This covers expenses incurred by the Insured due to illness &/or accident.
Various types of health insurance plans are being offered in the market. These are as follows:
- Traditional Insurance Plans offered by Insurers covering both Groups as well as Individuals.
- Managed Care Plans offered by Health Management Organisations such as AAR and Resolution Health.
- Self administered schemes which are somewhat similar to Managed Care Plans but the client pays a fee to a third party to manage the scheme. All medical costs are to be borne by the client as there is no payment of premium.
- International Plans offered by companies such as BUPA and Good Health
Most plans cover Inpatient costs i.e. costs that are incurred whilst being admitted as an inpatient in a Hospital. Nowadays, day care cases are also regarded as Inpatient which means a person does not have to stay overnight in Hospital. A patient may be admitted for a procedure and be discharged the same day.
It is important to note that Insurers will normally deduct National Health Insurance Benefit (NHIF benefit) from the costs if one is entitled to claim for this benefit.
Many plans also cover Outpatient costs i.e. costs incurred for visiting a GP or a Specialist, costs of drugs and dressings, pathological, X Ray, CT Scans, MIR, etc. Many Insurers now have credit facilities with the providers. This means that one goes to a provider and gets service without having to pay as the bill would be sent to the Insurer. However, claims on reimbursement basis as still very popular where one pays for the service and seeks reimbursement of the costs incurred from the Insurers. There may be limitations on the amount allowed.
Some HMO’s like AAR have their own clinics and therefore outpatient treatment can only be sought from their clinics or their partnership providers.
The Insurance Regulatory Authority has allowed International Insurance products to be offered by Intermediaries provided that they are licenced as a Medical Insurance Provider (MIP). Major Insurers such as BUPA International, Good Health, Allianz only deal through licenced MIPs. It is therefore important for clients to only deal through such Intermediaries.
REQUIREMENTS TO PLACE COVER
- Completed proposal form which requires medical history to be provided
- In some cases, a full medical report may be required
- Breakdown of the schedule of items to be covered with latest values
- Payment of premium
DOCUMENTS REQUIRED TO REGISTER A CLAIM
- Completed claim form filled by a Doctor
- All original Medical Bills including copy of prescription and requisition for pathological and other tests, where applicable
- Copy of Medical Report if available.