Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
This document discusses health insurance and life insurance. It defines health insurance as insurance that covers medical and surgical expenses. It lists the main types of health insurance plans including HMOs, PPOs, and high-deductible plans. It provides steps for obtaining life insurance and outlines advantages like tax benefits and disadvantages such as pre-existing conditions not being covered. The document also describes how to plan health insurance and the process for surrendering a health insurance policy.
Health insurance policies provide coverage for medical expenses incurred during hospitalization. They typically cover costs associated with room and board, nursing care, surgeon fees, and other medical costs, up to the specified sum insured. Insurance companies have networks of hospitals where policyholders can receive cashless treatment and the insurance company will directly pay the hospital bills. Common types of health insurance in India include employer-provided plans, government schemes like ESI and CGHS, community-based and rural health insurance, and individual and family floater policies.
The document discusses various types of health insurance policies in India. It provides details on individual health insurance, critical illness policies, travel insurance, and personal accident policies. For individual health insurance, it outlines the benefits for individuals, scope and coverage of policies, exclusions, and ancillary benefits like maternity, dental and optical coverage. It also discusses critical illness policies, common illnesses covered, waiting periods, and exclusions. For travel insurance, it summarizes typical healthcare and non-healthcare covers as well as exclusions. Personal accident policies provide compensation for accidental death or disability.
Health Insurance products offering by life insurersJaswanth Singh G
- The document discusses health insurance and various related topics such as whether it is necessary, differences between health insurance offered by life insurers versus general insurers, key proposed regulatory amendments regarding health insurance, and popular riders available under health insurance policies.
- It provides an overview of health insurance policies offered by life insurers versus general insurers, explaining that life insurers typically offer fixed-benefit plans while general insurers offer indemnity plans.
- It also summarizes some key proposed regulatory changes such as requiring uniform premiums for 3 years and incentives for policyholders who maintain good health.
There are three types of health insurance cover available in the market today. These are:
Mediclaim:
These policies cover you for hospitalization expenses. Actual hospitalization expenses are paid subject to a maximum limit of the sum assured opted for. All insurers offer policyholders cashless treatment in their network of hospitals. Policyholders can also pay upfront and then claim reimbursement from the insurer.
We recommend Mediclaim as a basic “must have” health insurance to our customers. Mediclaim can be individual or a family floater. In individual every person has his or her own individual policy. In a family floater the members of a family pay a single premium and have one insurance policy that covers the family. Sometimes parents and in-laws can also be included in the family cover. A floater cover provides a lot of flexibility for the family and normally works out more economical.
Fixed Benefit Cover
These is a new class of insurance products in the Indian market. These plans pay a pre-determined sum of money depending upon the number of days a person is in hospital and the type of surgery done. This amount may be more or less than the actual expenses you incur. We recommend this as an additional insurance to purchase after you have the basic mediclaim policy. Similar to the indemnity cover, fixed benefit cover has individual and family floater options. Fixed benefit policies will pay you the benefit even if the actual costs are reimbursed by a mediclaim policy.
Critical Illness plans
In these plans a fixed sum of money is paid if the person gets certain pre-specified diseases. Plans can cover anywhere from 9 to 35 diseases. In our view these plans are best bought after one has the basic medicliam and fixed benefit plans. They are ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure.
Each of the insurance plans described here can be taken for a single Individual or may include dependents such as the spouse, minor children, parents, parents-in-law, grandparents and grandchildren.
The document provides an overview of health insurance in India. It defines health insurance and describes what a typical health insurance policy covers, including room and boarding expenses, nursing costs, surgeon fees, and medical treatment costs. It notes that over 80% of Indians lack health insurance coverage. The major types of health insurance policies in India include hospitalization plans, pre-existing disease plans, senior citizen plans, maternity plans, daily cash plans, and critical illness plans. The document also outlines several government-run health insurance schemes in India like RSBY, Ayushman Bharat, and state-specific programs. It concludes with a discussion of public and private agencies involved in providing health insurance in India.
Importance of Health Insurance: Incase you get sick or need any kind of medical attention. Can you afford to pay for a doctor’s visit without insurance? Depending on the type of doctor and practice it can cost from www.lifethenfinance.com 2 $95–$265 per visit. Insurance co-pays: $5–$50 per visit. Are you certain you won’t hurt yourself or catch some type of cold? Do you have allergies, wear contacts or need any other type of regular prescriptions? Can you afford those medications without insurance? On average prescription generic medications start around $50. Insurance co pays usually around $5–$20.
Mediclaim policies and their silent features pptvish_1107
The document summarizes the key features of a Mediclaim insurance policy in India. Mediclaim is a hospitalization insurance policy offered by public and private insurers that reimburses expenses from hospitalization, surgery, accidents, or illnesses. There are individual, family, and senior citizen policies. Family policies allow the sum assured to be used by any family member. Mediclaim provides cashless payment of bills to hospitals and tax benefits. The key benefits covered are room costs, nursing, surgeon fees, medicines, and diagnostic tests.
