Health Insurance Basics - FAQs

How to choose the plan?

You proceed to choose your plan in following steps

1. Choose the plan type: Individual -if you want to protect single person or Family Floater -if you want to cover more than one life

2. Select Plan option:

a. Silver Option: You will get inpatient Hospitalization Benefit, Day Care Benefit, Pre & Post Hospitalization Benefit, Emergency Ambulance Benefit, Donor Expense Benefit

b. Gold Option: In case you want Hospital Cash Benefit, Wellness Benefit & Maternity Benefit (for Family Floater only) in addition to the benefits offered by Silver Option

3. Select the Sum Insured

4. Fill the application form

5. Pay the premium

Who is Proposed Policy Holder?

A Proposed Policy Holder is a person who is paying the premium on behalf of the life insured(s) who may or may not be a part of life insured.

Who is life insured?

Life insured is a person who has or has been insured by the Company under this Policy.

What is Sum Insured?

Sum Insured is the face value of the policy contracted between you and Company.

What is Annual Limit?

Annual Limit is the amount which defines our maximum annual liability under this policy in any particular policy year.

How Annual Limit is derived?

Annual Limit is the summation of Sum Insured and Multiplier Benefit. At inception of the policy, the value of Annual Limit will be equal to the Sum Insured.

What is Multiplier Benefit?

Multiplier Benefit is the limit which may increase or decrease depending on whether you have made a claim in the previous policy year. At inception of the policy, the value of Multiplier Limit is nil.

What is "Intensive Care Unit" or "ICU"?

"Intensive Care Unit" or "ICU" means an identified section, ward or wing of a Hospital which is under the constant supervision of a dedicated Medical Practitioner and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

What is meant by Pre and Post hospitalization expenses?

Relevant Medical expenses (expenses related to the treatment of the disease for which the insured is hospitalized) incurred 30 days prior and 60 days later for eligible in patient hospitalization are known as pre hospitalization and post hospitalization expenses respectively.

What is Day Care Procedure?

Day Care procedures are surgeries or procedures which do not require hospitalization and can be finished in few hours because of technological advancement. These could be performed in Hospitals or specialized Day Care centers which are fully equipped with advanced technology and specialized infrastructure for the eligible procedures. Day care procedures are mentioned in terms and conditions of policy document which is part of your policy docket and also same is available on *HDFC website.

What do you mean by Inpatient Hospitalization?

Inpatient Hospitalization means being hospitalized for a minimum of 24 hours on recommendation of a Medical Practitioner to seek medical intervention due to sickness/illness or accident.

What is free-Look Period?

Free look period is 15 days from the date of receipt of the policy document and in case of distance marketing it s 30 days.

What is 'Pre-existing Conditions'?

'Pre-existing medical condition' means any condition, ailment or injury or related condition(s) for which the Life Insured had signs or symptoms, and / or was diagnosed and / or received medical advice/ treatment, within 36 months prior to inception/reinstatement of the policy.

What do you mean by co-pay?

Co-pay means the percentage of admissible claim amount which has to be fully borne by you (customer)

When will the co-pay apply?

The co-pay shall apply when the life insured gets hospitalized in non-network hospital. However if you use a non network hospital in medical emergency (Cardiac or Accident), the co-pay shall not apply if you use a room as per the plan entitlement based on the room rent limit.

What is Pro-ration of Claims?

Pro-ration of Claims means that certain proportion of claims is borne by customer.

What is Network & Non Network hospital?

Network Hospital is all such hospitals, day care centers or any other medical service providers that have been identified by the company to provide services like cashless claims to Our Lives Insured.
Non Network Hospital is a Hospital which is not included in the list of Network Hospitals.

What is Cashless Claims Services?

Cashless service is a facility provided by Us wherein the Life Insured can get admitted and on seeking preauthorization can undergo the required treatment without paying directly for the medical expenditure. The medical expense, thus incurred and preauthorized, shall be settled by Us/TPA directly with the hospital. The Cashless claim facility can be obtained only at the Network hospitals.

