Below you’ll find answers to the questions we get asked the most about Insurance
Ethika Insurance Broking is a new age 100% bootstrapped insurance broking company started by a group of enthusiasts led by Mr. Susheel Agarwal, who made a transition from HR to CEO with Ethika Insurance Broking. Ethika Insurance aims to combine technology with Innovation to make employee health insurance simple and accessible. Ethika insurance has included the concept of Employee well-being and happiness in Employee health insurance, focussing on a well-ignored fact that happy employees perform better. Ethika Insurance Broking was conferred with a broker license to sell both life insurance and general insurance plans. Ethika Insurance Broker is recognised as the best insurance broker for corporate, small, midsize, and large businesses.
Ethika Insurance Broking offers life insurance plans such as Term life insurance, Pension insurance, Group Life insurance, Investment insurance plans, etc. Ethika also offers non-life insurance plans such as Vehicle insurance, Engineering insurance, construction insurance, Health insurance, Liability insurance, Personal accident insurance, etc. Ethika Insurance Broking is well known for its Group plans, such as Group health insurance, Group Term insurance and Group personal accident insurance.
Ethika Insurance Broking provides value additions to its customers in the form of tailor-made programs such as Employee wellness programs, Employee happiness programs, Employee assistance programs, Employee engagement programs, Group insurance software and Red carpet claims settlement services. Know about each of them in detail here.
Ethika Insurance Broking is not like any other insurance booking company in India as it tries to offer value-added services to its customers, such as the Employee Happiness Program, which is a unique and novel concept unheard of by the insurance industry in India. Ethika Insurance has a nearly 97% retention ratio, which is one of the highest in the insurance industry. This ratio means that most of the clients are willing to renew their insurance plans with Ethika Insurance, which in turn shows their trust in the company. In addition to these, Ethika Insurance offers all kinds of insurance plans so that customers can get all their insurance needs in one place. Ethika Insurance also makes the best use of technology with the group insurance software that can be linked to any company's HR portal, thereby semi-automating the addition and deletion of employees from the group insurance plans.
Ethika Insurance Broking’s main focus is to make the insurance process pleasant, as insurance has been considered a headache to go through for many people and firms in India for a long time. Ethika Insurance Broking revolutionized the insurance purchase and claim settlement process in India by focusing on adding the most important missing element in group health insurance: Employee happiness. Ethika’s main focus is to address the overall well-being of employees by conducting various activities in addition to insurance coverage. Ethika Insurance provides various value add-ons to clients which go beyond the traditional profit and loss view of an insurance broker.
A group health insurance policy is an application of a health insurance policy in which a single policy is given to a group of people. Group health insurance consists of employees in general who are the insured policyholders, and the employer is the owner/ coordinator of the policy. Group health insurance policies can be taken for the employees as well as their families. Group health insurance covers the medical expenses of the insured employees in case of an accident or illness up to the sum insured limit mentioned under the policy. Sum insured can be taken on an individual basis or a family floater basis in group health insurance.
The best group health insurance is the one that has no waiting period, extensive network hospitals, higher sum insured at low premiums, exceptional after-sales support, best intermediary support, covers all diseases, illnesses and accidents, no sub-limits and finally facilitates easy endorsements. Every other thing mentioned here would be common for most of the intermediaries. Still, the group insurance software and exceptional claim assurance depend to a greater extent on the insurance intermediary. Almost all the insurance companies would offer similar coverage in the group health insurance plan as it is a tailor-made policy. Still, the real deal would be the software and the claim experience. This is where Ethika Insurance Booking comes into the picture, offering world-class group health insurance software and red-carpet claim settlement service to its customers, thereby converting an ordinary group health insurance plan into an extraordinary one.
Group insurance comes in many forms depending on the customer's requirements. Group health insurance, group personal accident insurance and group term life insurance are the most common types of group insurance plans that can be availed in India. Of these, group health insurance is the most common type of plan in India. Other group insurance plans include workers' compensation insurance, group pension/ superannuation insurance, group gratuity insurance, group employee deposit-linked insurance, and group travel insurance. Every firm could avail of each of these insurance plans depending on their requirements. The minimum number of members would differ for each type of insurance. For example, group health insurance requires at least 7 members, whereas other group insurance plans require more than 15 members. The minimum requirements also vary from one insurer to another.