Types of Health Insurance in India - There are three types of health insurance in India. Health Insurance plays a very important role to every ones life. Get to know more about health insurance
Insuring yourself against the risk of incurring medical expenses is important. However, before choosing the health insurance policy, it is important to know more about the different health insurance plans. This SlideShare provides more information about medical insurance and its benefits. http://bit.ly/1pHFP90
This presentation discusses different types of health insurance plans. It defines group insurance, which is obtained through an employer, and individual insurance, which is purchased independently. It also explains managed care plans like PPOs, HMOs, POSs, and EPOs. PPOs encourage using preferred providers by paying higher benefits, while HMOs require using a primary care physician for referrals. POS and EPO plans combine aspects of PPOs and HMOs. Indemnity plans do not require using preferred providers and pay the same benefits anywhere.
Health insurance provides coverage for medical expenses through a network of hospitals. It works by paying premiums on a regular basis, such as monthly or yearly. Then, when hospitalization is needed, the insurance pays covered costs while the policyholder provides identification documents. There are many types of health insurance policies available from both private insurers and government organizations. Purchasing insurance can be done online, through agents, or directly from insurer offices. Factors to consider include the network of covered hospitals and choosing coverage appropriate for one's family or employer's needs. Proper documentation is required both when hospitalizing and filing claims to receive benefits.
This document provides an overview of health insurance, including definitions of key terms, models of health expenditure, and examples of health insurance systems in different countries. It discusses the history of health insurance beginning in Germany in 1883 and adoption in other countries. It also outlines the traditional model of health insurance focusing on insurers/employers and proposes a more flexible model to serve different populations. Private health insurance is described as having an important role to play in overall healthcare systems by enhancing access and increasing service capacity.
The document describes the key features of a group mediclaim insurance policy for corporate clients. It covers medical expenses for employees, spouses, dependent children and parents as inpatients in hospitals in India. The policy provides coverage for room and board charges, surgery costs, diagnostic tests, medicines and other medical appliances. It also includes maternity coverage, pre-existing disease coverage after waiting periods, and day care treatments. Claims exceeding the sum insured can be paid through a corporate buffer.
Health insurance provides coverage for medical expenses through a contract between an insurer and an individual. It offers key benefits like cashless treatment at empaneled hospitals, coverage for pre- and post-hospitalization expenses, and ambulance fees. When buying a health insurance policy, it is important to consider the age criteria, appropriate premium and coverage amounts, waiting periods, cashless hospital networks, and other clauses. Health insurance offers tax benefits under Section 80D and can help cover unexpected medical costs.
This document discusses health insurance options in India, including social health insurance schemes like ESIS and CGHS, voluntary private health insurance, and community-based health insurance (CHI). It notes that while social health insurance covers only a small portion of the population, voluntary insurance plans are often unaffordable for the poor. CHI has potential to improve access and reduce costs for vulnerable groups, but faces challenges in India due to poverty, illiteracy, and lack of institutional support. The government has launched various initiatives over the years, including state-run insurance programs and public-private partnerships, to expand coverage.
This document provides an overview of insurance products in India. It discusses the definitions of insurance, the regulatory body IRDAI, and the major players in life and general insurance - LIC, GIC and their subsidiaries. It also summarizes various life insurance products like children's plans, pension plans, whole life plans, and unit plans. For general insurance, it briefly covers types like motor insurance, health insurance, home insurance, marine insurance, travel insurance, and commercial insurance.
Health insurance covers medical expenses when a person incurs them. It works in two ways - the insured pays costs upfront and is reimbursed, or the insurer pays providers directly. The insured is the policy owner, and providers include doctors, hospitals, and pharmacies. Health insurance grew in India due to economic liberalization and awareness. It protects against high, unexpected costs and makes quality treatment affordable. Having health insurance keeps savings intact, encourages preventive care, and assures coverage for the family. It is essential as health costs rise and lifespans increase. The Indian health insurance market is growing rapidly but potential remains in semi-urban areas due to low coverage currently. Issues for insurers include a high claim ratio and
This document provides recommendations and information on various family insurance packages from AIMS Insurance Broking. It summarizes common risks families face and recommends policies for life, health, home, motor vehicle, and personal accident coverage. Sample packages tailored for low, middle, and upper income families are presented with the types of policies, sum insured amounts, and annual premium costs. General features of the policies and packages are also outlined. The overall purpose is to help secure families' financial futures through appropriate insurance coverage.
The document provides information about tourism organizations and conventions related to international travel and tourism. Some key points:
- It discusses several major international tourism organizations like IATA, UFTAA, TAAI, ICAO, PATA, and their roles in coordinating tourism globally.
