TATA AIG Mediclaim is a health Insurance brought to India by the joint collaboration of TATA group of companies and AIG from America. The first health plan is a plan where the company provides the insured with a lump sum irrespective of medical bills provided by the insured person. The plan is therefore called as, ‘Hospitalization’ having ‘Exclusion plan table benefit features’: Under this plan the insurance company takes care of all the hospital expenses for unforeseen hospitalization. Apart of hospital expenses like, the doctors fees, medicine, operation theatre, pathological test, X-ray etc this product also covers incidental expenses like food, commutation by the insured’s immediate family members. The hospital boarding charges varies in between Rs.1000, Rs.2500 and Rs.5000. Double hospital cash benefits are extended while in ICU. Along with that physiotherapy benefits are also given. Some additional features are:

· No medical examination is required

· 24 hours worldwide coverage

· Covers risk of accidental death, equivalent to 100 times daily hospital cash benefit.

· Ambulance charges

The second plan is called as ‘Maharaksha’:

Plan Table Cover Includes Features: Covers every part of the insured body, every minute of his life. It is the first of its kind in India. No other insurance company has come up with such a plan. It pays for cash benefits for a wide range of everyday injuries like- factures, burns, dislocation or internal injuries which might not need hospitalization. The benefits is payable with no conditions as to how the money should be spent. The insured can use it pay for special care such as the nurse’s expenses or buy a wheel. Targeted towards the ageing couples this policy can also be purchased by young individuals for self or as a gift for the parents.

The policy can be renewed up to the age of 75 and the premium does not increase with age. Multiple claims are accepted. There are ranges of sums assured for different injuries. It is Rs.300, 000 for everyday injuries and its Rs.10, 00,000 for everyday lifestyle which is the inability to perform the three daily activities. Cover of accidental loss is up to Rs. 500,000 which is reimbursed in 100%. The premium plans ranges from one to four persons and they can be paid monthly, quarterly, or annually. There are six levels of the premium plan. Premium amount has as wide from Rs.113 to Rs.22980

The experience of motherhood is one of the most beautiful moments of life. However as in other health problems this moment needs hospitalization too and there are a number of expenses related to it. Some insurance companies in India have maternity policies to make this moment smooth and comfortable.

According to the maternity benefit act 1961 in India an expecting mother has to be allowed a leave of 12weeks, of which she can take the first six weeks before delivery and the next 6 weeks after the baby is born. Now according to this act some corporate and even public sectors do provide the leave but where the payment of dues is concerned, rarely is it settled before going on leave. Invariably professional woman have to show the required documents to encash the leave salary. This too takes time. It is here that the maternity policy can solve the problem of a mother to be.

Some insurance company’s like ‘MaxBupa Health Insurance’ cover maternity benefits, coverage for new born and bear vaccinations costs for children under the Special maternity policy. The policy is named ‘Heart beat family floater’ under which ‘maternity benefits’ up to two issues are provided. The benefit is available after both spouses are insured under this scheme for 24 months continuously. Under the ‘New born coverage’ all new born babies for whom the insurance company has paid the claims will automatically covered from birth until the next renewal of the policy. The new born babies also get the benefit under the ‘Vaccinations for Children’ for the first year.

Mediclaim policies in India such as maternity insurance are provided by insurance companies as a component of group insurance policies to corporate houses. The companies which offer insurance policies for pregnant women are: Apollo DVK, ICICI Lombard, United India Insurance, Cholamandalam General Insurance and Star Health.

ICICI Lombard covers the expenses prenatal examination and medical costs.

United India Insurance offers maternity insurance under its group policy. It covers the maternity expenditure on imbursement of an additional premium and also covers the expenses during hospitalization. Patient admitted to nursing homes is entitled to an amount of Rs.50000 or the some assured whichever is less.

Apollo DVK covers both day care and expenses before and after hospitalization.

There are some factors that influence the premium insurance policy of India. It depends on the company’s profile and related risk.

A globally portable International health insurance is essential for Indians who reside abroad and travel abroad very often. Health insurance coverage anywhere in the world assures comprehensive health protection.

Everyone has different needs and priorities for their health coverage. International health insurance a solution provider for insurance plans offers flexible plans to meet the requirements of expatriates living round the world. Their advisors help choose and tailor plans to meet the health coverage needs.

For example if a person has to travel to US or is residing there, insurance companies like –BUPA, Allianz, Aetna, Integra Global can provide the best plans for health insurance. Contrary to the US where 60% of the Americans get insurance coverage from their employers or the American government, in China expatriates have to depend on foreign insurance companies. It’s therefore advisable for an Indian to travel with an International insurance plan before leaving his/her country. Here not only the cost of a particular treatment has to be covered by the insurance companies but from time to time the Chinese government may order for test to be conducted on the entire population for any kind of infectious disease like bird flu etc. The cost of such test at times proves to be expensive which is provided by the insurance companies.