A GMC, Group Mediclaim or Group Medical Coverage policy is a health insurance policy that covers a group of people. GMC policy offers financial compensation to the policyholder in case of hospitalization due to an illness or disease. Group mediclaim is often provided by employers to their employees as a part of employee benefits. It could be such that you might come across GMC in your salary slip where your employer deducted a certain amount. This amount is collected from employees and pooled together to pay for the GMC coverage to an insurance company. Group mediclaim policy covers your hospitalization expenses up to a certain limit mentioned under the policy.
Group mediclaim policy or GMC policy is usually offered to corporate companies, including small, medium and large enterprises, who have an employee strength of at least 15-20 members.
However, few ensure only so many offer group mediclaim coverage for as few as 5-7 members, which are known as micro-insurance plans. A company should be registered under the Companies Act to avail of the GMC policy, as the policy is given to firms and not individuals. A group in GMC refers to a group of people who are legally bonded together for work-related purposes, and any group that forms only to avail group medical insurance would not be considered as a group for insurance. The premiums could either be paid entirely or in part by the employer, depending on the company’s policies.
Super top-up health insurance plans can be considered as an extension of an individual or group health insurance plan. A super top-up health insurance plan is designed to cover the additional expenses incurred by the health insurance policyholders after the exhaustion of the base health insurance policy sum insured. The lower version of super top-up health insurance is a top-up health insurance plan. The main difference between top-up health insurance and super top-up health plan is that an aggregate deductible amount would be deducted in the first claim made under the super top-up plan during the policy period, whereas in a top-up plan, the deductible would be applied every time a claim is made. A super top-up health plan is usually taken to complement the existing individual or group health insurance plan. Super top-up health insurance plans can also be offered on a group basis.
Yes. You can top up your group health insurance plan by taking a group super top-up health insurance plan. Group super top-up plan provides an additional sum insured to the insured members on payment of additional premium. For more details on group health insurance top-up with group super top-up health plans, please talk to our health insurance experts at Ethika insurance broking .
In general, the waiting period for super top-up health insurance plans would be the same as those for normal health insurance plans. The initial waiting period is 30 days, the pre-existing waiting period is up to 4 years, and the specific disease waiting period is up to 2 years. An initial waiting period of 30 days is applicable to diseases, illnesses and other conditions, excluding accident-related hospitalizations.
The major disadvantage of a super top-up health insurance plan is that it comes with a high deductible, and the deductible is aggregate, which means the deductible is applied only once during the policy period, i.e. first claim. So, if your claim amount falls within the deductible limit during the first claim in the policy period, then you would not avail any benefits from the super top-up policy for the first claim. For example, if you have taken a super top-up policy for Rs. 1 crore with a deductible of Rs. 5 Lakhs and you make a claim for Rs.4.5 Lakhs, then your claim would not be covered as the claim amount falls under the deductible mentioned under the policy.
Yes. It is beneficial to purchase a super top-up health insurance policy when compared to increasing the sum insured in existing health insurance plans. An increase in the sum insured in existing health insurance plans would burden you financially as the premium would be high when compared to that of the super top-up plans. Nevertheless, it is advisable to buy a super top-up health insurance plan and, at the same time, have an individual or group health insurance plan. Super top-up health insurance plans come with premiums that are at least 50% cheaper than the base health insurance plans.
Group personal accident insurance is an application of a personal accident plan which covers a group of people under a single policy. Corporate companies usually take group personal accident (GPA) to cover their employees as a part of employee benefits. GPA plans cover the death and disability of the insured members up to a sum insured limit. Disability covered includes permanent total disability, permanent partial disability, temporary total disability, and temporary partial disability. The compensation for death is 100% of the sum insured, whereas for disability, it is based on the extent of loss as specified in the table. GPA may also provide add-on covers such as Child Education expenses, Transport of mortal remains, Legal fees, and Hospitalization expenses, etc.
The best GPA policy for corporate companies is the one that covers both the death and disability of the employees. The best GPA policy should have a high sum insured cover at low premiums. For best GPA policies, please visit Ethika insurance broking.
SBI Group's personal accident policy is the personal accident policy provided for a group of people by the SBI general insurance company. SBI Group's personal accident policy covers the death and disability of insured members. The policy is very useful for corporate companies having at least 10 employees. Features of SBI Group's personal accident policy include Ambulance cover, Accidental Death, Coverage up to 65 years, Permanent total disability cover, Child education cover and Adaptation Allowance to modify house or vehicle for convenience to the insured member in case of disability. SBI GPA covers all forms of disabilities, such as total and partial disability of permanent and temporary nature.