- It outlines some important international conventions regarding aviation and travel including the Chicago Convention, Warsaw Convention, Montreal Convention, and bilateral air transport agreements.
- It explains concepts like the "Freedoms of the Air" which establish commercial aviation rights between countries.
The document discusses key aspects of health insurance, including that it insures individuals against medical expenses through a contract between the insurance provider and policyholder. It defines important terms like premium, deductible, exclusions and lists some top insurance companies. It notes that exclusions are conditions not covered by the policy and can be permanent or time-limited. Riders can optionally expand coverage for things like newborn care. Cancer insurance is a supplemental policy that covers cancer treatment costs. The claims process and required documents are also outlined.
The document discusses health insurance in India. It covers the importance of health insurance, different types of health insurance including social (ESI, CGHS), private (Mediclaim), and community-based (RSBY) insurance. It outlines some of the key features of these insurance schemes including their benefits, contributions, and issues faced. It also discusses the roles of regulatory bodies like IRDA that oversees the insurance sector in India. In summary, the document provides an overview of the health insurance landscape in India, the different public and private options available, and some challenges faced by these schemes.
Motor insurance provides protection against physical damage and liability arising from traffic collisions. It is mandatory in India to insure vehicles before driving them. Insurance protects one's life, money, and liability to third parties by covering expenses in case of an accident. Premiums are decided based on factors like age, driving history, vehicle type, location, etc. Policies can be liability-only or comprehensive. Comprehensive policies provide coverage for damages from various causes while liability covers third party liability. Exclusions include contractual liability, war/nuclear risks, driving under influence. A case study describes an insurance company unjustifiably delaying and rejecting a claim for a stolen car.
The document discusses motor insurance policies in India. It introduces different types of motor insurance policies including liability-only and comprehensive policies. It describes key elements of motor insurance policies like third party liability coverage, own damage coverage, no claim bonus, and standard policy wordings as per the All India Motor Tariff. It also provides an overview of own damage claims process and settlements.
Motor insurance provides protection against risks associated with motor vehicle accidents, such as injuries to others, damage to other vehicles or property, or damage to the insured vehicle itself. It is mandatory in India under the Motor Vehicles Act to purchase a Liability Only policy that covers bodily injury and property damage to third parties. Insurers also offer optional policies that provide additional coverage like compensation for injuries to the owner-driver or damage to the insured vehicle. India has seen rapid growth in both motor vehicles and road accidents in recent decades, making motor insurance an important product for both individuals and the insurance industry.
1. The document discusses planning and saving for retirement, including estimating costs of one's desired lifestyle and identifying sources of retirement income such as pensions, 401ks, IRAs, Social Security, and other savings vehicles.
2. It explains compound interest and its power to grow savings over time, demonstrating concepts like the Rule of 72.
3. The importance of starting to save and plan for retirement early is emphasized.
The document discusses various types of perquisites and fringe benefits provided to employees in addition to their salaries. It defines perquisites as discretionary benefits given to senior employees and management. Some examples of perquisites mentioned include housing, vehicles, utilities, education, and stock options. Fringe benefits refer to various extra benefits provided to employees and include things like insurance, medical care, leave, and legal requirements under labor laws. The benefits are provided to motivate employees, improve welfare, and create better industrial relations.
The document discusses retirement planning and provides information about retirement benefits. It covers topics such as the importance of retirement planning, sources of retirement income like government and company programs, retirement benefit schemes, and strategies for retirement planning such as maximizing workplace savings and establishing IRAs. The document aims to help people understand retirement and the need for financial planning to ensure a comfortable retirement.
The document discusses compensation and benefits management. It defines key terms like salary, wages, and compensation. It outlines components of compensation including fixed pay, variable pay, benefits, and financial and non-financial rewards. It discusses factors that influence compensation strategy and policies, different compensation models and structures commonly used in India.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
This document provides an overview of fire insurance. It discusses key principles of insurance like utmost good faith, indemnity, and insurable interest. It also describes different types of fire insurance policies like valued policies, floating policies, declaration policies, and adjustable policies. The document outlines the scope of fire insurance and covers losses from fire and other perils. It also discusses the rights of insurers like salvage, subrogation, and contribution. Specific policy and average policy are also summarized.
The Insurance Act of 1938 was the first legislation governing all forms of insurance in India and provided strict state control over the insurance business. It aimed to safeguard policyholder interests and establish norms for smoothly conducting the insurance business and minimizing disputes. Subsequent acts like the Insurance Regulatory and Development Authority Act of 1999 established regulatory authorities to further protect policyholders, regulate the industry, and ensure its orderly growth.
