Insures against any hospitalisation expenses that
may arise in future. This policy is designed to
prevent the insured from paying for any
hospitalisation expenses owing to illness or injury
suffered by the insured, whether the hospitalisation
is domiciliary or otherwise.
It covers the expenses incurred on the following
- Room boarding expenses by the hospital nursing
home
- Nursing expenses
- Operation theatre expenses
- Surgeon, anaesthetist, medical practitioner,
consultants, specialist's fees
- Also for any cost of equipment like pacemaker,
artificial limbs and charges paid for anaesthesia,
blood, oxygen, operation charge, surgical
appliances, medicines and drugs, diagnostic material
and x-rays, dialysis and chemotherapy, radiotherapy,
and cost of organs etc.
The escalating cost of medical treatment today is
beyond the reach of a common man. In case of a
medical emergency, cost of hospital room rent, the
doctor's fees, medicines and related health services
can work out to be a huge sum. In such times, health
insurance provides the much needed financial relief.
An investment in health insurance scheme would be a
judicious decision. The health insurance scheme
could either be a personal scheme or a group scheme
sponsored by an employer. Some of the existing
health insurance schemes currently available are
individual, family, group insurance schemes, senior
citizens insurance schemes, long-term health care
and insurance cover for specific diseases.
The concept of TPA or the THIRD PARTY ADMINISTRATOR
has been introduced by IRDA (Insurance Regulatory
and Development Authority) for the benefit of both
the insured and the insurer. While the insured is
benefited by quicker & better service, insurers are
benefited by reduction in their administrative
costs, fraudulent claims and ultimately bringing
down the claim ratios.
In brief, the job of the TPA is to maintain
databases of policyholders and issue them identity
cards with unique identification numbers and handle
all the post policy issues including claim
settlements. In terms of infrastructure, the TPA
will need to run a 24-hour toll-free number, which
can be accessed from anywhere in the country. And
they will have full-time medical practitioners under
their employment who will immediately take a
decision on whether the ailment is covered under the
policy
Advantages of TPAThe policyholder will have full freedom to choose
the hospitals from the empanelled network and
utilise the services as per his/her choice
For every hospitalisation, the policyholder will be
well aware whether the treatment he/she is to
undergo is covered under his policy or not.If
covered, then he/she can seek cashless facility
without having to pay a single rupee at any of
empanelled hospitals.
During the time of Emergency Hospitalisation, the
policyholder or relative can flash the Photo ID Card
of the policyholder and gain admission into any of
our network hospitals.
Priority treatment at hospital is given without any
payment to be made at the any time of admission. So
also at the time of discharge, no payments to be
made. Thus, a complete CASHLESS TREATMENT.
Thus, the Individual does not run around for
arranging cash for paying for the hospital expenses
Hospital empanel with 1. MD INDIA healthcare services (TPA) P. Ltd
2. Paramount Health services (TPA) P. Ltd.
3. Apollo DKV Health Insurance
4. Health Quarters India P. Ltd
5. University of Rajasthan
 |
