Insurance assist the customers to look after their life as well as their family's health. In this there is a guarantee of compensation for specific period and it is specially made to protect the wellbeing of individual, company or other entity in the case of unexpected loss. After agreeing to the term and conditions the insurance policy creates an agreement between the policy holder as well as insurance company. There are several types of insurance some of the types are health insurance, general insurance, accidental insurance etc.
The health insurance is that type of insurance which is incurred medical expenses among individuals. It is contract between the insurance provider as well as the individual. The health insurance provides risk coverage against
This type of insurance also called as med claim policy that offers protection to the policy holder in case of unexpected medical emergencies.
TPA also called Third Party Alliance which is done with the help of third party and through which you get services. It is an important link between insurance company as well as the insured person.
Services offered by TPA for policyholder and health care provider
1. Cashless hospitalization: each policyholder is given a list of network hospital through which he/she can avail cashless hospitalization.
2. ID card: The TPA alliances offer the ID card in order to validate at the time of admission.
3. Claim: TPA administers & settles claims for hospitals & policyholders.
4.24 hours support: TPA provides assistance through its 24 hrs call center information regarding policyholder's data, provider network, claim status, benefits available with existing cardholder, etc is furnished on request.
These are the cashless services one should note down
Obtain a pre authorization form from TPA alliance before three to four days. Pre authorization form to be filled by doctor
Check about the pre authorization form approval at the insurance helpdesk within next 24 hours.
You can avail cashless treatment at the hospital after the receipt of written authorization form TPA form to be covered
Leave all the original documents and get signed claim at the time of discharge
In case of any questions contact the local TPA office.
Make payment to the hospital for the expenditure over and above the TPA approved limit and for the treatment not covered under the package.
A good type of policy called as cashless policy in which you don't have to settle down the hospital expenses at the time of discharge from hospital. This type of settlement is directly settled from the insurance company. Before admitting into the hospital it should be authorized by TPA.
The cashless plans are of two types:
1. Planned: in this case the insured person knows the hospitalization few days in advance.
2. Emergency: in this case the insured or other member of the family meets with sudden accident and requires hospitalization.
Before taking the cashless policy you need to take care of some documents
1. Intimate your TPA before admission to your nearest hospital.
2. Make sure you have valid identity card to show and also at the admission time.
3. Provide the complete information which is required in form.
4. You must carry medical as well as previous reports.
The cashless claim policy are divided into two types
1. Reimburse plans
2. Cashless plans
It is available 24 hours. We have three types of plan
1. Standard plan
2. Exclusive plan
3. Premium plan
The health insurance covers
1. Hospitalization expenses: it includes hospital, doctors as well as nurses, medical test, oxygen, appliances, blood
2.Day care treatment: in this treatment where 24 hours of hospitalization is not required subject to treatment/surgeries listed in the policy document.
3. Pre as well as post hospitalization: Medical expenses related to your treatment before and after hospitalization for a specified number of days.
4. Donor expenses: All hospitalization expenses incurred by the donor in case of major organ transplant are covered
5. Domiciliary hospitalization: All expenses related to a medical treatment, which is being administered at home, provided that (a) patients condition does not allow him to be shifted to a hospital; or (b) due to lack of accommodation at the hospital.
There is no maximum cover ceasing age in this policy. For Additional cover of Critical Illness maximum cover ceasing age in this policy would be 70 yrs.
The Waiting Periods mentioned in the policy will get reduced by 1 year on every continuous renewal of your Easy Health Insurance Plan.
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