Group personal accident insurance provides compensation to the insured members in case of death or disability due to an accident. An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means. It is to be noted that personal accident covers death or disability arising out of accidental circumstances and not natural means such as heart attack and other terminal illnesses.
Group personal accident policy provides benefits such as financial compensation to the family or nominee in case of death of the insured members, to the insured member in case of disability, child education expenses in case of death of the policyholder, and funeral expenses in case of death of the policyholder. GPA provides a financial cushion to the family members of the deceased policyholder. The claim proceedings from the policy could be used to maintain the lifestyle of the family members.
Group personal accident policy covers the death and disability arising out of an accident to the policyholder. GPA compensates the family members or nominees of the insured members in case of an accidental death of the policyholder and the insured in case of disability due to an accident. GPA policy is usually taken for a group of employees by the employer.
Group term life insurance is an application of term life insurance which covers the death of an insured member due to accidental and natural means. Group term life insurance (GTL) compensates the family members or nominees of the insured member in case of the death of the policyholder. Corporate companies usually take GTL for their employees as a part of the employee benefits. GTL is a form of life insurance that is taken for a particular term or period of time. Group term life insurance is given for a period of 1 year, after which it has to be renewed.
The employer usually takes group term life insurance for their employees, and therefore, the deciding authority would be the employee and not the insured employee. Employees cannot decide on the sum insured requirement in the case of GTL. In addition to this, employees would also face discontinuation risk, i.e., the policy coverage would be discontinued once the employee leaves the organization. As the choice rests with the employer, employees cannot decide on the coverage and add-ons under the policy.
The main objective of group term life insurance is to provide life insurance coverage to the employees. Group term life insurance helps employers plan for the future of employees while saving the tax for the company. However, the main objective of group-term life insurance is to provide life cover to the employees so that the families of the employees can at least be financially comfortable in the absence of the breadwinner.
Group term life insurance has the concept of nomination, which is a process of making a person or group of people beneficiaries receive the claim amount in case of any casualties, such as the death of the policyholder. GTL nomination is the process of naming a person or group of people to receive the claim proceedings in case of the death of the policyholder.
Group gratuity insurance is a type of gratuity policy in which the employer can set aside funds to pay future gratuities to the employees. Employees would be paid gratuity only when they satisfied and fulfilled the terms and conditions as laid down under the Gratuity Act. Gratuity refers to the amount that an employer would pay to the employees in return for the services offered by the employees to the company. In a group gratuity insurance policy, employers would periodically keep aside a certain amount for every employee so that the gratuity amount could be paid once the employee completes the minimum period specified under the Gratuity Act.
Group gratuity premiums are calculated based on various factors such as the number of employees, employee salary, etc. Retirement gratuity is calculated on the basis of the last salary withdrawn by the employee, which equals ¼ the of the last working month’s basic pay and dearness allowance for each completed six monthly periods of time. In general, the retirement gratuity.
Life Insurance Corporation of India has introduced a group gratuity scheme to help corporate companies pay gratuities to their employees as per the rules and regulations under the Gratuity Act. The LIC group gratuity scheme offers both life insurance coverage and gratuity coverage. Under this scheme, policyholders would be eligible for compensation in case of death during the policy period or before the retirement period and gratuity amount in case of retirement, resignation or superannuation of the employees from the company. The policy offers a guaranteed surrender value of up to 90% of the total contributions made by the insured into the Group policy account. LIC’s group gratuity scheme also permits additions and deletions similar to any other group insurance.
Personal health insurance is an insurance plan that covers a single person or a family against medical expenses incurred due to an accident, disease, illness or any other medical condition. Personal health insurance can either be in the form of an individual plan or a floater plan. In the case plan, the insured sum would be decided at an individual level, whereas in the case of a floater plan, there would be one insured sum that could be shared by the family members in the policy. Personal health insurance is the one which an individual takes for their personal use. It differs from group health insurance in the sense that an individual takes it, whereas an employer takes group health insurance for their employees.
Personal life insurance is an insurance plan that an individual takes for their personal use. Personal life insurance can either be taken as an individual plan or a joint plan. Personal life insurance covers the death of the policyholder due to natural and accidental causes. In general, personal life insurance is taken on an individual basis where the sum assured is decided by the insured, which in turn depends on the income earning capacity of the insured. Personal life insurance can also be defined as an insurance contract between the insurance policyholder and an insurance company, in which the insurance company promises to pay compensation to the nominee or family of the insured in case of death of the policyholder due to natural or accidental causes, in return for a premium to be paid by the insured periodically.
