health insurance claim

[udayan]

ok i need quick advice for new india assurance medical insurance

my bhabhi is going to be hospitalised in yashoda hospital ghaziabad because of some ailment , my brother has new india assurance medical insurance for many years now , but will avail its befits 1st time today .

brother has insurance of 3 lac rs , his son has 1 lac and his wife (bhabhi) has of 1 lac rs .

what are the advice/procedures for us for hassel free cashless experience at hospital .

need it quick as she will be hospitalized in a couple of hours

 

[bhojv74]

Usually, just inform the hospital at the time of getting admitted that it will be cashless. Carry your NIA cashless ID card and insurance papers, they would need a xerox of the same.

Also inform the doctor that it will be under insurance, so that he covers all the points in his prescription.

If you got the insurance through an advisor, inform him so that he will follow up with the company to get the cashless authorization. Even if you do not do this, you are fine.

 

[vijaypathak077]

also inform insurance company about the same.. and also make sure they have tie up with the hospital to avail cashless facility.

 

[bhojv74]

NIA usually gives a list of hospitals that they have tied up with. I believe you have already checked with the list or the hospital.

after 24 hrs of filing for cashless, you may call on 9674747272 (NIA) phone number to find out the status of your claim. This number works for me in Kolkata, your region may have a different number, find it out from your advisor.

 

[udayan]

Yes hospital is obviously listed

Only problem is that agent says that we have to get a general /normal room as our policy amount for patient is only 1 lac and only normal room is allowed in this category, if we get a better room then our claim won't be accepted

Didn't know this before or we would have gone for more amount or policy with better room /services

 

[bhojv74]

I think he is partially correct, 1L policy will only provide for a lower grade room, but if you choose a higher grade you would have to pay the difference. Check with him again, or check with the hospital.

 

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[vijaypathak077]

check the limit for rooms on your policy fine print.. it would be 1% of sum insured (for 1 lacs 1000 INR only)
so even if u selected normal room make sure it not exceed rs 1000..cross check with ur agent

 

[bhojv74]

Again, you can exceed the limit, but you will have to pay the difference.

Since you have an old policy, you must have accumulated bonus. Bonus can be used for hospital packages but not add ons like medicines or any equipment etc. I suggest go for a packaged treatment from the hospital if it is available.

 

[udayan]

I didn't understand packaged treatment

Please elaborate

 

[dextermorgan]

^ CGHS Package Rates for treatment in CGHS empanelled Private Hospitals

btw obviously lower insurance means lower grade rooms/general rooms/ non ac rooms.

 

[bhojv74]

Since few hospitals used to charge exorbitant rates specially if you were covered under insurance, most of them now has packaged prices for generic ailments which are preapproved by the insurance companies. Results in faster approvals and less hassle for the patients.

 

[udayan]

Ok we got it done on our own charges the tests etc costed 10k

Reason we didn't go for claim is that our current limit and policy is not very comforting and its sad we didn't pay much attention before, however we will be renewing it with some 8 lacs sum assured in floating account, means any member of the family can avail entire sum benefits individual or combined.

If we had gone for hospitalisation and claim the insurance company would have denied our upgrading of policy as the health of the insured was not perfect while upgrade, so it's better to wait and get it renewed and then avail benefits if and when needed

 

[udayan]

can health insurance be transferred to a new company and still have benefits of no claim and diseases which are covered after specific years ?

 

[chaibiskutbhai]

Yes. Insurance portability exists.

 

[udayan]

Just checked but can only be transferred on renewal time that too minimum 45 days before expiry.............. We have 22 days left so not possible this year