The highlights of your “Health Insurance” plan The Health Insurance comes to your rescue at the time of your desperate need thereby protecting you from sudden medical emergency or any kind of illness you face. The insurance company pays for the expenses and you’re relieved of tension and worry. It provides you with a sense of security that you and your family are protected during the time of sudden medical emergency or any kind of illness you face.  Common Features of Health Insurance: • Eligibility: Anybody aged between 3 months and 65 years can take Health Insurance Policy. For buying health Insurance you need to undergo a Medical checkup after 45 years of age, but in some companies this age is extended to 55 years. • Health Insurance Coverage: It has got the following covers:Hospitalization cover: It covers for the hospitalization expenses if the insured is hospitalized for more than 24 hours. • Family Floater Plan: It is a plan where your entire family will be covered under one Premium and one cover, whenever any member of your family needs medical treatment, the Floater Plan will cover your whole Family, but it has a limit to the age for children.  • Critical Care Plan: Critical Insurance policy covers you for major illnesses and offers a lump-sum benefit on diagnosis of critical illness such as life-threatening cancer, Bypass Surgery, stroke, heart attack, kidney failure and paralysis, organ transplant etc. Different Insurance companies provide different Critical Insurance policies and coverage; some provide insurance cover against 4 major critical ailments, while some cover up to 10 ailments. Pre and Post Hospitalization Expenses. Pre existing diseases are covered after two, three or four continuous renewals depending upon company to company.  Day care medical expenses are also covered where insured is requiring less than 24 hours of hospitalization. • Pre-existing illnesses: Insurance Companies don’t cover you for the diseases which existed at the inception of the plan but some companies cover you after two, three or four continuous renewals depending upon company to company.• Personal Accident cover: It is a benefit cover or add on cover where insurer provides compensation if the person has met with an accident and has sustained a bodily injury. In case of death and Permanent total Disablement (PTD), additional compensation will be paid. • Pre and Post Hospitalization cover: Normally Health Insurance Policy covers for medical expenses incurred 30 days prior and 60 days after hospitalization. In some companies this cover can extend to 60 days prior and 90 days Post Hospitalization. • Claim Procedure: For making an insurance claim you need to contact the insurer, send a letter and do remember to keep a copy with yourself. The insurer should send you a claim form, which you should fill out completely and send it back. For planned hospitalization, please inform insurer one day before admission to the hospital and cashless facility can be availed in all network hospitals. • Cashless claim: It is one of the most convenient ways for getting claim in case of any medical emergency. You need not to spend initially and getting reimbursed later, your Medical Expenses will be directly incurred by the insurer through a TPA who will have a tie-up with the network hospitals. For this you will be issued a Health Card by the insurer, which will help you in settling your cashless claim.

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Do’s

1. Obtain pre – authorization form from Insurance Helpdesk 3 – 4 days prior to the
admission for planned hospitalization.
2. Pre – authorization form is to be filled in by treating doctor.
3. Check about the pre – authorization approval at the Insurance helpdesk within next 24hrs.
4. You can avail cashless treatment at the hospital after receipt of written authorization from TPA for the covered.
5. Leave back all the original documents…

Q. Who is a Third Party Administrator (TPA) & What are their functions?

A. An important link between Insurance companies policyholders & healthcare providers (Hospitals and nursing homes) is the Third Party Administrator (TPA). The TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

The Unique Services offered by TPA for Healthcare Provider and policyholders.

1 Easy and Cashless Hospitalization: A list of…