Private health insurance is the health insurance plan that the insurance companies offer without the intervention of any government. Individuals should purchase private health insurance to avail themselves of health insurance benefits, whereas government health insurance would be offered almost free of cost to individuals. Private health insurance costs in India depend on the age of the applicant, number of insured members, sum insured under the policy, coverage, and add-ons under the policy. Private health insurance plans in India start from Rs.1000 and can go up to a couple of lakhs depending on the type of plan, coverage, number of members, etc.
The no.1 health insurance company in India is the one that offers the best coverage at low premiums. Best coverage includes high sum insured, no sub-limits, few exclusions, low waiting periods, etc. Low premiums refer to the policy being low in premiums to be payable when compared to similar plans in the markets. Health insurance plans in India vary from one insured to another. They are differentiated based on the services offered instead of the coverage, as the coverage is almost similar across insurance companies. There are many no.1 health insurance companies in India, which include stand-alone companies such as Aditya Birla, Niva Bupa, Star Health, Manipal Cigna and Care health insurance and Non-life insurance companies such as ICICI LOMBARD, BAJAJ ALLIANZ, TATA AIG, CHOLAMANDALAM MS etc.
Mediclaim insurance is also known as health insurance, in which the insurance company would compensate the insured policyholder up to the sum insured limit mentioned under the policy. Best Mediclaim is the company that provides the best claim settlement service to their customers and also charges low premiums by offering the best coverage. In India, we have mediclaim companies such as New India, United India, National Insurance, Oriental Insurance, etc., which are the best in their terms.
Work competition policy or Workmen's compensation policy provides benefits such as medical expenses, lost wages, and rehabilitation expenses to the employees injured during the course of employment or at the workplace. Workers's compensation policy is designed to provide benefits to employees who lose their life or health while working for an organization. Workmen's compensation policy is mandatory for every organization registered under the Indian Companies Act, subject to the condition of employing a certain number of people. In short, Workmen's compensation policy provides compensation to the nominee or family members of the insured in case of death of the insured member and compensation to the insured member in case of disability or hospitalization.
Any firm, contractor or subcontractor who employs workmen as defined under the Workmen's Compensation Act, 1923 is eligible to take the Workmen's Compensation Policy. It is usually taken by firms that employ individuals to carry out specific activities in a firm, such as construction firms, mines, plantation and construction sites, etc. The firms defined in the Workmen's Compensation Act are mandated to take the WC policy if they employ more than 20 members.
Workmen's compensation policy is designed to protect the rights of employees working in certain organisations such as mining, manufacturing, plantations etc. Workmen's compensation policy compensates the nominee or family members of the insured in case of death of the insured during the policy period. It also compensates the employees if they are hospitalised during their course of employment due to occupational diseases or accidents at the workplace or outside the workplace.
Workmen's Compensation Policy premium depends on various factors such as the number of members, employment type, previous claim history, location and payroll of the employees. The average premium in Workmen's compensation policy ranges from Rs. 10 to Rs. 170 per thousand of the premium under the policy. The workmen compensation rate would vary from one occupation to another. For example, the tariff rate for marketing staff is 3.9, whereas for Machinists, it's 12.15 per thousand of the sum insured.
Workmen's compensation policy is compulsory for certain occupations mentioned under the Workmen's Compensation Act of 1923. It is mandatory for manufacturing companies, mining companies, construction companies, factories, plantation companies, etc. For all these companies, at least 20 employees should be in the organization to avail workmen compensation policy. Workmen's compensation policy is a statutory liability of the employer towards their employees in case of workplace accidents or deaths.
Business insurance covers a business’s financial, proprietary, physical and intellectual assets against any unforeseen events. Businesses are made up of physical, intellectual and financial assets, which are to be protected as any loss to these could lead to bankruptcy of the business. Business insurance also covers the legal liability of the insured customer arising out of damage or losses suffered by a third party due to the actions of the insured or at the premises of the insured.
Insurance is a contract between the insured customer and the insurance company in which the insurance company agrees to compensate the insured in case of loss due to property damage or third-party liability in return for a nominal amount known as a premium. Insurance is a backup for any business, which could protect the business from becoming bankrupt due to reasons beyond the control of the business owner.
Business term insurance is a term life insurance policy designed to cover business owners and their employees. The business term insurance is available to all business owners who employ at least 15 members and want to cover their employees against death due to an unforeseen event.