The document provides an overview of the healthcare industry in India. It discusses various aspects of the industry including emerging diseases, infrastructure issues, the growth of the health insurance market, medical tourism, Ayurveda, surgical equipment, pharmaceuticals, and the top pharmaceutical companies. It also includes survey results on perceptions of healthcare infrastructure and recommendations to improve the industry.
The document discusses employee benefits and services. It provides definitions and examples of benefits like paid time off, health insurance, retirement plans. It explains that benefits are used to attract, retain, and motivate employees. The document also covers factors that influence benefit decisions, common types of benefits, and some potential issues with benefits programs.
This chapter discusses employee benefits and their management. It covers the growth in benefits costs due to laws and taxes. Common benefit programs in the US include social insurance, private group insurance, retirement plans, and family-friendly policies. The chapter also examines strategies for controlling benefits costs, such as healthcare plans, wellness programs, and regulatory compliance. Effective communication with employees about benefits is also discussed.
The document discusses various types of insurance, including life, general, health, and property insurance. It provides definitions and classifications of insurance, explains concepts like premiums and insurers, and gives examples of specific insurance policies and plans like health, home, and renter's insurance. Key details covered include classifications of insurance, definitions of terms, common policy elements and exclusions, health insurance initiatives and schemes in India, and importance of property and health insurance.
Insurance products 2 ( General Insurance)Rohit Kumar
General Insurance refers to non-life insurance that covers risks other than death, such as home, auto, commercial risks. It is also called property and casualty insurance. General insurance policies are formed through an offer and acceptance process, where the insured pays a premium in exchange for the insurer's promise to provide indemnity. Common types of general insurance include health, liability, motor, marine, and property insurance. Health insurance covers medical costs, while liability insurance covers legal responsibilities. Motor insurance covers car risks, and marine insurance covers shipments. Property insurance protects homes and possessions.
Life and Health Insurance Tips and Complete Guide.pdfIGILife
Family Floater Health Insurance - A family floater health insurance is a type of policy customized to suit the entire family, under one single premium. The same protects and covers all family members against various illnesses, accidents, hospitalization, and other medical needs that may arise during one's lifetime.
This is based on Health assurance, what will be the benefit for purchasing health assurnace. just check it out and plz give comment on lokeshpayasi@gmail.com
Dear all,
I am excited to present my project, which is a comprehensive analysis based on the book "What Every Indian Must Know Before Investing" by Vinod. The main focus of my presentation revolves around health insurance. Through an in-depth study of the book, I gained valuable insights into the structure of health insurance and the essential factors that investors must consider to identify the most suitable options from the wide array of insurance available.
Drawing from my understanding, I have carefully curated the most crucial points and endeavored to present the content in a simplified and easily understandable manner. It is important to note that I have omitted the tax benefits sections for now, but I may incorporate them at a later stage.
I genuinely hope that this presentation, along with the book, proves to be as helpful to you as it was to me in navigating the complexities of health insurance as an investor.
Thank you for your attention and consideration.
This document provides an overview of various types of health insurance plans in India including social health insurance programs like CGHS and ESIS. It discusses key health insurance terms like social health insurance, types of plans including hospital cash plans, top up covers, critical illness plans etc. It also outlines the process for choosing a health insurance plan and making claims. Some advantages of health insurance are risk coverage, cash allowances and tax benefits while disadvantages include restrictions to networked hospitals and lack of coverage for pre-existing diseases.
The document discusses health insurance in India. It begins with a brief history of health insurance in India since 1947. It then defines health insurance and lists some key reasons for purchasing health insurance, such as preventing financial burden from medical costs and receiving tax benefits. The document also compares the differences between life insurance and health insurance. It outlines some common technical terms used in health insurance and describes the typical cycle of a health insurance claim. Finally, it discusses some popular health insurance products in India and highlights factors considered during the underwriting process.
Securing Health Is A Necessity | Health Insurancepolicy21st12
A Health Insurance, thus is not a luxury for a few to possess but a necessity for everyone to must have. There are several policies available in the country because there are so many deadly disease and double digit medical inflation rate in the country, so these polices give you a lot of room to decide and choose from.
Assure is a comprehensive health insurance coverage plan from Religare Health Insurance. It covers Critical Illness, Surgical Procedures, Medical Events as well as give Personal accident cover.
This document provides an overview of health insurance. It discusses what health insurance is, the types of health insurance plans available including individual, group, critical illness, and specific disease plans. It covers factors that determine premium costs such as age, medical history, job, and term of the policy. Tips are provided for choosing the right health insurance plan and saving on premium costs. The steps for filing a health insurance claim are outlined. Recent government incentives for health insurance in India are also mentioned.
