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IRDAI License No. 010, Period of Certification : 21/03/2017 to 20/03/2020

FAQs

1. How to decide upon the best health cover?

  • A careful analysis needs to be done before deciding upon the insurance cover.
  • A Mediclaim policy with a family package is suited when a wide cover and income tax benefits are needed.
  • Those who need a wide coverage for a long-term can opt for the Term Hospitalization
  • Policy which gives benefits that is not included under a simple Mediclaim policy.
  • If you plan to go for a cheaper health cover with tax benefit and limited coverage you could choose the Jan Arogya cover.
  • For those close to retirement age, the long-term retirement benefit plan would be an ideal option.

2. What insurance policies are available in India for accidental cover?

  • In India, Personal accident (individual/group), Janata personal accident and Gramin personal accident policies are available for accidental risks.

3. What is the scope of cover under Personal Accident policy?

  • It covers death, permanent total and partial disablement and temporary total disablement. The policy also offers cover in case of accidental death, the reimbursement of funeral expenses and can also be extended to cover medical expenses arising out of accident up to 20 percent of the claim amount subject to maximum of 10 percent of the amount of insurance.

4. What is the difference between Mediclaim & Critical illness policies?

  • A Mediclaim policy is a reimbursement of the medical expenses whereas Critical Illness insurance is a benefit policy.

5. Which illnesses are covered under the Critical Illness policy?

Five major illnesses that are covered in this policy are:

  • Cancer
  • Kidney failure
  • Organ transplant
  • Multiple sclerosis
  • Coronary artery

6. What is the coverage offered by the Mediclaim policy?

  • A Mediclaim policy reimburses hospitalization expenses for the treatment of sickness or accident occurring during the period of insurance.

7. Is the maternity benefit extension available under an individual Mediclaim policy?

  • No maternity benefit extension is available under an individual Mediclaim policy.

8. What is family discount under Mediclaim?

  • Under a Mediclaim Policy, when the husband or the wife and children or dependant parents are covered under same policy, a discount of 10 percent is given on the total premium by way of family discount.

9. What are the factors which determine the premium payable under Mediclaim?

  • Under Mediclaim, the age and the amount of cover are the factors that decide the premium.

10. Who will receive the claim amount under Mediclaim if the policyholder dies during the time of treatment?

  • Under Mediclaim, the claim amount is paid to the nominee of the policyholder. In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.

11. Who is entitled to an overseas Mediclaim policy?

  • Anyone traveling abroad for business or pleasure or as student going for higher studies can qualify for an Overseas Mediclaim. However, it does not cover trips abroad for pre-planned medical treatment.

12. What is �Cumulative Bonus�?

  • The compensation payable for the death, loss of limb/s or sight or permanent total disablement is normally increased by 5 percent of the Capital Sum Insured for every completed year of insurance.
  • This compensation payable in event of any of the above-mentioned medical contingencies is known as Cumulative Bonus.
  • However, the cumulative bonus is subject to a amount that can never exceed 50 percent of the Capital Sum Insured.

13. What is Mediclaim insurance?

  • Mediclaim insurance consists of the reimbursement of hospitalization and/or domiciliary hospitalization expenses for any illness/diseases or injury sustained by the insured individual.

14. What is meant by Pre-hospitalization and Post-hospitalization expenses?

  • The relevant medical expenses incurred during 30 days prior to hospitalization are known as �Pre-hospitalization expenses.�
  • Medical expenses incurred for 60 days after hospitalization are known as �Post-hospitalization expenses.�

15. What is Cashless Facility?

  • Cashless Card Facility implies a service provided by the insurer to the insured wherein the insured can get admitted and can settle all hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company or the TPA.

16. What is a Network Hospital?

  • It includes hospitals that are empanelled with Focus Health Services(TPA) Private Limited to extend cashless facilities at an agreed rate. Before availing a cashless treatment, the insured should consider the list of network hospitals.

17. What are Mediclaim policy and its benefits?

  • The policy covers your hospitalization expenses along with pre and post hospitalization expenses, subject to exclusion and limit of the policy.

18. What is the minimum period of hospitalization required to be eligible for claim?

  • The minimum period of hospitalization required is 24 hours. However, this is relaxed in respect to cataract and other eye surgery, kidney stone removal, tonsillectomy, D&C, dialysis, chemotherapy, radiotherapy and other disease as laid down in the policy.

19. Will the medical cost be reimbursed from day one of the cover?

  • There is a general waiting period of 30 days. For further details please refer your policy details.

20. What are pre and post hospitalization expenses?

  • Pre hospitalization: these are relevant medical expenses incurred during the period of 30 days prior to date of admission.
  • Post hospitalization: these are relevant medical expenses incurred during the period of 60 days after the date of discharge from hospital.

21. Will I be covered under the mediclaim policy when I am abroad?

  • The mediclaim policy is only applicable for treatment within India.

22. What are the major exclusions under the mediclaim policy?

  • The major exclusions are pre existing conditions, first year exclusions for certain diseases, 30 day general waiting period of all diseases, drug abuse, naturopathy treatment, pregnancy related treatment, etc. for details, kindly consult your policy.

23. What happens in the case of an emergency?

  • In case of emergency the member may get admitted in the hospital and then apply for cashless facility within 8 hours of admission to avail cashless services. In case of non network hospital, intimation should be sent to FOCUS and the bills settled directly by you. The bill is then sent to FOCUS for claim. In case of denial, the bill is to be settled by the member and then claimed from FOCUS, subject to the Terms & Conditions of the policy.

24. What if I lose my FOCUS Smart Card?

  • You have to provide your Focus ID (which has been written on your password letter) at Focus Health Insurance TPA Private Limited office, then Focus Health Services(TPA) Private Limited will issue a duplicate Focus Smart Card after paying 100 Rs. as a lost charges.