Corporate insurance refers to the insurance policy offered to corporate companies. Corporate insurance includes group term insurance, group personal accident insurance, group health insurance, business insurance and Workman's compensation insurance. Corporate insurance covers the legal liability of the business owners against third-party bodily injury and property damage.
The owners of the business usually pay corporate insurance. Corporate insurance includes various types of insurance plans, such as life insurance, Non-life insurance and health insurance. There are instances in group health insurance where employees would also contribute to the premium payment process. Nevertheless, on an overall level, the premium in corporate insurance is paid by the business owners.
Employee happiness can be promoted through various ways, the most infamous one being insurance. Insurance can be used to promote employee happiness, as employees who are satisfied with the claim settlement process would be very happy. Research has proved that employee happiness can be improved by providing access to healthcare through group insurance, thereby reducing employee absenteeism and increasing productivity simultaneously.
The top five factors that contribute to employee happiness include recognition for the services offered by the employees, employee benefits such as provided funds, insurance plans for self and family, challenging work, work-life balance, and a certain degree of autonomy in the decision-making process.
Employee happiness can be increased through various factors such as employee benefits, work-life balance, recognition schemes for employee performance, inclusive and transparent workplaces, etc. Of all these, employee happiness can be increased through group insurance both for the employees and their families.
There are many scales to measure employee happiness, but one of the most common scales used to measure employee happiness is the output or productivity of employees. Happy employees are found to produce high output or be highly productive. Employee happiness would also be reflected in the time spent by the employees in an organization. Happy employees tend to stay longer in the organizations when compared to unhappy or dissatisfied employees.
The top 5 types of employee benefits include group health insurance, group term life insurance, group personal accident insurance, group gratuity insurance, health care reimbursement for medical checkups undergone by the employees, retirement benefits, flexible work schedules, Wellness programs and professional development opportunities.
Employee benefits in India include healthcare reimbursements, group insurance plans such as health insurance for self and families, personal accident cover for self, term insurance for self, gratuity for self, wellness benefits, rewards and recognition at the workplace, flexible work schedule and inclusive workplace.
Payroll benefits are a part of employee benefits, which are the benefits given to the employees in kind. These benefits are also known as fringe benefits, prerequisites or perks, which include various non-wage related benefits provided to the employees in addition to the wage-related benefits in the form of payroll. Every employee would be paid a certain salary, which comes under the payroll of the company and is handled by the Human resource department.
Employee engagement can be defined as the emotional and physical investment the employees make towards their employer. Employee engagement is the key to the success of any organization, as highly engaged employees are productive when compared to others. Engaged employees identify the goals of their organization and strive to align their goals with those of the organization to achieve the desired goals.
The 5 Cs of employee engagement include Care, Connect, Coach, Contribute, and Congratulate. Care refers to the steps taken by the employer to make their employees happy in all aspects. Connect refers to the need to build strong relationships at the workplace so that employees can break barriers and engage freely. Coach refers to the coaching of employees by senior management in order to prepare the next generation to take over the reins of the organisation. Contribute refers to the willingness of employees to contribute to the growth of the organisation by connecting their personal goals with those of the organisation. Congratulations refers to recognising and appreciating employees for their efforts towards achieving the goals of the organisation.
The 4 pillars of employee engagement include Communication, Learning & Development, Work-life Balance and Recognition & Rewards. The success or failure of an organization depends entirely on the performance of these pillars. Any organization that follows these pillars religiously is expected to increase employee engagement.
Engagement in employment refers to the degree of alignment of the goals of the employees with those of their organization. It can also be defined as the emotional and physical investment an employee makes towards their organization in order to achieve the goals of the organization.
Health insurance is a financial plan that covers medical expenses, providing a safety net for individuals in times of illness or injury.
Health insurance safeguards you from unexpected medical costs, ensuring access to quality healthcare without significant financial burden.
Policies usually cover hospitalization, doctor's fees, medication, diagnostic tests, and sometimes additional benefits like maternity or dental care.
Premium is the amount the Customer pays the Insurer to avail the health insurance coverage.
Consider factors like coverage, network hospitals, premium costs, and additional benefits to find a plan tailored to your needs.
A deductible is the amount you pay out of pocket before your insurance starts covering costs.
Some policies cover pre-existing conditions after a waiting period. One should check the policy details for specific information.
Network hospitals are medical facilities that have a tie-up with your insurance company. Treatment there often results in cashless claims.
