Family Health Insurance- What it should cover?

Having gone through the brochures of health insurance offered by different insurance companies, one should raise certain queries from the Insurance Company to clarify what covers the insurance policy will provide?

What are the treatments covered under the heal insurance policy, what are dos and do nots of health insurance policy? etc.

Here is a sample of the points raised by the client organization that want a comprehensive health policy for its member community from the insurance company. This example would certainly help others. 

          Application of Scheme 

a.      In the schemes i.e.5 family members (Husband, Wife and 3 children) are covered. In case of a bachelor , his dependents i.e. parents, brothers/sisters subject to maximum of 5 are covered or not?

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.

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