Q: Why do we need a Healthcare insurance?
Ans : Health insurance will insure your family against sudden medical expenses providing cashless hospitalization facility and give you a peace of mind even in a medical emergency situation which you cannot attend to immediately sitting overseas.
Q: What is the Family Floater?
Ans : The floater health plan covers your entire family under one policy with one sum insured and one premium. This cover takes care of the hospitalization expenses of your 04 nominated beneficiaries in blood relations in India. This takes care of all the medical expenses during sudden illness, surgeries or accidents. e.g.: The Mishra Family covered under a traditional health insurance plan - Mr. Mohan (Father) Rs. 1 lac, his Mother Rs. 1 lac, Sister Rs.1 lac each and they have paid premium for all these 3 policies. In an unforeseen situation, wherein surgery and hospitalization bill of his Sister amounts to Rs. 2 lac. The existing policy will cover only Rs. 1 lac while Mishra family will have to bear the balance Rs. 1 lac from his pocket.
With Family Health Floater Insurance, Mishra family is covered up to Rs. 2 lac and utilization of cover is on a need basis. Thus, Family Floater would have covered entire Rs. 2 lac medical expenses of his sister as per the eg above.
Q: What is a Health Card?
Ans : On the basis of details provided by the insurer, service provider issues a Health Card to the beneficiary under the Health Insurance policy. The card is issued for identification / verification purpose only and should not be construed as an authorization to the hospital to proceed with the treatment. This card would entitle you to avail cashless hospitalization facility at any of the network hospitals. You need to present your health card (issued by service provider) at the time of admission into the hospital.
Q: What services are included under Healthcare Services?
Ans : Healthcare services consists of Individual Healthcare Services and Preventive Healthcare packages.
Q: What is the duration for availing the Preventive Healthcare Packages?
Ans : These packages are available for a maximum of one (01) year from the order date except for Antenatal Care Plan which is for
a period of nine (09) months from the order date.
Q: Who will bear the cost of medicines used for treatment during hospitalization?
Ans : Cost of medicines used for treatment during hospitalization will be borne by insurance company.
Q: What kind of medicines can be arranged in Medicine Delivery Service?
Ans : All medicines that are available at the local medical shop and supported by a medical prescription by a doctor can be arranged for through this service.
Q: Can the medicines be arranged without the Doctor’s prescription?
Ans : No, medicines cannot be arranged without the Doctor’s prescription.
Q: If the medicines are not available would they be arranged from a neighboring city or somewhere else?
Ans : Yes, we can arrange the medicines from a neighboring city if it is not available locally but actual charges for transportation & others have to be borne by the end user.
Q: What do the network hospitals mean?
Ans :Network Hospitals are hospitals all over India to which you can go for treatment which number over 2500+ hospitals.
Q: Are there any additional expenses apart from the cost of the package in Preventive Health Care Packages?
Ans : All checkup charges/ consultancy charges as mentioned in the package are included in the cost of package. However, the consumer will bear cost of checkup other than that mentioned in the package, the cost of medicines and other items used for treatment if any.
Q: Any discounts available for high end user?
Ans : Sahara Care House offers up to 10% off to its Silver members on all the listed services (excluding shopping services). Any other discounts if available/applicable would get reflected on the website accordingly from time to time.
Q: Is there co-pay for doctor visit, medicine and hospitalization?
Ans : Hospitalization - Doctor visit and medicine covered [Expenses on vitamins, tonics if not directly related with the treatment will not be covered.]
Q: Does it cover basic illness like flu/ cold etc.? Are they only covered if you go to one of the hospitals mentioned?
Ans : It shall cover only in case followed by hospitalization on doctor’s recommendation. Your nominated beneficiary can avail cashless facility in our network hospitals and Non-cashless/ reimbursement for non-network hospital.
Q: Does it cover medicine in hospitalization?
Ans : Medicines are covered in hospitalization except expenses on vitamins, tonics if not directly related with the treatment.
- The Cashless Health Care services shall only be available across India where our network hospitals exist and that too at the designated hospitals in these cities.
- If your family moves to a city, where our network hospital does not exist then your nominated family member will have to settle the bills directly with the non-network hospital and subsequently claim reimbursement from service provider by submitting the required documents in original to the service provider Through SCH.
Note: Non-network hospital should be a recognized hospital
and have atleast 15 inpatient beds or 10 beds for Class “C” town.
- Claim must be filed within 30 days from date of discharge from the hospital.
- There is no additional cost involved if your family member relocates in any of the
cities across India.
Note:Intimation needs to be provided to Sahara Care House
to update records through its (24x7) call centre.
Q: Pre existing diseases exclusion: would like to know if all the diseases are
covered under the policy e.g. Cancer, Heart disease, dialysis and diabetes etc?
Ans : Yes.(Coverage for pre-existing disease after 6 months.)
Q: 30 days waiting period exclusion: If the disease mention above is included
then will these be covered from day one of the Policy being taken?