Yes, many policies allow you to include your spouse, children, and sometimes parents for comprehensive family coverage.
Yes, there's typically a waiting period for specific treatments or pre-existing conditions. It varies between policies.
Cashless hospitalization allows you to receive treatment at network hospitals without paying upfront. The insurer settles bills directly with the hospital.
Some policies cover alternative treatments like Ayurveda or Homeopathy. One should check the policy for details.
Yes, you can switch plans, but consider waiting periods and portability options. Consult your insurance provider or your insurance broker for a seamless transition.
Co-payment is the percentage of the claim amount you pay, with the insurer covering the rest. It helps lower premium costs.
Many plans cover maternity expenses after a waiting period. One should verify coverage and waiting periods before selecting a policy.
Yes, you can purchase health insurance for your parents, providing them with financial protection for medical expenses.
One has to submit bills and relevant documents to the insurance company after treatment. The claim is then processed based on the policy terms.
Some policies offer coverage for preventive check-ups and vaccinations. It's advisable to review policy details for such benefits.
Renew your health insurance policy annually by paying the premium before the due date. Continuous coverage ensures uninterrupted benefits.
Dental coverage varies among policies. Some offer it as an additional benefit, while others have separate dental insurance options.
Waiting periods exist for specific treatments or pre-existing conditions. Understanding these periods is crucial for comprehensive coverage.
Most policies allow you to add newborns to your coverage, but it's essential to update your policy promptly after their birth.
The free-look period allows you to review the policy terms. If unsatisfied, you can cancel within a specified timeframe for a refund.
Yes, premiums paid for health insurance are eligible for tax deductions under Section 80D of the Income Tax Act.
The grace period is a brief extension beyond the policy expiry date to pay the premium without losing policy benefits.
A Third-Party Administrator (TPA) assists in claim processing, coordinating between the insured, hospitals, and the insurance company.
Top-up plans provide additional coverage once the basic sum insured is exhausted, offering extra protection against high medical expenses.
The exclusion period is the initial waiting time for certain illnesses or pre-existing conditions not covered by the policy.
Some insurers cover pre-existing conditions after a waiting period. One should always disclose all details accurately when purchasing the policy.
Renewing on time is crucial. If forgotten, contact your insurer immediately to explore renewal options and prevent a coverage gap.
Critical illness coverage provides a lump sum amount upon diagnosis, aiding in managing treatment expenses for specific severe conditions.
Individual plans cover a single person, while family plans extend coverage to the entire family, making them cost-effective for multiple members.
Yes, many policies allow you to enhance the sum insured at the time of renewal of the policy.
A nominee is the person designated to receive the policy benefits in case of the insured's demise. One should ensure accurate nominee details.
Day-care treatments are medical procedures that require less than 24 hours of hospitalization and are covered under health insurance.
No-claim bonus rewards policyholders with increased sum insured or premium discounts for each claim-free year, encouraging a healthy lifestyle.
Yes, while some policies may have certain restrictions, many insurers offer coverage for individuals with a high Body Mass Index (BMI).
Pre-authorization is obtaining approval from the insurer before planned hospitalization, ensuring seamless claim processing.
Some policies include emergency ambulance services, reimbursing the expenses incurred during hospital transport.
Co-insurance requires the policyholder to share a percentage of the claim amount, promoting cost-sharing and reducing premium costs for the insured.
Many policies cover diagnostic tests when prescribed by a medical practitioner as part of the treatment.
Indemnity plans reimburse actual medical expenses, while fixed-benefit plans provide a lump sum amount for specific illnesses, offering diverse coverage options.
Most policies have a waiting period for maternity; the period could range from 9 months to a couple of years. One cannot make a claim for maternity during such waiting period.
Coverage for alternative treatments varies. Some policies include acupuncture and similar therapies, one should check the policy details before making such claims.
Generally speaking health insurance claims do not have a surveyor, but the Insurance company does carry out audits from time to time. As a matter of fact, Insurers can drop in to your hospital at the time of a claim to assess your identity to prevent fraud.
While there may be an entry age limit, many policies offer renewability for a lifetime, ensuring continuous coverage for life. As long as one continues renewing the policy.
In-network hospitals have a tie-up with the insurer, offering cashless services, while out-of-network hospitals might require you to apply for reimbursement after treatment.
Yes, self-employed individuals can purchase health insurance, providing financial security for medical expenses.
Health insurance for seniors are normally expensive and might have ailment related cappings.
