What is Health Insurance?
Health insurance is a contract that requires an insurer to pay part or all of an individual’s healthcare costs in exchange for a premium. It typically covers medical, surgical, prescription drug, and dental expenses. Health insurance can either pay the care provider directly or reimburse the insured for expenses incurred due to illness or accident. Often included in employee benefit packages, health insurance premiums are partially covered by employers and withheld from employee paychecks. For company employees, healthcare premiums are generally deductible, and the benefits are tax-free.
Benefits of health insurance
- Lump Sum Payout: If an incident covered by the policy occurs, the insurance provider pays out a guaranteed sum assured, irrespective of the actual treatment cost.
- No Restrictions: These policies offer the freedom to choose any medical facility. The benefit is paid out upon diagnosis of a covered illness without needing to submit medical bills.
- Non-Medical Fees: Non-medical expenses like medications, caregiver costs, and transportation can be covered by the lump sum settlement.
- Affordable Premiums: Fixed benefit health insurance plans often have lower premiums, making them accessible to more people.
- Fixed Premiums: Insuring yourself for a longer period with consistent rates.
- Tax Benefits: Under Section 80D of the Income Tax Act, you can deduct up to ₹25,000 in health insurance premiums for yourself and relatives. If the insured is over 60, the deduction increases to ₹50,000. The same benefits apply to health insurance premiums paid for parents.
Why Choose PTIC?
PTIC INDIA offers a wide range of health insurance plans and Mediclaim policies, ensuring strong financial protection during medical emergencies. Given the rise in health issues due to changing lifestyles, having a comprehensive health insurance plan is essential. Without health coverage, you risk significant financial gaps, making it vital to prioritize health insurance.
How to claim health insurance?
Cashless Claims
- Check and Pre-Inform: Verify if the hospital has a contract with your insurance company and if the illness is covered.
- Form for Pre-Approval: Fill out a pre-authorization form at the hospital’s Third-Party Administration desk.
- Documents: Submit your Cashless Health Card and KYC papers for identity verification.
- Letter of Authorization: The insurer sends an authorization letter to the hospital, approving or denying the claim. You’ll be notified via your registered mobile number and email.
Reimbursement Claims
If cashless claims are not possible, pay out-of-pocket and get reimbursed later.
- Claim for Compensation: File a reimbursement claim within 30 days of discharge.
- Documents: Gather all pre-and post-hospitalization bills and reports, and submit them along with the claim form to the insurance company.
- Form of Discharge: Submit the discharge form received from the hospital.
- Wait for Payment: It may take up to 21 days for the insurer to process the documents. If denied, you will be notified via email and text message.
Tips for Faster Claims
1. Set Initiation on Time: Notify the insurer of hospitalization promptly.
2. Get Pre-Authorization: Fill out the preauthorization form accurately to verify eligibility.
3. Resolve Queries Timely: Address any insurer queries promptly to avoid claim reject
4. Establish Trust: Provide all original documents in the proper sequence to minimize errors.
5. Contact a Claim Expert: Seek assistance to understand the policy terms and ensure correct documentatio
These tips help streamline the claim process, ensuring you get the payout you deserve efficiently.
By choosing PTIC for your health insurance plans, you can ensure comprehensive coverage and financial security during medical emergencies