures.
Exclusions of Health Insurance Policy
Pre-existing Conditions
Illnesses or conditions that existed before the policy’s effective date might be excluded for a certain waiting period.
Cosmetic Procedures
Elective cosmetic surgeries or treatments are generally not covered unless they are medically necessary due to an accident or illness.
Non-Medical Expenses
Expenses related to non-medical items like vitamins, health supplements, and over-the-counter medications are often excluded.
Experimental Treatments
Treatments or procedures that are experimental or not widely accepted in the medical community might not be covered.
Self-Inflicted Injuries
Injuries sustained intentionally by the insured individual might be excluded from coverage.
Injuries from Hazardous Activities
Injuries sustained during hazardous activities like extreme sports might not be covered.
Pregnancy and Fertility Treatments
Some policies exclude coverage for pregnancy-related expenses, fertility treatments, or childbirth.
Non-Allopathic Treatments
Traditional or alternative treatments like Ayurveda, homeopathy, or naturopathy might be excluded.
Mental Health and Substance Abuse
Some policies have limited coverage or exclusions for mental health treatments or substance abuse rehabilitation.
War or Terrorism
Injuries or illnesses resulting from war, terrorism, or civil unrest might be excluded.
HIV/AIDS
Certain health insurance policies may have exclusions related to HIV/AIDS treatment and related complications.
Out-of-Network Treatment
Expenses incurred for treatments outside the network of the insurance provider might not be covered, except in emergencies.
Routine Health Check-ups
Regular health check-ups or preventive services might not be covered, although some policies include limited coverage.
Specific Illnesses
Some policies exclude coverage for specific illnesses or conditions, especially those with high treatment costs.
Illnesses by Birth
Illnesses or conditions present by birth might also not be covered under the policy.
It’s important to keep in mind that exclusions can vary between insurance providers and policies. Reading and understanding the terms and conditions of your health insurance policy is crucial to know the specific exclusions that apply to your coverage. If you have any doubts or questions about the exclusions, don’t hesitate to clarify them with your insurance provider or agent.
Documents Required for Claim Settlement under Health Insurance Policy
Claim Form
A duly filled and signed claim form provided by the insurance company.
Policy Copy
A copy of the health insurance policy document for reference.
Medical Reports
Relevant medical reports, prescriptions, and diagnosis details from the treating doctor.
Hospitalization Details
Discharge summary, hospital bills, and receipts indicating the details of hospitalization and treatment.
Doctor's Prescription
Prescription for medicines and treatment recommended by the attending doctor.
Bills and Invoices
Original bills, receipts, and invoices for medical expenses incurred during the treatment.
Investigation Reports
Copies of investigation reports like X-rays, MRI, CT scans, blood tests, etc.
Discharge Certificate
A certificate issued by the hospital upon discharge, detailing the treatment received.
Medical Certificate
A medical certificate confirming the nature and severity of the illness or injury.
Insured's Address Proof
A valid address proof document, such as Aadhar card, passport, utility bill, etc.
Insured's PAN Card
Copy of the PAN card for identification and tax-related purposes.
Insured's KYC Form
A Know Your Customer (KYC) form with personal details of the insured.
Claimant's Bank Details
Bank account details for direct claim settlement through electronic transfer in case of Reimbursement
Authorization of Assigned Doctor
A signed declaration and authorization is need from Doctor for processing the claim.
Any Other Relevant Documents
Any additional documents specified by the insurance company.
It’s important to note that the specific documents required may vary depending on the nature of the claim, the insurance company’s policies, and the type of treatment received. To ensure a smooth claim settlement process, it’s recommended to thoroughly review your policy document and coordinate with your insurance provider or agent for accurate and up-to-date information on the required documents.
Contact Information for Claim Settlement: related to Health Insurance Policy
If Policy Obtained through Agent/Broker
Claims are the reason we get a car insurance in the first place! Therefore, ensure the claim process of your desired car insurance is smooth and doesn’t take too long. When you’re in trouble, the last thing you want is, to spend all your time and energy in just filing a claim!
If Policy Obtained Directly from Insurance Company
Claim Settlements are basically getting your compensations done right. Claims being such an important part of a car insurance, check for your desired insurer’s claim settlement ratio so that you’re assured that no matter what, your claims will be settled!
Claim Contact Information for Policy from Beemawala.com
If you have taken the policy from Beemawala.com, please use the following contact details to register your claim.
- Phone: +91-9654259715
- Email: services@beemawala.com
Frequently Asked Questions: (FAQs) on Health Insurance
A: The best health insurance for a family depends on factors like coverage, premium, and network hospitals. Compare plans to find the most suitable one.
A: Family floater health insurance covers the entire family under a single policy, sharing a common sum insured. It provides coverage for medical expenses.
Family floater is better for families as it covers all members under one policy, whereas individual plans provide coverage only for a single person.
A: You can buy family health insurance online through insurance company websites or via insurance brokers.
You can increase coverage by opting for add-ons or riders. It’s best to compare different plans for cost-effective options.
The cost varies based on factors like family size, age, sum insured, and coverage. It can range from a few thousand to lakhs of rupees.
Family health insurance covers medical expenses for the entire family under a single policy. The sum insured can be utilized by any family member.
You can add family members during policy purchase or renewal by providing their details and paying an additional premium.
The best plan varies based on individual needs. Look for comprehensive coverage, network hospitals, and affordable premiums.
The Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance coverage of up to 5 lakh for eligible families.
The cost depends on factors like age, sum insured, and plan chosen. It’s recommended to get personalized quotes.
Monthly premiums for family health insurance vary based on coverage and family members. Compare options for accurate quotes.
Family floater is a type of health insurance that covers all family members under a single sum insured, allowing flexibility in utilization.
Good family health insurance offers comprehensive coverage, a wide network of hospitals, and easy claim settlement.
Compare quotes from different insurers, consider coverage and premium, and choose a policy that suits your e-rickshaw’s needs and your budget.
The best plan depends on family needs. Look for a plan with adequate coverage, network hospitals, and affordable premiums.
The best family floater insurance varies based on individual preferences. Compare plans to find the most suitable one.
The best health insurance for a family offers comprehensive coverage, affordable premiums, and a wide network of hospitals.
Monthly premiums for family health insurance vary widely based on factors like coverage, age, and family size. Get personalized quotes for accurate estimates.
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