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How to Read Your Health Insurance Policy Document: A Section-by-Section Guide

How to Read Your Health Insurance Policy Document

AI OVERVIEW A health insurance policy has four key parts: the Policy Schedule (who is covered, sum insured, dates, premium, add-ons, declared conditions and the product’s IRDAI Unique Identification Number), the Customer Information Sheet (IRDAI-mandated one-page summary of key features, exclusions and waiting periods), the Policy Wording (definitions, coverage, exclusions, conditions, claim procedure and grievance […]

What is TPA in Health Insurance? Meaning, Role, Benefits, and Claim Process

TPA in health insurance

AI OVERVIEW A Third Party Administrator (TPA) is an IRDAI-licensed company that an insurer appoints to handle health insurance services on its behalf, mainly claims processing (cashless pre-authorisations and reimbursements), issuing health cards, managing network hospital relationships, and running helplines. TPAs are governed by IRDAI’s TPA (Health Services) regulations and are paid by the insurer, […]

Reimbursement Claim in Health Insurance: Process, Documents and IRDAI Timelines

reimbursement claim in health insurance

AI OVERVIEW A reimbursement claim is when you pay the hospital yourself and then claim the admissible amount from your insurer. It’s used at non-network hospitals, when cashless isn’t approved, and for pre- and post-hospitalisation expenses. The process: inform the insurer promptly, pay and collect original documents, submit the claim form with bills, discharge summary, […]

HDFC ERGO Vs ICICI Lombard Health Insurance: Which One Actually Has Your Back?

HDFC Ergo Health Insurance vs ICICI Lombard Health Insurance

QUICK GIST  HDFC ERGO vs ICICI Lombard is a face-off between two bank-backed general insurers that sell health cover alongside motor, travel, and property insurance. HDFC ERGO leads on almost every claims metric in this comparison: a 97% Claim Settlement Ratio (CSR), an 86% Incurred Claim Ratio (ICR), and just 9.28 complaints per 10,000 claims. […]

What Is a Deductible in Health Insurance?

Quick Gist A super top-up plan is a second layer of coverage that switches on only after your medical bills cross a set threshold in a policy year. That threshold is the deductible in health insurance, the entry barrier your expenses need to clear before the top-up steps in to pay.  For example, if your […]

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