Medical insurance plans of different type’s like- individual, family and group can be availed by the insured which would travel with them abroad to meet their requirements and cover their medical expenses.

For claims to be processes there are particular claim departments in different countries. The claim support teams of the insurance companies help in negotiating with the claims and materializing them.

The insured can contact the insurer through emails or through Skype call which is cheap. At times some insurance companies have their own office or representatives to assist their customers or it is done to a third party like the solution provider. The benefits are same as provided in India.

Safeway TPA Services (p) Ltd is a third party service provider based at New Delhi in India. Its main objective is to assist policy holders for a hassle free claim settlement. It was established in 2004. The authorized and paid capital of the company is 1 crore as per IRDA regulation.

It provides with some key benefits to the policy holder:

It provides a photo identity card or health card to the policy holder.

Provides immediate cashless hospitalization facility at network hospitals to the insured inpatient on receipt of information and documents from the hospital.

It settles the claims within 3 days of receipt of information and documents.

It has a wide network of hospitals/ nursing homes and provides 365 days and 24hours helpline call center.

To enhance its services it also provides some key benefits to the insurer:

It forms a part of the bench of the insurance company for convincing corporate and groups regarding policy details, benefits and coverage.

It Forms a network with hospitals at pre-negotiated and discounted rates which proves to be cost effective for the insurer.

It keeps a control on cost and quality of treatment provided for application cost containing measures to bring down the claim ratio by eliminating false and exaggerated claims.

It has pooled its R&D and database with insurers and advocates use of ‘alto’ coding of diseases and creation of common cost of treatments, standards and credentials of providers.

It accepts the feedback and suggestions of insurers to categorize hospitals.

It is essentially an intermediary which has undertaken the entire administration of health plans of insurance companies. Apart from settling claims, they also process business, provides customer service and technical support. It not only interacts with doctors and hospitals to reduce claim substantially but also improves customer relationship.

When an insured is hospitalized the cashless amount is paid by this TPA. They are directly concerned with the medical institution regarding health insurance packages and the terms and conditions related to them. Any amount that is not payable under the insurance scheme is paid by the insured and later reimbursed from ‘Safeway’ just in contrast to the earlier method opted by TPAs where the insured had to first clear the hospital bills after treatment and then get it reimbursed from insurance companies through the TPAs .

Safeway’s way of working has not only made claim settlement hassle free but also trauma free for the insured.

Park Mediclaim Consultant Pvt.Ltd. is a TPA (Third Party Administrator) in corporate in 2001 under the company act 1956, having the license number 025 from IRDA.

The main objective of the company was to provide service to the Insurance companies both PSU and private. Its service has been widely accepted, acclaimed and appreciated by PSU insurance companies. In addition the company is engaged by insurers to manage claims of a number of corporate/groups. Simultaneously their promoters have developed an innovative state of art software in conjunction with an IT expert based on their vast experience and expectation of the insurers regarding the functional procedures involving in servicing the mediclaim and health insurance policy holders. The software has been successfully demonstrated before the insurance companies, corporate/groups and IRDA.

Its main objective is to assist health insurers to achieve access of healthcare facility to masses. To establish and deliver a customized, flexible, sensitive IT based managed healthcare system with competitive advantage and cost containment which would make it a pleasure for all business partners, service providers and policy holders.

It gives a wide range of key benefits to insurers:

Effective cashless service and hassle free claim settlement to policy holders.

It forms part of insurance bench to convince the corporate/groups regarding the policy details and role/benefits of TPA.

Form a network with hospitals at desired location at pre-negotiated and discounted rates.

Control on cost/quality of treatment provided and application of cost containing measures to bring down the claim ratio by eliminating exaggerated and false claims.

The company pools their R & D and database with insurers and advocate use of ‘WHO’ coding of diseases, creation of common cost of treatment standards and credentials of insurers/service providers.

The company takes feedback and suggestions for categorization of hospitals.

It devises comprehensive, need based, newer and customer friendly insurance covers in line with government trusts.

In addition it has also kept in mind the insured and provided them too with some key benefits:

Prompt delivery of photo identity card or health card to the insured within 3 days of receiving the policy documents from the insurer.

Cashless facility is delivered immediately to the policy holder on receipt of requisite information and documents from the hospital.

It offers an access to 365 and 24hours call center for personal healthcare information.

It provides a free access to grievances redressal committee.

It operates from New Delhi.

In today’s modern world stress related ailments has taken an onset in every person’s life and therefore the need for a smart health policy to meet the untimely and unforeseen expenses related to health. Bharti AXA Health insurance has a number of such policies which caters to the health needs and expenditure of the citizens of India.