US healthcare insurance can be public (e.g. Medicare, Medicaid) or private (employer or self-purchased plans). Medicare has parts A, B, C, and D that cover different services like hospitals (Part A) and prescription drugs (Part D). Plans may require premiums, deductibles, co-payments, or co-insurance. They often have limits and do not cover all costs. Private insurers provide additional plans like PPOs, HMOs, or Medicare Advantage plans combining Part A, B, and D benefits. SCHIP provides coverage for children from families that do not qualify for Medicaid.
This document provides an overview of health insurance. It discusses why health insurance is needed given rising healthcare costs. It outlines the types of medical expenses that can be incurred and that most health insurance policies cover expenses related to hospitalization. There are two major types of health insurance plans - indemnity plans which reimburse expenses, and managed care plans which provide incentives to use selected healthcare providers. When determining an appropriate level of health insurance coverage, factors to consider include age, health history, income, financial obligations, profession, and the option of a floater policy that provides coverage for a family rather than individuals.
The document defines health insurance as a contract between an insurance provider and an individual or organization that covers medical expenses. Key aspects of health insurance include premium payments, deductibles, copays, coverage limits, and what medical costs are covered. Rates are calculated based on personal health history and risks. Premiums can increase if claims are high or an individual's health status changes. Missed payments can cause a policy to lapse or be cancelled. The document also outlines some common types of health insurance plans and tax benefits.
HEALTH INSURANCE PROVIDED BY GOVERNMENT VS PRIVATE SECTOR IN INDIAVedica Sethi
Healthcare is significant for each individual on the planet, on account of this each nation should focus on wellbeing, because of increment pace of sickness and ailments.
In India medical coverage part is an undiscovered market, still it has crying needs. There is colossal potential for this part. The medical coverage suppliers are not satisfying this interest. After 1999 the privatization of protection area, the protection segment has developed in past decade. By and by there are 25 medical coverage suppliers, in that four are with open area and twenty one private medical coverage suppliers. The piece of the overall industry of open segment is 60 rates while the rest with other private players.
This paper inspects the present status of medical coverage in India, advancement in health care coverage area and difficulties looked by it. It additionally investigates the job of both open and private medical coverage players to arrive at most extreme inclusion in health care coverage.
Health insurance provides coverage against medical expenses for illnesses or injuries. It is an agreement between an insurance provider and an individual or their sponsor. The coverage can be for a set time period or lifelong. It specifies what health care costs will be covered. Health insurance first emerged in the late 19th century and became formalized in 1912 with the first Insurance Act. However, only 3-5% of Indians have health insurance coverage today. Out-of-pocket medical expenses from conditions like heart disease or cancer could be financially devastating for most Indians without insurance.
L&T Insurance introduces my:health Medisure Classic Insurance, a health insurance plan that covers hospitalization expenses and other medical costs. Key features include coverage for hospital room rent, surgery, medicines and more. It also covers pre-and post-hospitalization costs, day care procedures, domiciliary hospitalization, and maternity expenses. Customers can avail of optional covers like critical illness insurance. The plan offers lifelong renewability, tax benefits, and covers the proposer, spouse, children and parents.
L&T Insurance presents myhealth medisure Classic Insurance, a meticulously designed insurance
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plan to ensure their complete well-being. Especially designed through a scientific process,
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The document promotes a health insurance product called "Health Wallet" as a revolutionary product that ensures customers get comprehensive healthcare coverage and savings benefits. Health Wallet provides insurance for both inpatient and outpatient expenses, allows savings to grow over time, covers future health needs, and has additional benefits like critical illness coverage and tax benefits. It is positioned as a better option than traditional health insurance by providing ongoing returns and coverage for healthy individuals.
V25 jul2012- Investment Patterns of ITES EmployeesSunia Mukherjee
This document summarizes a study conducted on the investment patterns of ITES employees in Bangalore. It includes sections on the objectives of the study, research methodology, data analysis and findings. A survey was conducted of 202 ITES employees to understand how much of their salary they invest, their preferred investment avenues, and factors influencing their choices. The data found that most employees invest between 5-15% of salary, with insurance and fixed deposits being most popular. However, only 10% preferred mutual funds despite having a medium-risk profile. The conclusions recommend that employees should save and invest more to plan for the future, and consider mutual funds to gain from equity returns.
Trend analysis of Investment Patterns of ITES EmployeesSunia Mukherjee
After analyzing data from over 200 employees in the BPO industry, the author observed trends in how employees at different career levels and ages save and invest. Younger employees initially spend most of their salaries on rent and expenses when first joining from other cities. After a few years, as salaries become taxable, most begin investing in instruments like PPF and insurance to save on taxes. Across age groups, employees showed a preference for medium-risk medium-return investments like FDs and mutual funds. The goal of education funding for children was also a major motivator for investments. Real estate was popular, though more challenging for those without family support. Attitudes evolved over time and careers, with lessons learned from recessions influencing more prudent
This document provides an introduction to the ITES (Information Technology Enabled Services) industry and business process outsourcing (BPO). It discusses how companies outsource business functions like call centers, finance, and human resources. The document then covers investment patterns among ITES employees, including their sources of income, expenditures, savings, and investment options. It introduces the objectives and importance of the study, which is to understand how ITES employees allocate their earnings across spending, savings, and different investment avenues.
