In cashless mediclaim settlement, it is settled directly with the network hospital. In cases where this is no cashless settlement, the claim amount is paid to the nominee of the policyholder.
In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.
Under health insurance, the age and the amount of cover are the factors that decide the premium. Usually, younger people are considered to be carrying lower health risk and thus pay lower annual premium. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher.
An adverse medical history, such as presence of pre existing diseases could lead to loading of premiums.
While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses.
In certain cases, the insurer may do a medical examination.
It is important to disclose any disease you might be suffering with before buying the health insurance policy. Insurance is a contract based on “utmost good faith” and any deliberate non disclosure of facts make the policy voidable at the discretion of the insurer. If you hide the diseases, you run the risk of getting into a contract that is voidable.
Permanent exclusions like AIDS,cosmetic surgery and dental surgery which the policy will not cover at all.
Temporary exclusions like cataract & sinusitis which are not covered in the first year of the policy but are covered in subsequent years.
Conditions arising from diseases existing before the purchase of the policy are not covered. These “pre-existing” diseases are covered usually after 4 years of the policy being in force depending on the policy terms & conditions.
Family Floater is a policy wherein the entire family of the insured, comprising of insured, spouse and two dependent children, is covered under single sum insured.
The advantages are:
a) All members of the family can be covered under one policy.
b) A single Premium is payable for the entire family. This amount is lower than the amount if all members were to be insured separately for the same amount.
c) The amount of Sum Insured floats over the entire family i.e. the limit can be used by any member of the family and for any number of times.
d) One does not have to keep a track of renewals for different members; a single renewal date is to be remembered.