Accurate disclosure of pre-existing conditions is crucial during policy purchase, preventing claim rejection due to non-disclosure. Always provide complete and truthful information to the insurer.
A lot of people think that insurance is a scam, and an equal number of folks think that everything would be covered from Day 1. Both are incorrect.
Well unless it is a group policy where all waiting periods are covered from Day 1, most policies have certain waiting periods. These could range from a year to about 4 years. These could typically be classified into A common waiting period - normally about 30 days Waiting periods for hospitalizations like Cataract, Hernia i.e. hospitalizations that can be prolonged - these could be around 1 to 2 yearsWaiting periods for degenerative diseases which could be around 4 years.
Well there is no one size fits all for that. But generally speaking you should consider factors like the number of members in your family, their age, their health before you decide on the sum insured.
Generally speaking retail health policies do not cover maternity. Some policies that do cover maternity have a waiting period of atleast a year before you can make a claim. And the policy also has a maternity sum insured cap.
A super top up policy covers you after a particular sum insured. It is easier to understand with an example. Say suppose you have a Super Top up policy where the Threshold is 5 Lakh and your Sum Insured is 10 Lakh - the Insurer will cover all your claims above 5 Lakh and upto 10 Lakh, but any claim below 5 Lakh will not be covered by the Insurer.
An insurance broker is someone who has the technical expertise and understands the industry. The broker also has huge experience with claims settlement. They can not only guide you to the right insurer but are of immense help at the time of a claim settlement. So, the answer to your question is, why should you not.
The Broker works for the Customer while the Agent works for the Insurance Company. The Agent can be considered as the sales touchpoint for the Insurer. Imagine that the Insurer has launched a new product that has a higher margin for the Insurance Company as well as a higher margin for the Agent, what product would the Insurer sell you?
In very simple terms, a deductible is an amount you will have to pay in case you make a claim - this will be before your insurance policy pays for any claim. A deductible will typically be a one time charge. Copay on the other hand is a % that you will have to bear at the time of settlement of each and every claim.
Generally your TPA, but if you have gotten your policy through an Insurance Broker, the Broker will help you with all the claim proceedings.
A Cashless mode of settlement is one where your insurance company settles your hospital bill with your hospital directly. You would typically not have to bear any charges. Reimbursement is when you pay for your hospital bill first and then claim the amount from the Insurer. One should always go for cashless as far as possible.
Typically yes, because your group policy has standard coverages which are cost efficient for your organization as a whole. With a retail policy, you can tailor the policy as per coverages that are suitable to your family. A retail policy also ensures that you stay covered irrespective of your job status.
Portability, in the context of health insurance, refers to the ability to transfer your existing health insurance benefits to a new one without losing continuity.
You should migrate the policy from your current employer into an individual health policy. That way, you retain the continuity benefits and your policy becomes independent of your employment status.
TPA or a Third Party Administrator is the agency that settles your claim on behalf of the Insurer. The TPA under your policy could at times be more important than the Insurer.
Generally speaking, the turnaround time is about 3 hours, but more often than not what happens is that the TPA desk at the hospital has not forwarded your final papers to the TPA. You should therefore ensure that all your papers have been forwarded to the TPA as soon as your final bill is generated.
The Insurers have access to tons and tons of data. Based on this data they arrive at a median cost of surgeries and procedures in particular cities. Based on these costs they design packages for surgeries. So hypothetically the package cost for a cataract procedure in a city like Mumbai might be 30000 Rs, which essentially means the Insurer would not compensate you more than 30000 Rs.
Constant vigilance. In case you are applying for the reimbursement mode of settlement, you have to ensure that you check all the amounts that are being charged, all the time.
Yes, where you buy your policy from is immaterial to where you make the claim as long as it is in India. Most health policies have the geographical limits set to India.
Generally speaking you should not. The most important reason is the fact that your Bank is not technically adept to sell you the insurance policy. The other important factor to consider is the fact that your Bank will not be able to help you at the time of your claim settlement.
While that could depend from policy to policy, most policies tend to cover children till about a particular age or employment, whichever happens earlier.
Most policies will not cover married daughters or sons for that matter as dependents in the policy. But you can avail continuity benefits when your daughter buys the new policy. Ensure you ask the Insurer for that. It can be particularly helpful in case of maternity coverage.
That would depend on the terms and conditions of the policy, but generally speaking most policy have an age cut off for dependent children.
