Health Insurance Queries

POSTED BY monGenie ON March 10, 2013 1:22 pm COMMENTS (2)

Hello there,

I have a few queries regarding health insurance – 

  1. What is the general process to reimburse the medical bills in any insurance? (For instance, like for cashless claim typically we need preauthorization from TPA and need to inform insurance company in case of emergency hospitalization. What do we do in case of reimbursement?)
  2. Suppose you insurer covers your drugs, specialist fees, consultation fees (i.e. services we need more often than actual hospitalization), is it enough to show insurance cards to the hospital / medical practitioner at the time of visit in India like we do here is States? How does cashless insurance work in India?
  3. Who is my TPA? Is it same as my Policy Fulfiller? (Fulfiller is the insurance company person who reminds me of my renewal and that company has in-house TPA in my case. So, is he my TPA?) Since I am under impression that I have to contact this person if claim arises, but till now we didn’t have to.
  4. If not, who is my TPA?
  5. I used to be Proposer for health cover of my mom-dad for last four years, but since I have left my job I want my brother to be the Proposer and claim the tax benefit. Can he continue to purchase the same policy online and become new Proposer? Because, ideally it would a new contract for this year.
  6. Before my marriage, I bought two health policies for my parents from an Nagpur-based insurance agent, probably independent. Now, when I got shifted to Pune after marriage I got that (parents’) policy transferred to Pune and my parents now reside with my brother in Bangalore. So, should I get it tranferred to Bangalore again? Please clarify its implication during claim settlement as I have read that TPA (if they are TPA) should be in your city / state. 
Please guide.

 

2 replies on this article “Health Insurance Queries”

  1. monGenie says:

    Thanks a lot, I also did talk to my policy fulfiller and got exact details.

  2. What is the general process to reimburse the medical bills in any insurance?
    –> You need to inform insurer reg. hospitalization and your intention to claim reimbursement. After doctor declares you fit you need to send all bills for reimbursement

    How does cashless insurance work in India?

    –>planned hospitalization required prior (few days) intimation via hospital. The card is of little value. Emergencies will be cleared after admission in a few hours

    Who is my TPA?
    –>Depends on the insurer. Some insurers handle claims themselves. Some let a third pary handle it. You renew with insurer and claim to TPA

    I used to be Proposer for health cover of my mom-dad for last four years, but since I have left my job I want my brother to be the Proposer and claim the tax benefit. Can he continue to purchase the same policy online and become new Proposer? Because, ideally it would a new contract for this year.

    –> In principle possible. You need to contact the insurer. A new proposer may mean a new policy but they could take into account the old policy.

    Before my marriage, I bought two health policies for my parents from an Nagpur-based insurance agent, probably independent. Now, when I got shifted to Pune after marriage I got that (parents’) policy transferred to Pune and my parents now reside with my brother in Bangalore. So, should I get it tranferred to Bangalore again? Please clarify its implication during claim settlement as I have read that TPA (if they are TPA) should be in your city / state.

    –> Not really necessary. I did cashless settlement with a Banglaore based TPA a couple of days back (I am in Chennai). Everyone is well connected in many ways today.

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