How maximum coverage in floater mediclaim varies with insurer

Ashish Mehrotra

Is there any ceiling on the amount for a floater medical insurance plan?

– Gaurav Rastogi

Maximum coverage amount (known as sum insured) varies from insurer to insurer. It is important for a customer to assess the demographics before deciding the coverage amount. Things to keep in mind are: city in which one is residing as the medical cost varies accordingly; family size (larger the family size more should be the coverage amount; type of hospitals in which one would go at the time of hospitalisation (cost varies with hospitals); medical inflation (a sum insured which looks sufficient today may not be adequate in the future).

Should I go for periodic health check-up after taking a health insurance policy?

—Vipul Nautiyal

Normally, health insurance policies in the market today provide health check-up as a benefit. Policies which provide health check-ups at least on an annual basis should be preferred for monitoring health conditions periodically.

My health insurance company has not paid me the full amount of the hospital bill. How is the claim amount calculated and can I file a complaint against the company?

—Manoj Kumar

There are certain exclusions in the policy which should be read carefully before choosing the policy. Apart from these exclusions, a few policies have in-built cost sharing options like co-payment, sub-limits, deductible, etc.; due to which a part of claim has to be borne by the customer. In case a customer is not satisfied with claim adjudication, he/she can contact the grievance cell of the insurer (details can be found in the policy terms and conditions). If an escalation is required, customer can contact Irdai’s insurance ombudsman. List of insurance ombudsman is available at Irdai’s website (www.irdai.gov.in )

Do I have to inform my TPA before any planned hospitalisation for cashless benefit?

—Vinod Gupta

For availing cashless facility, it is always suggested to take approval from the insurance company directly. It helps in avoiding confusion and reduces the time taken for approval.

source:www.financialexpress