Aga Khan Health Service, India

Regional Board for Western India

Awareness on

Health Insurance

Mawlana Hazar Imams Guidance

Hazar Imam wants His jamat to have financial access to quality health care. Every Individual should have adequate Insurance to cover all medical expenses. Your Insurance coverage should be enough to cover all expenses for quality health care.

 Today getting treated for illnesses is getting very costly. It is beyond a common mans resources to pay for the hospitalization of one self or the dependents. Our lifestyle is such that all of a sudden, a hail & hearty person is diagnosed for Angiography or heart bypass surgery for which the expenses incurred is anywhere between Rs.2 lacs to Rs.5 lacs. Diabetes & Blood Pressure have become as common as a common cold. Due to this, it has become absolutely necessary for each one of us to get a HEALTH INSURANCE commonly known as MEDICLAIM INSURANCE POLICY.

Insurance Adequacy
In todays scenario, do you think that coverage of Rs.1.00 Lac to Rs.2 Lacs is ADEQUATE ? The answer is a BIG NO? Than, what sum would be adequate according to you in the present scenario of rising costs of medical expenses and diseases

Recommended Coverage
Depending in the city you stay. Class & hospital in which you desire to take treatment. Depending on the families medical history. Expenses cap: The companies have started fixing the maximum amount payable in case of different illnesses, irrespective of the Sum Insured.

Companies have also put a cap on the room, boarding and nursing expenses admissible to the insured not exceeding to 1% of the sum insured, e.g. a person having policy of Rs 50,000/- would be eligible for a room, boarding and nursing expenses not more than Rs 500/- per day.

Early Insurance
It is advisable to take an insurance policy at an early age so that you get benefit of no-claim bonus. An individual should also take maximum coverage before the age of 40 yrs to avoid medical checkups.

Important Pointers in Health Insurance

You must read the policy exclusions & the limitations in various covers properly before buying a Health Insurance plan because you should know what all your policy includes & excludes. You should have the list of network hospitals covered by your insurance company as this will help you to get cashless & hassle-free claims. You must know that the medical expenses incurred within the first 30 days of buying the health insurance plan are not covered, unless the injury has occurred out of an accident. You must disclose all the Pre-Existing diseases to the insurer before buying the health plan as the insurer doesnt cover them, now a days General Insurers have started covering these diseases normally after 3-4 years varying from company to company.

Understand your policy

Understand your policy

Document List for Submission

1. Copy of the original medical policy. 2. Letter informing the insurance company about hospitalization. 3. Completely, correctly and signed filled claim form. 4. All original prescriptions and bills from the Doctor for medicines as well as diagnostic tests. 5. Hospital Discharge card. 6. Death Summary Report in case of Hospital Death. 7. Summary sheet of the documents submitted. 8. Additional documents suggested by the agent if any. 9. Always keep a photocopy of all the documents submitted to the insurance company and if possible get it duly attested by your treating doctor.

Document List for Submission

10. Death Certificate (This certificate is issued by the local Municipal Authority or any local authority). 11. Death Summary (As the patient has died & then shifted from hospital, there is no Discharge Certificate issued for such cases. In lieu of Discharge Card, a Death Summery is issued indicating the patient condition & cause of death at hospital. This is MUST for cases involving death at hospital).

Ensure
Intimation to the TPA/Insurance company within 24 hours of hospitalization. Reimbursement claims MUST be submitted within 7 days from the date of discharge from Hospital. Bills related to post hospitalization expenses can be submitted as second claim within 67 days of discharge from hospital.

Important Considerations: Planned surgeries, if can wait, try to post pone them at the end of your policy year. Understand your policy thoroughly do not depend on agents, ensure you know all the requirements for claims. Ensure to collect all the required documents at the time of discharge from hospitals. Children are vulnerable and also need to be insured adequately.

Jagruti Policy Highlights

The entire family is covered under Family floater Policy 1+5 family members Pre-existing diseases covered Pre & Post Hospitalization expenses for 30 days and 60 days respectively from date of illness are covered No health check-up required Room, Boarding and Nursing expenses are covered but limited to 1% of sum insured Ceilings on Diseases Minimum hospitalization of 24 hrs

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 100,000

Tonsillectomy / Adenoidectomy / Adenotonsillectomy FESS + Septoplasty MASTOIDECTOMY with TYMPANOPLASTY Surgery for varicose veins (including laser) Appendicectomy - Laproscopic Cholecystectomy - Laproscopic Circumcision Fistulectomy Fissurectomy + Sphincterotomy + Sentinal Pile Haemorrhoidectomy (excluding staples & trackers) Perianal Abscess Pilonidal Sinus Radical Mastectomy Modified Breast Lumpectomy Thyroidectomy - Total Inginal Hernioplasty (including Mesh) Hysterectomy (laproscopic) Phaco with Unifocal/ Foldable Lens (Per Eye) Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) 13000 25000 24000 30000 20000 30000 3000 15000 12000 12000 8000 6000 40000 15000 15000 16000 25000 13000 10000

