There are practically as many types of Health Insurance plans as there are insurance Companies – and both Life and General Insurance Companies offer various schemes, which directly or indirectly cover health expenses and even offer lump sum payments for major illnesses/accidents under some products.
We at Heritage maybe one of the few Intermediaries who understand the finer differences in each of the product – as we do have sister concerns who are Third Party Administrators of Health Insurance for Indian Companies. We also have our own Organisation who act as Claims Administrators for Health and travel Policies.
Backed with this kind of experience we could be of assistance in putting in place a scheme of health plans which does not just concentrate on the price but also affords a most comprehensive health safety net to keep your employees and yourselves comfortable when faced with big Medical bills.
More information about the general features of Medical Insurances most commonly available under:-
Mediclaim
Overseas Mediclaim (Individual)
Overseas Mediclaim (Corporate)
Personal Accident Insurance
Householder's Policy
Scope of Cover
This is a composite policy offering a package of insurance covers and is broadly divided into ten sectors, which are:-
Fire and Allied Perils
Burglary, Housebreaking and Theft
All Risks
Plate Glass
Breakdown of Domestic Alliances
TV/VCR/VCP etc.
Pedal Cycle
Baggage
Personal Accident
Public Liability/Workmen Compensation.
Optional Extensions
Medical expenses arising from accident up to 10% of Capital Sum Insured (CSI) or 40% of admissible claim, whichever is lower, subject to payment of additional premium of 20% of the basic premium (UNDER PERSONAL ACCIDENT).
Actual expenses in respect of carriage of dead body (death from accident) of the insured to his residence subject to limit of 2% of CSI or Rs. 1,000 whichever is less.
The risks covered or excluded are generally the same as applicable to respective insurance/policy, when taken individually.
General Exclusions
War and nuclear risks
The proposer/insured must opt for at least 4 sections to qualify for this package insurance.
Mediclaim (individual and group)
Health Insurance
COVER – Cover is available for reimbursement of Hospitalisation expenses in India in respect of both individuals and Groups. This insurance provides cashless Hospitalisation, for the treatment of any covered illness or disease or accidental injury contracted during the Policy period. For administering this arrangement and to provide hassle free admission and discharge from the Network hospitals, Third Party Administrators (TPAs) have been empanelled by Insurance Companies. There are various options for the extent of coverage sought to be insured – i.e. the Sum Insured. It differs from Insurer to Insurer and ranges from Rs. 15000 to Rs. 5 lakh per person.
Expenses reimbursed or provided cashless:
- Hospitalisation expenses only for illness/diseases contracted or injury sustained
- Room, Boarding expenses as provided by the Hospital/Nursing Home
- Nursing Expenses
- Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Anesthesia, Blood, Oxygen, Operation Theater Charges, Surgical Appliances
- Medicines and Drugs
- Diagnostic Materials and x-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs and Cost of Organs and similar expenses
- Maternity expenses – in group policies
An added attraction in this insurance is that the premium paid towards this cover upto Rs. 10000 (by cheque) is entitled for tax rebate under Section 80D of the Income Tax Act.
CUSTOMERS
Persons residing in India and aged between 5 to 80 years can be covered. Children between the age of 3 months and 5 years can be covered, provided one or both parents are covered concurrently.
Families as defined under the Policy can avail discount in premium under the Package covers.
Groups maybe Associations/Institutions/Corporates and Groups with more than 50 persons provided it has a central administration. Discounts in premium can be availed of depending on the group size and profile.
Errors & Omissions Liability Insurance / Professional Indemnity
COVER – This policy is meant for professionals to cover the LEGAL liability falling on them as a result of negligent acts, errors and omissions in the performance of professional service.
The policy is meant to pay both for defence expenses and damages and includes amounts that the insured is legally required to pay because of judgments, arbitration awards or the like rendered against the insured, or for settlements negotiated in accordance with the coverage afforded by the policy.
The cover will be operative only for the works executed in the policy period. Liability for bodily injury and property damage claims do not fall under this insurance (a separate Public Liability policy would be required).
CUSTOMERS
Professionals such as Doctors, medical practitioners, Engineers, Architects, Lawyers, Advocates, Chartered Accountants and Medical Establishments can avail of such covers.
Group Policies with group discounts on premium can also be arranged. Customised Policies for sophisticated and special liabilities relating to Companies such as IT, BPOs, Media Companies, Consultants and Law firms can also be arranged.
Overseas Mediclaim Insurance/Travel Insurance Plans (Individual and Corporates)
CUSTOMERS
Indian residents traveling abroad can take this policy. In some countries, it is even compulsory for all visitors to have medical insurance cover. A corporate frequent traveler who makes more than one journey in a year can take an annual policy instead of individual Policies for each trip.