During my Diploma in Management from Welingkar Business School, our team Krishna N, Merlyn Shobha and Bhavani N had done an extensive project on ''Investment Patterns of ITES employees'' under the guidance of Prof Hema Doreswamy
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In June 2024 we launched GeShiDo Foundation (Get Sh*t Done Fndn) a Canadian charity supporting organizations to scale their solutions to move 1 Million Canadians from a state of crisis to stability.
GeShiDo focuses on three intersecting issues - addictions, attainable housing and food security.
Private equity firms are investment partnerships that buy companies and manage them prior to selling them (hopefully for a profit).
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Health ppt
1. Health Insurance Over View
Individual Health Insurance Overview
USGI Health Insurance
2. Health Insurance Overview
Health insurance (popularly known as Medical Insurance or Mediclaim)
protects you and your dependents against any financial constraints arising
on account of a medical emergency.
It includes disability and long term medical needs. In Mediclaim, you pay
a premium and in return the insurer commits to pay a predetermined sum
of money to meet the claims.
Health insurance is new in Indian context and is slowly catching up with
the consumers.
Consumers understand the objective of health insurance and it’s
offering to cover the ever rising medical expenses.
Before buying a health insurance policy, plan your requirements carefully.
It will save you from buying a policy which might not be appropriate for
you and can also be expensive.
3. What is Health Insurance
A health insurance policy is a contract between an insurance company and an individual.
Sometimes it is associated with covering disability and custodial needs.
The contract is renewable annually.
Health insurance is affordable and carries the assurance and freedom from insecurities that
threaten normalcy now and then
type and amount of health care costs that will be covered by the health plan are specified in
advance
4. Benefit of Health Insurance
Benefit depends on the policy you choose and the coverage it provides
It helps securing a better future by paying a fraction as an expense today called
the premium.
It reduces saving huge amount of financial losses, risk of financial breakdown in
case of expensive medical and post-illness care.
It definitely induces a sense of security to the insured.
It provides financial security to the family members.
It covers your hospitalization and medical bills.
It also covers disability and custodial bills.
You can avail tax benefits on the premium paid under section 80D of the Income
Tax Act.
The best factor, you can also opt for health insurance policies even after the age
of 60.
5. Types of Health Insurance
Health care costs have seen a phenomenal rise in the recent times
There are two types of health Insurance
Medical Insurance also know as indemnity cover
Critical Illness Insurance also know as benefit cover
Medical Insurance
This is typically a hospitalization cover and reimbursement of the medical expenses incurred
in respect of covered disease or surgery while the insured was admitted in the hospital as a
patient.
Different types of medical insurances are available in the market like individual medical
insurance, group medical insurance and overseas medical insurance.
There are health policies that reimburse you the actual hospitalization cost for treatment of
any disease and are offered by the non-life insurers only.
These policies are popularly called "Mediclaim" policies.
Critical Illness Insurance
Critical Illness plan insures you against the risk of serious illnesses in return of a premium
you are required to pay.
6. Cont…
In this type of health insurance plan, the insured receives a lump sum amount within a few days of
diagnosing critical illness as per his sum Insured
This gives you the same security of knowing that a guaranteed cash sum will be paid if the unexpected
happens and you are diagnosed with any one of the critical illness.
Sometimes a critical illness can change your lifestyle in addition to help within the home or the family.
Once this lump sum is paid, the plan ceases to remain in force. Typically, a critical illness plan would
provide cover for the illnesses mentioned below.
Aorta graft surgery
Cancer
Coronary artery bypass surgery
First heart attack
Kidney failure
Major organ transplant
Multiple sclerosis
Paralysis
Primary pulmonary arterial hypertension
Stroke
7. Glossary
DEFINITION:
1. Proposal form: The application form You sign for this insurance and any other information You give to us or which is given to
us on Your behalf.
2. Policy: Policy wording, the Schedule, the Proposal form and any applicable endorsement or memoranda.
3. Schedule: It provides details of the insured person(s), which are in force and the level of cover Insured Person(s) have.
4. Sum Insured: It means the Monetary Amounts shown against insured person(s) which will be our maximum liability during the
Policy Period.
