20% Co-pay will mean that Insurance company will settle 80% of the claim amount..
If co-pay is opted in an insurance policy, the insured has to pay a fraction of the claim amount. Co-payment is shown as a percentage of the total claim amount. If co-pay is included in the Insurance Policy, the premium will be lower.
For example, if the total hospital expenditure is ₹1,00,000/- and if the co-pay is agreed at 20%, then the insured has to pay an amount of ₹20,000/- and the balance of ₹80,000/- will be paid by the Insurance Company.
The policy holder need not pay for treatments at Insurer’s Network Hospitals..
Upon availing services/ procedures in an Insurer’s Network Hospital, the policyholder will not be required to pay for the treatment, and the Insurer through the TPA will directly pay the hospital.
Continue reading “Cashless Facility”IRDAI licensed Third Party Administration process the claims under health insurance on behalf of the Insurance Companies, on a fee-for-services basis. Their responsibilities typically include claims administration, loss control, co-ordination for cashless claim settlements and risk management consulting.
Insurance Companies tie-up with leading hospitals with pre-agreed rates for treatments..
Hospitals and other health care providers contracted to provide services to customers of the insurance companies on a pre-agreed fees are called Network Hospitals or Provider Network. If the policyholder undergoes treatment in any of these network hospitals, there is no need for the Policyholder/ Insured to pay hospital bills, which is called ‘Cashless Facility’.
Continue reading “Network Hospitals”A clause in health insurance policies, where if there is a capping on per day room rent in the policy and you avail a room higher than the eligible room all the other hospital expenses like consultation charges, surgeon charges, operation charges, etc. will get reduced as a proportion based on the difference between the eligible and the availed room charge. Only the cost of medicines and consumables which are sold as MRP are paid as per actual.
Continue reading “Proportionate Deduction”No Claim Bonus (NCB) is the benefit accrued to an insured for not making any claims during the previous policy period.
No Claim Bonus (NCB) is the benefit accrued to an insured for not making any claims during the previous policy period. As per current norms in India, the discount ranges from 20% on the Own Damage premium (and not on Liability premium) and progressively increases Year on Year of no claim to a maximum of 50%.
Continue reading “No Claim Bonus (NCB)”