Drat Letter for Health Insurance Policy

Many member based organizations offer family health insurance opportunity to its members or community. Negotiating with Insurance Company is a difficult task.

Here is a draft that is written to the Insurance Company to clarify some of the points that the policy covers. This letter may also help you in developing health insurance policy or writing to the Insurance companies.

Subject: FAMILY HEALTH INSURANCE FOR (Members of Club/Council/Community/Organization)

Having gone through the details of the Health Insurance Plan, following points need to be clarified:

            Application of Scheme

a.       In both the schemes i.e. I&II, 5 family members (Husband, Wife and 3 children) are covered. In case of a bachelor Engineer, his dependents i.e. parents, brothers/sisters subject to maximum of 5 members should also be covered.

b.      Room Rent:   In Scheme I, Room Rent permissible is Rs 2800/- per day. For treatment/admission in good hospitals the room rent admissible is too less. It should not be less than Rs. 4000/- per day.

c.       Maternity Limit: Annual limit laid down for C-section/multiple birth as Rs. 25,000/- is less. Presently hospitals are charging approximately Rs. 35,000/- to Rs. 45,000/- . Moreover coverage of lab tests/medicines also needs to be specified. (Rs. 15,000 = Delivery/Abortions/ Sterilization/ Infertility)

d.      Personal Accident: Compensation in case of disability or death is not mentioned/specified for applicability of the said policy. Will the panel hospitals treat medico-legal cases = Road Traffic Accident.

e.       Emergency Cases: In case of emergency, if the patient cannot be brought to the hospitals on panel, then he may be allowed treatment at any hospital closer to his place and payment be made according to the condition of the patient.

f.       Prolonged Illness:  Prolonged illnesses (Hepatitis Interferon Therapy, TB, Cancer, Stroke/Paralysis) and all existing sickness should also be covered in the policy.

g.      Day care surgery: Temporary detention in the ward and emergency treatment given to the patient should also be covered.

h.      Procedure for getting insurance cover from panel hospitals may please be outlined.

i.        Minimum number of members/family for execution of this policy is laid down as 1000 Nos. Reaching to the figure of 1000 Nos may take lot of time. This will result in denying this facility to the engineers who become member at initial stage i.e. prior to figure of 1000 Nos.

The above points be clarified, so that these points can be discussed in a joint meeting as and when convenient.

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