5. Period of Insurance: The time Period for which the contract of insurance is valid as shown in the schedule Individual Health
V3bd 06-11-08
6. We/Ours/Us It means UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LTD.
7. You/Your: It means the person(s) named as Insured in the Schedule
8. Insured Person: The person named as Insured person(s) in the Schedule which may include You and Your family inclusive of
dependent parents
9. Injury: It shall mean accidental bodily injury solely and directly caused by external, physical and visible cause.
10. Disease: It shall mean a condition affecting the general Wellbeing and health of the body that first manifests itself in the
Period of Insurance and which requires treatment by a Medical Practitioner.
Disease does not include any mental disease ( a mental or bodily condition marked by disorganization of personality, mind, and
emotions to impair the normal psychological, social or work performance of the individual) regardless of its cause or origin.
11. Medical Practitioner: Person holding a Medical degree of a recognised institution registered by Medical Council of respective
State of India.
12. Qualified Nurse: Person holding certificate of recognized Nursing Council
13. Hospital/Nursing Home : It means an institution registered as a Hospital or Nursing Home within India, established for indoor
care and treatment of disease/injuries.
9. USGI IHI overview
It is comprehensive Health Insurance Policy
Policy designed in a way to suit your need and fit your pocket while providing a wide
Coverage
The Policy is your protection against spiraling medical costs
The Policy is available for Individuals and Families.
It covers pre and post hospitalization
Claim includes cashless and reimbursement options
Include day care hospitalization and Domiciliary Hospitalization
It does have an option of critical illness and daily cash
10. Key Benefit and Eligibility
Key Benefit
Covers Day care hospitalization and Domiciliary Hospitalization
Add on includes critical illness
Cashless Facility provided in over 5000 network hospitals across India
Having wide range of sum insured option from 1 to 5 lacs depending on which premium varies
No co payment
No medical charges for age above 45yrs
No Loading – In case of claim in previous year there ill be no loading on premium at times of renewal
1year Exclusion – there are few ailments which are covered after 1yrears where as in most of the
companies it is covered after 2 years
Eligibility
The enrollment age is between 3month to 65 yrs
Policy is renewable up to 70yrs
Maximum 2 Adult and 2 kids can be covered under one policy
No health Check up is required up to 45 years of age
11. Coverage and Addons
Sr.No Coverage INDIVIDUAL HEALTH
1 SI/Person/Policy/Year(in lakhs) 1 LAC TO 5 LACS, multiples of 50000
2 Pre-hospitalization 30 days
3 Post-hospitalisation 60 days
4 Day Care Procedures Covered both on Cashless and Reimbursement basis
5 Domiciliary Treatment Up to 20% of Basic Sum Insured
6 Pre Existing Cover After (yrs) Covered after 3 Claim free Policy Years with Us
7 Pre Hospitalisation For upto 30 days prior to Hospitalization
8 Post Hospitalisation For upto 60 days post hospitalization
9 Daily Cash Allowance
0.1% of the Basic Sum Insured or Rs. 250/- per day for the duration
of hospitalization whichever is less subject to maximum of Rs.
2500/-
10 Critical illness cover
upto the SI/ additional 50% of the Basic Premium shall be
applicable
11 Network Hospitals 5000 ALL OVER INDIA
12 Medical Practitioner/ Consultant fees Upto 25% of Basic Sum Insured
13 Policy Taken With out Medical Examine (Yrs) Upto 45 years
14 PRE POLICY MEDICAL TEST EXPENCES BORNE BY INSURED
15 Major Organ Transplant a) Kidney b) Lung c) Pancreas d) Bone Marrow
16 Emergency Ambulance
Limit of 1% of Basic Sum Insured subject to maximum of Rs.
1000/- each Claim
17 TAX BENEFIT
tax under Section 80 D up to Rs. 15,000/-, for Senior Citizens the
limit is Rs. 20,000/-.
Add on: Critical Illness Rider (On Cashless basis)
Available at inception, facility to double the Basic Sum
Insured for the following 5 Critical Additional Premium
• Paralytic Stroke• Cancer• Chronic End Stage Renal failure •
Coronary Artery Bypass• Major Organ Transplant(Kidney, Lungs,
Pancreas, Bone Illness on Payment of Marrow)
12. Exclusions
30 days exclusions Any Illness contracted within 30 days of Period of Insurance Start
Date, except those incurred as a result of Injury.
1year exclusion Any Medical Expenses incurred by You on treatment of following Illnesses
within the first two (1) consecutive years of Period of Insurance Start Date:
Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy
Hernia, Hydrocele
Fistula in anus, Piles
Arthritis, Gout, Rheumatism
Joint replacement unless warranted due to an accident
Sinusitis and related disorders
Medical Management of tonsillitis.
