Coverage for expenses related to hospital stays, room charges, nursing care, and intensive care unit (ICU) charges. 

Coverage for medical treatments, including doctor’s consultations, diagnostic tests, surgeries, and medical procedures. 

Coverage for medical procedures that don’t require an overnight hospital stay, such as dialysis, chemotherapy, and cataract surgery. 

Coverage for medical expenses incurred before and after hospitalization, including doctor visits, medication, and diagnostic tests. 

Coverage for ambulance services required during medical emergencies or hospital transfers. 

Facility to avail cashless treatment at network hospitals, where the insurance company settles the bills directly with the hospital. 

Coverage for emergency medical care needed due to accidents or sudden illnesses. 

Coverage for maternity-related medical expenses, including prenatal and postnatal care, delivery charges, and newborn care. 

Coverage for medical expenses related to organ transplantation, including surgery and post-operative care. 

Coverage for room rent charges during hospitalization, subject to policy terms and conditions. 

Some policies may offer coverage for alternative treatments like Ayurveda, Homeopathy, and Naturopathy. 

Coverage for medical treatments done at home due to the non-availability of a hospital room. 

Optional coverage for critical illnesses like cancer, heart attack, stroke, and kidney failure, providing a lump sum benefit upon diagnosis. 

Coverage for procedures that don’t require hospitalization, such as dental treatments, eye examinations, and vaccinations. 

Some policies provide coverage for routine health check-ups and preventive screenings. 

Reward for not making any claims during the policy term in the form of increased sum insured or reduced premium. 

Additional coverages that can be added to the policy, such as accidental injury cover, maternity cover, and critical illness cover. 

Provides a lump-sum payout if the insured is diagnosed with a critical illness listed in the policy, helping to cover the high costs of specialized treatments. 

Offers coverage for maternity-related expenses, including pre and postnatal care, delivery charges, and newborn care. 

Provides coverage in case of accidental death, permanent total disability, or partial disability due to an accident. 

Offers a daily cash allowance for each day of hospitalization, helping to cover incidental expenses. 

Provides additional coverage once the basic sum insured is exhausted, helpful in case of large medical bills. 

Restores the sum insured amount if it gets exhausted during the policy year, providing coverage for subsequent hospitalizations. 

Covers expenses incurred for OPD consultations, diagnostic tests, and medicines, even without hospitalization. 

Offers preventive health check-ups, discounts on gym memberships, nutrition counseling, and other wellness-related benefits. 

Provides coverage for dental treatments and procedures, which are often not included in standard health insurance plans. 

Covers expenses for alternative treatments like Ayurveda, Homeopathy, and Naturopathy 

Provides coverage for obtaining a second medical opinion from a different specialist before undergoing a major medical procedure. 

Offers a fixed daily cash benefit for each day of hospitalization, irrespective of the actual medical expenses. 

Covers medical expenses related to organ transplantation for both the donor and recipient 

Covers expenses for ambulance services required during emergencies or hospital transfers. 

Extends coverage to international medical treatments, useful for those who frequently travel abroad. 

Provides additional coverage for accidental death or disability on top of the base health insurance policy. 

Additional coverage for medical procedures that don’t require hospitalization for 24 hours, such as cataract surgery or chemotherapy. 

Covers expenses for medical treatments and services provided at home due to the unavailability of hospital rooms. 

Allows adding family members like parents, spouse, and children under the same policy with additional coverage. 

The age of the insured members is considered as younger members generally pose a lower risk of accidents, leading to relatively lower premiums. 

Some Compnay charge the premium on the basis of city big city like mumbai , delhi , kolkatta , cheenai . they ahve higher premium as the treatment is costly as comapre to tire 2 & TIRE-3 CITIES 

The sum insured or coverage limit chosen by the insured group impacts the premium. Higher coverage limits will lead to higher premiums. 

f the insured group opts for additional add-ons or riders to enhance the policy coverage, it will affect the overall premium cost. 