What are the services offered by TPA?

- 24x7 assistance to policyholders through toll free number
- Online assistance during hospitalization & claim management
- Assistance for authorizing & processing Cashless facilities
- Claim processing & Reimbursement of claims for Non Network hospitals

Why should I always carry Health Card?

It will allow you to avail cash less facility in any of the Network Hospital across Country on production of the health card.

In emergency situation, if I don't have Health Card with me, then what is procedure to get admitted in hospital?

- The life insured is to be rushed to the nearest hospital.
- Life insured to avail emergency life saving treatment at the hospital.
- Within 24 hours of hospitalization the family members to contact our appointed TPA on the help-line as mentioned in the Health Identity Card

What documents I need to obtain from hospital before discharge in case of cash less claim?

On discharge, you are expected to verify the hospital bill for its accuracy and sign it. Any additional amount that you may have to pay at the time of discharge (over and above the amount pre-authorized), must be claimed by you by submitting the necessary claim documents to our TPA or company.

What is Network Hospital?

The TPA has created a network of reputed medical providers including hospitals, nursing homes and daycare centers known as 'Network hospital' for you to access across the entire country.

In a network Hospital or Nursing Home, you will have the advantage of getting cashless services (subject to terms & conditions of your policy). A comprehensive list of the Provider Network has been provided and may also be accessed on the website. As the Provider Network is subject to addition and deletion, kindly refer to the TPA or Our website for updated information or call TPA Helpline.

What is Non-network Hospital?

Non network hospitals are the medical providers with which the appointed TPA does not have a cashless tie up. When you avail treatment here, you first settle the bills yourself and then submit the relevant documents and bills to TPA. The eligible amount, consequently, is reimbursed to you based on policy terms and conditions.

What do you mean by cashless hospitalization?

Cashless hospitalization is a facility provided by Us wherein the Life Insured can get admitted and on seeking preauthorization can undergo the required treatment without paying directly for the medical expenditure. The medical expense, thus incurred and preauthorized, shall be settled by Us/TPA directly with the hospital. The Cashless claim facility can be obtained only at the hospital network the TPA has a tie-up.

What is Pre-Authorization?

Pre-authorization is basically an authorization issued by Us, specifying the value of the medical treatment that can be claimable under their insurance policy. To receive a pre-authorization, you need to submit duly fill in the Pre-authorization request form.

What do you mean by Reimbursement?

In case of a reimbursement claim, the Life Insured pays the expenses = himself with the hospital and then claims for a reimbursement of those expenses.

What to do in case of Medical Emergency?

The life insured is to be rushed to the nearest hospitalLife insured to avail emergency life saving treatment at the hospitalWithin 24 hours of hospitalization the family members to contact our appointed TPA on the helpline as mentioned in the Health Identity Card

*premium Amount for Male, 35 yrs, 10 year term, Silver option, including tax.
HDFC Standard Life Insurance Company Limited.

Insurance is the subject matter of the solicitation. For more details on risk factors, associated terms and conditions and exclusions please read the product brochure before concluding a sale. HDFC Life Health Assure Plan (Form No. P501-105, UIN: 101N087V01) is the name of traditional health plan offered by HDFC Life. HDFC Standard Life Insurance Company Limited is only the name of the Insurance Company, HDFC Life is only the name of the brand and HDFC Life Health Assure Plan is only the name of the product. The name of the company, name of the brand and the name of the product does not in any way indicate the quality of the contract, its future prospects or returns. HDFC Standard Life Insurance Company Ltd. IRDAI Reg No. : 101. ARN: MC/03/2015/6186.
CIN: U99999MH2000PLC128245. Tax benefits are subject to change in tax laws.

Corporate Office & Registered Address

HDFC Standard Life Insurance Company Ltd.
Lodha Excelus, 13th Floor Apollo Mills Compound,
N.M. Joshi Marg, Mahalaxmi
Mumbai, Maharashtra 400011
Telephone: (022) 67516666

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