Smart health insurance policy provides for eventualities arising out of hospitalization such as –hospitalization expenses, domiciliary expenses, daycare treatment, pre and post hospitalization expenses, covers for treating pre-existing illness/diseases, critical illness, dreaded disease recuperation and transplantation of organs. The policy covers the entire family even children up to the age of 23yrs.

The sum insured amount varies from Rs.50000 (smart basic) to Rs.5lacs (smart premium and smart optimum). The eligibility criteria is any person between the ages of 5 to 65 can opt for the plan.

Smart health essential insurance policy assures financial assistance during the time of hospitalization. The charges are paid in cash to the hospital authorities for the insured. A daily cash allowance of Rs.1000 to Rs.3000 is paid according to the plans- A, B and C. In case of ICU the charges are doubled. The policy can cover a maximum of four in a family. The members should be in the age group of 3months to 65years renewable up to 75 years. The benefits are applicable irrespective of the number of times the insured is hospitalized during the policy period subject to the some insured.

Smart health critical illness policy covers all expenses incurred due to some critical illness. The insured can opt for reimbursement of expenses for treatment of any critical illness or payment of compensation on diagnosis of any critical illness on survival for more than 30 days. The policy covers almost the whole of human body that may be affected critically by illness/disease.

Smart health high deductibles policy acts as a top up policy that covers any of the health insurance policies. It offers extended coverage for hospitalization expenses for illness/disease after applying the deductibles the insured has opted for. It also provides the expenses of a person accompanying the patient to the hospital. Apart from hospital charges, ambulance charges, expenses incurred for treating pre-existing diseases and expenses for transplantation of organs it also provides tax benefits under section 80D, a discount from 5% to 25% for every claim free renewal year.

Bajaj Allianz presents the widest array of health insurance plans.

The Individual Health Guard policy takes care of the hospitalization expenses and offers a wide coverage for pre and post hospitalization expenses of the insured. Under this plan this is the first company to offer a sum insured of 10lacs. The entry level age for this policy is between 3month and 55years. For sum insured from 1lac to 5lac the entry age varies from 56months to 65yrs. and can be renewed up to the age of 80.

Health Ensure policy offers health protection to the insured and his family at an affordable premium and sum insured. The proposer can get insured at Rs.50000, 75000 and 1lac. At an affordable sum insured the individual gets the benefit of 2% hospitalization expenses towards both pre & post hospitalization.

Extra Care is a unique policy that allows the insured to extend his/her existing health insurance cover. This is a floater policy with a single sum insured and single premium for a whole family. The premium charges are quite cheap compared to the sum insured. It’s only Rs.2500 per annum for a sum insured of 10, 12 or 15lacs.It can be taken as an add on policy with some other insurance policy.

Family Floater Health guard is a perfect health protection for an entire family. It takes care of the expensive medical treatment incurred during hospitalization resulting from serious illness/accident. For a sum insured of Rs.2lac to 10lac can be opted from 3 months to 55yrs and that for 1lac to 5lacs can be opted from 56yrs. to 65yrs.

Critical illness health insurance plans covers the expenses if the insured is diagnosed of any serious illness. The company extends a lump sum amount in advance for the treatment. The sum given is sufficient to meet the expenses of the donor in transplant surgery whether in India or abroad.

Star package health insurance covers a family’s hospital cash, health, critical illness, personal accident, education grant, householders’ content, travel baggage and public liability.

Personal guard is a policy that supports the insured person’s family in case of some accidental death, if he is the bread winner of the family.

Tax Gain is a family floater health policy which covers the outpatient expenses and hospitalization expenses along with tax benefits.

Silver plan is for senior citizen.

Claims are handled by the company directly.

Star health is an exclusive health insurance company in India promoting and protecting health with a 24hour helpline service, cashless hospitalization facility. Free general physician’s advice. Unlimited free outpatient consultation for a small premium. No medical examination for insurance proposal up to the age of 50. In addition to all the above facility a quick and hassle free claim settlement in provided by the company itself without the involvement of any third party. It has about 4600 hospitals within its network where the insured can avail treatment.

The company has a number of insurance policies catering to needs of the Indian citizens like:

Medi-classic insurance policy aims at providing reimbursement of hospitalization expenses incurred as result of illness, disease and/or accidental injuries. Under this policy every insured above the age of 50 would have to under a compulsory check up at the cost of the company. The pre- existing illnesses are covered only after 48 months of continuous insurance with the company.

The policy benefits are: hospitalization covers @ 2% of the sum insured for boarding or a maximum of Rs.4000. It also covers the expenses of nursing, medicine, doctors and consultants fee. Ambulances charges @ Rs.750 which can be extended to a maximum of Rs.1500. Pre and post hospitalization charges at about 7% of the sum insured or a maximum of Rs.5000.