Salient Features
- Basically there are two types of plans
- Overseas Mediclaim Insurance – A (Worldwide travel excluding USA and Canada)
- Overseas Mediclaim Insurance – B (Worldwide travel including USA and Canada)
- Apart from this for Corporate Frequent Flyers there is the annual Policy – OMP E The insured is covered for a maximum of 180 days abroad, irrespective of number of visits. However maximum number of days under each visit is limited to 60 days.
- Also there are Policies covering Students who go abroad for studies.
Benefits
- The policy basically provides for emergency medical expenses of the insured during his/her stay abroad
- Apart from the above, the policy also covers personal accident, total loss of checked baggage, delay of checked baggage, loss of passport and personal liability, at no additional premium
- Repatriation Benefits: If the insured is required to be sent back to the home country on account of sickness suffered, the expenses incurred therewith are also paid
- The expenses are reimbursed in the local currency of the country visited
Personal Accident Insurance
COVER – The Policy pays the Sum Assured for accidental death or bodily injury causing Permanent Total Disablement. Only accidents caused by violent, visible external means are covered.
In addition to these covers are available for permanent partial disablements, temporary total disablements and medical expenses following such disablements.
Cover is excluded for suicide, disease, dangerous sports, occurring during war or war-like operations being carried out.
Both individuals as well as Groups can avail of such covers.
Group covers can be customized in accordance with the Organisations varying needs and limitations and for different Sums Assured for different sections of the group. Group discounts could also be worked out for large groups.
CUSTOMERS
A useful cover for individuals – self-employed people who travel frequently and are exposed to accidents
For Organisations/Businesses and all Employers to extend a benefit to their employees and their dependents
For Associations or other Groups
For Schools and other Educational Institutions
This can also be offered as a Value Addition to customers of your own products (sold in conjunction with the product of your business)
Shopkeepers
Scope of Cover
The Scope of cover under this insurance is the same as under Office Package Policy with attendant extensions and exclusions. The package is divided under following broad section:
Fire and Allied Perils
Burglary and Housebreaking
Electrical and mechanical appliances
Electronic Appliances
Money insurance
Baggage
Fixed Plate Glass and Sanitary Fittings
Neon Sign/Glow Sign/Hoarding
Personal Accident
Infidelity/Dishonesty of Employees
Legal Liability towards Employees
Legal liability towards third parties
Motor Vehicles
Customers – As per the provisions of the Motor Vehicles Act it is compulsory for all owners of vehicles plying in a public place to possess a valid Third Party Liability cover as prescribed in the ACT of Section 146 of Motor Vehicles Act 1988.
This is a basic Insurance cover. In case the vehicle is also to be insured then a Comprehensive Cover is to be availed of – which will cover both the ACT Liability as well as the vehicle (or OWN DAMAGE). Whenever vehicles are purchased by taking out a loan, financiers insist upon a Comprehensive Policy to take care of their interest as collateral security.
Cover-
Third Party Insurance.
The scope of cover is to pay compensation for death of or bodily injuries to third parties and damage to the property of third parties as per the MV ACT Provisions.
This policy provides personal accident cover of Rs. 2,00,000 to owner- driver.
While the compensation for the personal injuries to third parties is unlimited, property damage is limited to Rs. 7,50,000.
Package Policy (Comprehensive)
The perils covered are:
Damage to vehicle by accidental external means, fire, lightning, explosion, self-ignition, Burglary
Housebreaking
Riot & strike, malicious acts and terrorist acts
Earthquake, Flood, inundation, cyclone etc
Landslide/ rockslide while in transit by rail, road, air, inland waterways, lift or elevator
The above is only an indication of the perils covered and depending on the type of vehicle (especially usage) the scope would vary.
The geographical limits for use of the vehicle is India but the limits can be extended to Bangladesh, Bhutan, Pakistan, Nepal, Sri Lanka and Maldives by charging an extra premium of Rs. 500 for package policy and Rs. 100 for Liability policies.
Policies can be issued for periods less than one year. In such cases, short period scales are charged, which are higher than pro-rata rates.
No claim Discount: For every claim free year, the insured is rewarded with discounts in premium up to an extent of 55% (Package policy only). In case of a claim in any year, bonus earned till that year is wiped out. In case of adverse claims, premiums maybe loaded.
Premium
Until 1st January 2007 this type of Insurance was governed by the Motor Tariff and the premium charged by all the Insurance Companies were uniform.
Since detariffing each insurance company have their own rating models and the premium broadly depends on:
The type of vehicle, purpose of use and Model-manufacturer,
Power and Type of its engine,
Age of the vehicle,
Value,
Geographical Areas where vehicle is used,
Particulars of the Driver,
Past history.
Extra Benefits can be availed of for higher premiums.
Discounts are available.
For No claims, Limited Third Party Property Damage.
Anti Theft devices fitted on the vehicle.
Member of Automobile Association.