Ans : This waiting period reduced to 10 days provided
the photographs of the beneficiaries are made available to Sahara Care House.
Q: If there are any diseases which are not covered in the Policy?
Ans : Some of the diseases excluded are Circumcision,
vaccination, inoculation, cosmetic or aesthetic treatment, plastic surgery, cost
of spectacles, contact lenses, hearing aids, dental treatment/surgery unless requiring
hospitalization, convalescene, general debility, rundown condition or rest cure,
congenital external disease or defects or anamolies, sterility, veneral diseases,
intentional self injury, use of intoxicating drugs/ alcohol expenses arising out
of any condition directly or indirectly caused to or associated with Human T- cell
Lymphotropic Virus Type III.
Q: Expenses covered under the policy?
Ans : Policy covers expenses incurred in treatment
under following heads.
(a) Room, Boarding expenses as provided by Hospital/Nursing Home
included in (b) Nursing Expenses
(c) Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist Fees
(d) Anesthesia, Blood, Oxygen, Operation Theatre charges, Surgical appliances
Medicines and Drugs, Diagnostic Material and X-ray, Dialysis, Chemotherapy, Radiotherapy,
Cost of pacemaker, Artificial Limbs and cost of organ and similar expenses.
Q: Does it cover existing heart condition?
Ans : Yes it does cover. However Hypertension shall
only be covered in case followed by hospitalization on doctors recommendation
Q: Expenses not covered under medical policy?
Ans : The expenses not covered includes following:
(a) Admission Charges,
(b) Extra bed charges for attendant,
(c) Expenses on luxury items unless within the room package,
(d) Telephone expenses,
(e) Expenses on vitamins, tonics if not directly related with the treatment,
(f) Food & beverages for attendant,
(g) Xerox/certifying charges if any,
(h) Sanitary items
(i) Vaccination, Dietician Fee etc.
(j) Expenses of external aids e.g. spectacles, hearing aids, clutches etc.
(k) Pre & Post hospitalization expenses in excess of defined period under the policy
or
(l) Any other expenses as specified under the policy.
(m) Cost of treatment that has been specifically or otherwise excluded under the
policy.
The above list is not exhaustive.
Q: How to avail Cashless Hospitalization?
Ans : Cashless Hospitalization facility is available
only at Network Hospitals. Cashless Hospitalization facility enables the Insured
to obtain admission at designated hospitals after obtaining an Authority Letter
from the service provider. This certificate will authorize the hospital to deliver
treatment up to the limits. This shall be organized by the network hospital.
In such cases, service provider settles the hospital bills directly on your behalf
Q: Conditions where the cashless request may be denied?
Ans : The cashless facility may be denied in the
following circumstances:
(a) Where sufficient medical/past insurance information is not available to us.
(b) Where the reported symptoms/available inputs are inadequate in the opinion of
EMSL medical team as regard to determine the liability under the policy.
(c) Where the intimation of claim has not been given in time.
(d) Where any information has been concealed or misrepresented in the proposal form
available on record.
(e) Where the reported ailment/treatment is excluded under the policy.
Q: Cashless emergency conditions which do not require hospitalization?
Ans : Expenses on Hospitalization for minimum period
of 24 hours are admissible. However this limit will not apply for specific treatment
i.e. Dialysis, Chemotherapy, Radiotherapy Eye surgery, Dental Surgery etc taken
in Hospital/Nursing Home and Patient is discharged on the same day, the treatment
will be considered to be taken under Hospitalization benefit.
Q: What services are spend first claimed later?
Ans : When hospitalization is in a non- network hospital.
Please note non-network hospital should be a recognized hospital and a have at least
15 inpatient beds or 10 beds for Class “C” town. Claim must be filed within 30 days
from date of discharge from the hospital with required documents.
Q:What documents are required for reimbursement of expenses for taking treatment
in Non-Network hospitals or in non-Cashless situation?
Ans : If cashless facility is not availed/or pre-authorization
is denied or treatment is availed at a non-network hospital, the insured will have
to settle the bills directly with the hospital and subsequently claim reimbursement
from service provider by submitting the following documents in original :
1. All doctors prescriptions.
2. All test/investigation reports along with the prescription of Doctor.
3. All cash memos and bills for medicines.
4. Discharge Summary of the hospital.
5. A duly filled Claim Form along with a signed Discharge Voucher.
6. Package Break-up (if Applicable).
7. Copy of Health Card.
8. Hospital Registration Certificate.
Q: What are the pre-existing diseases covered under the policy?
Ans : The nominated beneficiaries of members of Sahara
Care House can avail insurance cover of the expenses on treatment of pre-existing
diseases like Cataract, Benign Prostatic Hypertropy, and Hysterectomy for congenital
internal disease, fistula in anus, Piles, Sinusitis and related disorders.
Q: What is the age limit?
Ans : Maximum age limit is 80 years for beneficiaries of members covered
under our Mediclaim cover.
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