Typically, the maximum amount of claim you will get in a policy year is the sum insured of your policy. But there could be cappings for diseases. For example, most policies have a capping for Cataract & Hernia. You should be aware of these.
That is incorrect. You should never go for reimbursement at a hospital if the cashless facility is available. Insurers bargain with Hospitals for rates on your behalf. They get you a discounted rate. Moreover in case you go for a reimbursement, not only would the hospital charge you more, but your Insurer would also not settle your entire bill.
Grace period is a benefit that the regulator has given to the Customers to carry the benefits of continuity forward. At the moment the Grace period in Health Insurance policies is 30 days. You cannot however make a claim when in the grace period. As a matter of fact, if your hospitalization originates in the grace period, that claim will not be admissible.
Public Liability Insurance (PLI) is mandatory coverage required by the Public Liability Insurance Act, 1991, for businesses handling hazardous substances exceeding specified quantities. It provides financial protection to the public in case of accidents involving these substances.
Businesses handling hazardous substances as defined under the Environment (Protection) Act, 1986, exceeding the threshold quantity set by the Public Liability Insurance Act, are required to obtain PLI.
No-fault liability: The owner of the hazardous substance is liable for compensation regardless of fault in case of an accident.
Mandatory insurance: Businesses handling hazardous substances must acquire PLI.
Compensation for: death, bodily injury, or property damage caused by an accident involving hazardous substances.
You can consult the official website of the Ministry of Environment, Forest and Climate Change (MoEFCC) or seek guidance from a qualified insurance professional.
Penalties can include heavy fines and imprisonment for the business owner or operator.
Doctors, architects, engineers, lawyers, accountants, IT professionals, and consultants are among the professions that often require Professional Liability coverage.
Policies might have a "retroactive date" to determine coverage for past work. Discuss your specific needs with your broker.
Claims-made policies cover claims reported during the policy period, while Occurrence-based policies cover incidents happening during the policy period, regardless of reporting time.
Yes, it typically covers defense costs even for unfounded claims.
Any business involved in manufacturing, distributing, or selling products could benefit from Product Liability coverage.
It might also cover design defects, labeling issues, or failure to warn about potential dangers.
While not widely mandatory, certain industries or specific product categories might have regulations.
Some policies might include product recall expenses with specific terms and conditions.
The risk profile of the product, sales volume, target market, and past claims history all influence premium calculations.
D&O insurance protects against personal liability if directors and officers are sued for decisions made for the company.
Yes, while more common for large firms, any company faces potential liability lawsuits against its management.
Covers misrepresentation, breach of duty, HR issues, shareholder disputes, and other allegations of mismanagement.
Exclusions usually apply for fraud or other deliberately illegal actions.
Yes, this is a critical coverage component of D&O policies.
Cyber Liability Insurance protects businesses against financial losses arising from data breaches, cyberattacks, and other technology-related risks.
While not mandatory, businesses heavily reliant on technology or handling sensitive data (e.g., healthcare, finance) are strongly recommended to consider Cyber Liability coverage.
Coverage may include:
Employers' Liability Insurance (ELI) protects employers from legal liabilities arising from employee injuries or illnesses sustained at work.
Yes, ELI is mandatory for organizations with ten or more employees under the Employees' State Insurance (ESI) Act, 1948.
ELI covers compensation for medical expenses, lost wages, and permanent disability benefits in case of work-related injuries or illnesses.
ELI helps employers:
CGL insurance protects businesses from financial losses arising from third-party claims of bodily injury, property damage, or other harm caused by business operations (e.g., slip-and-falls on premises, product defects).
CGL is not mandatory for all businesses in India. However, businesses with higher risk profiles or contractual obligations might find it essential.
Common exclusions include:
Premiums consider factors like:
Basic CGL policies might offer limited product liability coverage. For comprehensive protection, consider a separate Product Liability insurance policy.
E&O insurance, also known as Professional Indemnity (PI) insurance, protects professionals from financial losses arising from claims of negligence, errors, or omissions in their professional services.
Doctors, engineers, architects, lawyers, accountants, IT professionals, consultants, and other professionals offering services where mistakes could lead to financial harm to clients are strongly recommended to have E&O coverage.
Exclusions might include:
Premiums consider factors like:
Provides financial protection against legal liabilities
Basic E&O coverage might not explicitly include data breaches. Consider consulting with your insurance broker to discuss adding cyber liability coverage to your policy for comprehensive protection.
Contact your insurance provider immediately after any incident that could potentially lead to a claim.