The insured gets a discount of 5% to 25% in premium charges for every claim free year.

The Star Unique health policy covers both pre-existing disease and diseases/illness that may crop up in future. No medical examination is necessary to get insured for this policy. Under this policy the HIV and AIDS patients are also covered.

Star health’s Diabetes care plan covers patients suffering from diabetes Mellitus type II. Diabetic patients (except those who have reached the last stage like severe ulceration of foot or renal failure) from the age of 26 to 65 can get insured under this plan. Along with regular treatment coverage is offered for specific conditions like ‘Diabetic Retinopathy, Diabetic Nephropathy and Diabetic foot ulcer.

Start health wedding gift plan covers the maternity expenses of the insured for the first child only. It covers hospitalization and expenses related to the delivery of the new born, both pre & post delivery expenses.

Senior citizen red carpet plan is for people between the age of 60 and 69 and can be renewed after 69.

Reliance offers three policies under its health insurance section, they are – Individual mediclaim health policy, Critical illness policy and Reliance health wise.

The ‘Individual mediclaim policy’ can be opted for by an individual for him and his family. The key advantages of this policy are:

· It covers the insured and his family for hospitalization and related expenses.

· Family members between the age of 5 and 80 can be covered.

· The policy provides health insurance for children between the age of 3months and 5years even if one parent is insured

· Claim free bonus:

The company pays a bonus amount of 5% for every claim free renewal. This can be accumulated up to 50%.

· Tax Advantage:

The insured can avail income tax benefits under section 80D.

Policy Coverage:

Reliance mediclaim policy will cover various medical expenses:

a) Hospital expenses: This includes room charges and operation theatre charges, nursing expenses, fees of doctor’s and consultants and anesthetist.

b) Medicines, consumables and diagnostic expenses: This includes cost of medicines and drugs, anesthesia, oxygen, blood, surgical appliances, diagnostic material, X-ray, radiotherapy, chemotherapy, dialysis, pacemaker, artificial limbs and organs.

c) Day care treatment: The policy will cover expenses of technologically advanced treatment that does not require hospitalization for more than 24hours.

d) Domiciliary treatment: The policy also covers the expenses of treatment administered at home by the insured or the members of his family subject to specific condition.

e) Pre and post hospitalization expenses: Reliance mediclaim policy bears the expenses of treatment up to 30days prior and 60days after hospitalization.

To avail this policy one does not need a medical check up to the age of 45. However the insured can avail free checkups after three consecutive claim free renewals.

The policy can be issued to any person between the age of 5 and 80.

To process the claims the company has appointed TPA (Third Party Administrator) licensed by the IRDA. For processing the claim the insured has to just make a call to the TPA helpline number which is toll free. An online link is provided at the reliance insurance website under the claim process option on which one can click and get the different contact details. The insured has to furnish the TPA with his own contact numbers, policy number, membership ID number, name of the insured person who is sick, kind of ailment/accident and location of loss.

ICICI Lombard is one of the largest general insurance companies in the country. In the form of health insurance it provides different types of mediclaim policies. The most common and preferred policy is the ‘Family floater health insurance policy’. It is a comprehensive policy that ensures financial security to the insured family during sudden illness, surgery and accident as well as against terrorist activities. The plan lets the family share the entire sum insured without any individual upper limits which means –suppose the sum insured is 4lacs, then if any of the members in the insured person’s family requires to be hospitalized, he/she can use the sum insured and the reimbursed amount remains the same each and every member of the family and does not vary as in individual mediclaim policy of other insurance company.

The key benefits that the policy offers are:

· Cashless claim facility at over 4000 network hospital across India

· Quality service even during claim settlement through ICICI Lombard’s health care, their own in-house claim processing and wellness team.

· No sub-limits in case of room rent, doctors fees and hospital charges for any disease excepting cataract (which is Rs.20, 000 per eye.

· The insured need not make any co-payments.

· The entire family can avail free health checkups during the policy period through a health checkup coupon.

The monthly premium amount ranges from as less as Rs.326 to Rs.2, 180 for a sum insured varying from 2lacs to 4lacs for a period of one year. While for a period of two years it varies from Rs.587 to Rs.4, 359. The age of the senior most member in the family should not be more than 60yrs. and not less than 18yrs.

The ‘Health advantage plus’ is a policy that covers the outpatient expenses like diagnostic test, dental treatment, medical bills, ambulance charges etc. of the insured and gives him tax benefits under this policy. The maximum age limit for this policy is 65yrs. and only a maximum of two adults can be covered under a single policy. The proposer needs to be above the age of 18yrs. and cannot avail free health check up to the age of 45.

‘Critical care insurance policy’ coverage is worldwide though the premium can be paid in Indian Rupees. It offers financial support of the entire sum to cope with life style after a critical illness.