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 100,000

Arthroscopic Surgery Total Knee Replacement (cost of Implant extra) Total Hip Replacement (cost of Implant extra) Fracture Neck Femur (cost of implant extra) Laminectomy / Discectomy / Stabilzation of Spinal Cord TURP Hydrocelectomy PCNL (percutaneous Nephrolithotripsy) ESWL Haemo Dialysis (per sitting) Coronary Angiogram (incuding Dye) Angioplasty - PTCA (excluding stent) Valve Replacement CABG Acute gastro enteritis Management LRTI Management Urinary Tract Infection Management Therapeutic D & C Management of Fever due to unknown etiology or Malaria or Typhoid (approx stay 3 -4 days without ICU requirement, without complications) 30000 60000 60000 60000 45000 30000 15000 25000 15000 1500 10000 50000 80000 80000 8000 15000 8000 10000 12000

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 2,00,000

Tonsillectomy / Adenoidectomy / Adenotonsillectomy FESS + Septoplasty MASTOIDECTOMY with TYMPANOPLASTY Surgery for varicose veins (including laser) Appendicectomy - Laproscopic Cholecystectomy - Laproscopic Circumcision Fistulectomy Fissurectomy + Sphincterotomy + Sentinal Pile Haemorrhoidectomy (excluding staples & trackers) Perianal Abscess Pilonidal Sinus Radical Mastectomy Modified Breast Lumpectomy Thyroidectomy - Total Inginal Hernioplasty (including Mesh) Hysterectomy (laproscopic) Phaco with Unifocal/ Foldable Lens 21000 40000 33000 45000 34000 47000 7000 24000 17000 21000 13000 10000 62000 27000 24000 27000 38000 24000

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 2,00,000

Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) Arthroscopic Surgery Total Knee Replacement (cost of Implant extra) Total Hip Replacement (cost of Implant extra) Fracture Neck Femur (cost of implant extra) Laminectomy / Discectomy / Stabilzation of Spinal Cord TURP Hydrocelectomy PCNL (percutaneous Nephrolithotripsy) ESWL Haemo Dialysis (per sitting) Coronary Angiogram (incuding Dye) Angioplasty - PTCA (excluding stent) Valve Replacement CABG Acute gastro enteritis Management LRTI Management Urinary Tract Infection Management Therapeutic D & C Management of Fever due to unknown etiology or Malaria or Typhoid (approx stay 3 -4 days without ICU requirement, without complications) 24000 45000 76000 76000 66000 62000 42000 24000 34000 22000 2000 13000 66000 110000 110000 14000 21000 18000 14000 19000

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 5,00,000

Tonsillectomy / Adenoidectomy / Adenotonsillectomy FESS + Septoplasty MASTOIDECTOMY with TYMPANOPLASTY Surgery for varicose veins (including laser) Appendicectomy - Laproscopic Cholecystectomy - Laproscopic Circumcision Fistulectomy Fissurectomy + Sphincterotomy + Sentinal Pile Haemorrhoidectomy (excluding staples & trackers) Perianal Abscess Pilonidal Sinus Radical Mastectomy Modified Breast Lumpectomy Thyroidectomy - Total Inginal Hernioplasty (including Mesh) Hysterectomy (laproscopic) Phaco with Unifocal/ Foldable Lens Retinal Surgery (vitrectomy / retinal detachment, glaucoma etc) 39000 72000 64000 84500 65000 100000 13000 45500 33000 39000 25000 20000 117000 52000 45000 50000 73000 35000 (per eye) 49500

AILMENTWISE CAPPING SUBLIMITS (Rs) SI 5,00,000

Arthroscopic Surgery Total Knee Replacement (cost of Implant extra) Total Hip Replacement (cost of Implant extra) Fracture Neck Femur (cost of implant extra) Laminectomy / Discectomy / Stabilzation of Spinal Cord TURP Hydrocelectomy PCNL (percutaneous Nephrolithotripsy) ESWL Haemo Dialysis (per sitting) Coronary Angiogram (incuding Dye) Angioplasty - PTCA (excluding stent) Valve Replacement CABG Acute gastro enteritis Management LRTI Management Urinary Tract Infection Management Therapeutic D & C Management of Fever due to unknown etiology or Malaria or Typhoid (approx stay 3 -4 days without ICU requirement, without complications) 84500 125000 125000 115000 117000 85000 45500 65000 35000 2000 20000 80000 200000 200000 25000 35000 26000 24000 35000

Renewal of the policy

MOST IMPORTANT: THERE IS NO GRACE PERIOD FOR RENEWAL OF THIS POLICY. PLEASE DONT WAIT FOR THE LAST DATE OR SOMEBODY TO REMIND YOU. DEPOSIT THE PREMIUM AT LEAST 30 DAYS IN ADVANCE AND ENSURE THAT THE CHEQUE IS DULY CLEARED FROM YOUR A/C BEFORE THE DUE DATE. OTHERWISE, IT WILL BE TREATED AS A FRESH POLICY AS FAR AS PREEXISITING DISEASES ARE CONCERENED, WHICH IS MAJOR LOSS.

Remember, the longer the policy has been in force without a break, the lesser is the probability of a claim being rejected.

Thank You