Stone in the urinary and biliary systems
Dilatation and Curettage
13. Cont….
Skin and all internal tumors/cysts/nodules/polyps of any kind, including breast lumps unless malignant, adenoids and
hemorrhoids
Dialysis required for renal failure
Surgery on tonsils and sinuses
Gastric and duodenal ulcers
4years Exclusions-In case the Illnesses mention in 1st year exclusions or any other illness mention by insured are Pre-
existing condition(s) at the commencement of this Policy, then those Illnesses shall be covered after 48 months of
continuous claim free coverage has elapsed, since Period of Insurance Start Date
Permanent Exclusions
Injury or Diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign
enemy, war like operation (whether war be declared or not).
Circumcision unless necessary for the treatment of a Disease not otherwise excluded or required as a result of
accidental bodily injury; vaccination, inoculation, cosmetic or aesthetic
treatment of any description(including any complications arising thereof),plastic surgery except those relating to
treatment of Injury or Disease .
Cost of spectacles and contact lens or hearing aids.
Dental treatment or surgery of any kind
Convalescence, general debility, run down condition or rest cure, congenital disease or defects or
anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohols.
14. Cont…….
Any expense on treatment related to HIV, AIDS and all related medical conditions.
Expenses on Diagnostic, X-Ray, or Laboratory examinations unless related to the treatment of
Disease or Injury falling within ambit of Hospitalization or Domiciliary Hospitalization claim.
Expenses on treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or
complications of any of these, including caesarean section and any infertility, sub fertility or
assisted conception treatment.
Injury or Diseases directly or indirectly caused by or contributed to by nuclear weapons/material.
Any expense on treatment of Insured Person as an outpatient in a Hospital.
Any expense on Naturopathy, non allopathic treatment and/or any treatments not approved by
Indian Medical council Any expense related to Disease/Injury suffered whilst engaged in
adventurous sports.
Any Expense of any treatment related to Human T-Cell Lymphotropic Viruses types III (III-LB-III)
or Lymphadinopathy Associated viruses (LAV) or the Mutant derivatives or Variations Deficiency
Syndrome.
External medical equipment of any kind used at home as post hospitalization care like
wheelchairs, crutches, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or
continuous peritoneal ambulatory dialysis (C.P.A.D) and oxygen concentrator for bronchial
asthamatic condition, etc.
15. Cont….
Any expense under Domiciliary Hospitalisation for
• Pre and Post Hospitalisation treatment
• Treatment of following diseases:
I. Asthma
II. Bronchitis
III. Chronic Nephritis and Nephritic Syndrome
IV. Diarrhoea and all type of Dysenteries including Gastroenteritis
V. Diabetes Mellitus
VI. Epilepsy
VII. Hypertension
VIII. Influenza, Cough and Cold
IX. All types of Psychiatric or Psychosomatic Disorders
X. Pyrexia of unknown origin for less than 15 days
XI. Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharingitis
XII. Arthritis, Gout and Rheumatism
XIII. Dental Treatment or Surgery
• Any treatment not exceeding three days.
17. War, riots, strike, terrorism acts, nuclear weapon induced treatment
16. Claim Process
Cashless Overview
Get admitted in any one of the TPA’s networked hospital
Fax the pre-authorisation form along with relevant documents (Investigation
reports, Previous consultation papers, Cashless ID, Photo ID)
Your service provider reviews your claim request and accordingly will approve, query or
reject the same
Your service provider settles the claim
(as per policy terms & conditions) with the hospital after completion of all formalities.
Reimbursement Overview
Upon discharge, pay all hospital bills and collect all original documents of treatments and
expenses undergone.
Mail the duly filled (and signed by insured and treating doctor) claim form and required
documents to your service provider (TPA).
Your service provider reviews your claim request and accordingly will approve, query or
reject the same
Your service provider settles the claim
(as per policy terms & conditions) and reimburses the approved amount.
17. Claim documents
Required Documents
Duly filled Claim form (signed by the Insured and the treating doctor)
Discharge summary (with details of complaints & the treatment availed
Final Hospital Bill (detail breakup) along with interim bills
Payment Receipts
Doctor's consultation papers
All investigation reports (e.g. Blood report, X-ray, Sonography, MRI, etc.)
All pharmacy bills supporting with doctor prescriptions
Implant sticker / invoice, if used (e.g. lens details in cataract case, stent details in
angioplasty)
Medico Legal Certificate (MLC) and / or FIR for all accident cases
For miscellaneous charges - detail bills with supporting prescription of the Treating
doctor
Copy of Health card
Any other related documents
Note: All documents should be Original
18. Contact us
USGI
Product Related
080-41538832
Email ID – insure@kanoeindia.com
Third Party Administrator(TPA) –Ericson TPA
Toll free no 1800 22 2034
Email ID – satyadeep@ericsontpa.com
Contact Address
ERICSON TPA Healthcare Pvt. Ltd.
4th Floor, New Vijay Cinema Building,
S. T. Road, Chembur,
Mumbai-400071, Maharashtra.
Tel: 022-25280280