|Product||Room rent capping||No||Additional discount can be given if one opts for room rent cap|
|Restoration Benefit||(100% of Sum Insured)
No additional premium
No endorsement request
|Auto Trigger of benefit in below scenarios:
Applicable from 1st Accidental claim
Applicable from 2nd non-Accidental claim
|Annual Health Check Up||1 free Health Check Up for each adult in each policy year||Facility provided regardless of any claim in current policy or previous year KGI policy|
|Organ Donor Cover||up to Sum Insured||Expenses covered of Donor and Receipient|
|Ambulance Cover||20k and 50k per annum for Sum Insured up to 20lacs and higher respectively||Ambulance cover (amount) is on per annum basis and not per claim thereby covering any single instance where Ambulance cost is high|
|Cumulative Bonus||10% every year - 50% & 100% of base policy for Sum Insured up to 20lacs & 100% respectively||No reduction in Cumulative Bonus in case of a claim|
|Additional Discounts||Distributors authority
No dependency on Insurance co.
|1. Cross-sell discount (using any live KGI policy) - 10%
2. Applying Room Rent Capping - 5%
3. Long Term Policy tenure - 2.5% and 5% for 2 and 3 years
|Pre-policy Medical test||No medicals upto 65 years||Subject to:
Sum Insured not more than 25lacs and
No PED is declared by the prospect in Proposal Form
|Clear UW guidelines||No loading on proposals basis medical conditions||Either a proposal is accepted or declined - but no Loading|
|Highly Competitive Pricing||for age group 20-45yrs and Sum Insured more than 7.5lacs in all combinations|
|High BMI range||allowed up to 39||it is up to 30 in most insurers
Add this with no loading policy - gives you more range of customers at no higher premium Systems
|Operational Support||Quote generation
Sharing quote on Whatsapp/Message
Digitial payment link generation
Online policy issuance
No Proposal form required
|Agent Portal and BPOS has all these feature|
The pre-authorisation form is the form that is sent to the insurance company to avail of cashless service, after being duly filled by the insured and the attending doctor. This form is available at the insurance helpdesk/cashless counter in the hospital.
Network hospital refers to all such hospitals/nursing homes in which the cashless facility may be availed by the insured for treatment as provided herein. The list of network hospitals is subject to amendment from time to time and shall be available with the Company.
Yes, you are eligible to lodge he claim with us. Please note, the hospital/nursing home should meet the criteria as defined in the Policy. Your claims will be assessed on reimbursement basis subject to other terms and conditions of the Policy.
The health policy covers medical expenses incurred towards the ailment, subject to the condition that the ailment is admissible under the Policy. Following are the broad heads of expense:
Cashless/Reimbursement requests can be turned down under the following circumstances:
In such a case, the hospital will request the Insurance Company to increase the amount approved if needed during the treatment. The request will be assessed by the Insurance Company and additional approval will be given subject to terms and conditions of the Policy and availability of the sum insured.
The following information should be provided while intimating a reimbursement claim:
The claim documents, duly completed, should be submitted at the following address as early as possible, but no later than 30 days from the date of discharge. Health claims department address:
Family Health Plan Insurance TPA Limited,
Srinilaya – Cyber Spazio, Suite # 101,102,109&110,
Ground Floor,Road No. 2, Banjara Hills,
Hyderabad : 500034, Telangana , India.
The pre-hospitalisation claim documents duly completed should be submitted at the following address within 15 days from the date of discharge. All post-hospitalisation claim documents should be submitted within 30 days from the date of completion of treatment, or expiry of the post-hospitalisation period as per the Policy, whichever is earlier.
The following documents are required for the processing of reimbursement claims:
You need to submit the original documents to one of the insurance companies. After settlement of the claim, you need to obtain certified true copies of the documents along with a settlement letter and submit the same to the other insurer for the claim.
It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.
Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs
A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.
Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.
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