The duration of the policy, whether it is a one-year term or a longer period, impacts the premium calculation. 

The medical history of the insured members, if considered for coverage, may influence the premium amount. 

Inform your health insurance company as soon as possible about the hospitalization or medical treatment. This can often be done through a toll-free helpline or online portal. 

Provide all necessary documents to the insurer, including the claim form, medical bills, prescriptions, diagnostic reports, discharge summary, and any other relevant records. 

The insurer will review the documents to assess the claim’s validity and coverage as per the policy terms. 

If you’re availing cashless treatment at a network hospital, the insurer will directly settle the bills with the hospital. If you’re opting for reimbursement, you’ll need to pay the bills initially and then claim the expenses from the insurer. 

The insurer will process the claim based on the policy terms, coverage, and your medical records. 

Once approved, the insurer will either directly pay the hospital (for cashless) or reimburse you (for reimbursement) as per the policy coverage. 

The settlement time can vary, but insurers strive to process claims within a reasonable period, often within a few weeks. 

If there are any discrepancies or additional information required, the insurer will communicate with you. Stay in touch to ensure a smooth claim settlement process. 

In case of claim rejection or dispute, you can appeal to the insurer’s grievance cell and provide any necessary clarifications or documentation. 

Familiarize yourself with the policy’s terms, exclusions, and claim procedures to make the process smoother. 

Illnesses or conditions that existed before the policy’s effective date might be excluded for a certain waiting period. 

Elective cosmetic surgeries or treatments are generally not covered unless they are medically necessary due to an accident or illness. 

Expenses related to non-medical items like vitamins, health supplements, and over-the-counter medications are often excluded. 

Treatments or procedures that are experimental or not widely accepted in the medical community might not be covered. 

Injuries sustained intentionally by the insured individual might be excluded from coverage 

Injuries sustained during hazardous activities like extreme sports might not be covered. 

Some policies exclude coverage for pregnancy-related expenses, fertility treatments, or childbirth. 

Traditional or alternative treatments like Ayurveda, homeopathy, or naturopathy might be excluded. 

ome policies have limited coverage or exclusions for mental health treatments or substance abuse rehabilitation. 

Injuries or illnesses resulting from war, terrorism, or civil unrest might be excluded. 

Certain health insurance policies may have exclusions related to HIV/AIDS treatment and related complications. 

Expenses incurred for treatments outside the network of the insurance provider might not be covered, except in emergencies. 

Regular health check-ups or preventive services might not be covered, although some policies include limited coverage. 

Some policies exclude coverage for specific illnesses or conditions, especially those with high treatment costs. 

Illnesses or conditions present by birth might also not be covered under the policy. 

A duly filled and signed claim form provided by the insurance company. 

A copy of the health insurance policy document for reference. 

Relevant medical reports, prescriptions, and diagnosis details from the treating doctor. 

Discharge summary, hospital bills, and receipts indicating the details of hospitalization and treatment. 

Prescription for medicines and treatment recommended by the attending doctor. 

Original bills, receipts, and invoices for medical expenses incurred during the treatment. 

Copies of investigation reports like X-rays, MRI, CT scans, blood tests, etc. 

A certificate issued by the hospital upon discharge, detailing the treatment received. 

A medical certificate confirming the nature and severity of the illness or injury. 

A valid address proof document, such as Aadhar card, passport, utility bill, etc. 

Copy of the PAN card for identification and tax-related purposes. 

A Know Your Customer (KYC) form with personal details of the insured. 

Bank account details for direct claim settlement through electronic transfer in case of Reimbursement 

A signed declaration and authorization is need from Doctor for processing the claim. 

Any additional documents specified by the insurance company. 

Contact your agent or broker first, as they will guide you through the claims process and assist in reporting the claim. 

Contact the insurance company’s claims department directly to report the claim and follow their instructions for a smooth claims settlement.