- 1 United India Family Medicare Plan coverage
- 2 What are the exclusions in United India Family Medicare Plan coverage?
- 3 The procedure of claiming United India Family Medicare Plan coverage
- 4 Procedures for the cashless claims:
- 5 The claim process for the plan
- 6 Regarding the Reimbursement of Treatment Costs:
- 7 Take Away
Family members are completely covered by a single sum assured by United India Family Medicare Plan for Family. Any dependent child between the ages of three and eighteen is required to be insured as long as one of the parents is. Between 1 and 10 lakhs are offered as the money insured. The admission age ranges from 18 to 80 years old, and everyone over 45 must undergo a medical examination. For the insured members, there are more than 7000 network hospitals to choose from for cashless and claim reimbursement treatment.
According to section 80D of the Income Tax Act, contributions made to United India Family Medicare Plan for Family are deductible from taxable income. This plan covers hospital costs, daycare costs, and Ayush costs.
United India Family Medicare Plan coverage
Given that the costs are incurred on the written medical advice of a medical professional and are incurred on the insured person’s medically necessary treatment, the policy offers the base coverage as indicated in the following section:
- In-patient Hospitalization Expenses: If the admission date of the hospitalization due to disease or accident occurs within the policy period, the following medical costs incurred by an insured person during hospitalization will be covered by the policy at reasonable and usual charges:
Room, Boarding, and Nursing expenses: For a sum insured less than 5 lakhs, the limit is 1% of the sum insured and for a sum insured above 5 lakhs, 1% of the sum insured or single occupancy standard air-conditioned room charges whichever is higher. Nursing care, RMO fees, IV fluids, blood transfusion, and injectable administration fees are just a few examples of the costs that fall under this category.
- Up to the following maximums, there are fees for lodging in an intensive care unit or intensive cardiac care unit: For a sum insured less than 5 lakhs, the limit is 2% of the sum insured and for a sum insured 5 lakhs and above, the limit is the actuals.
- The costs incurred by the doctors, surgeons, specialists, and anesthesiologists who treated the insured person.
- Charges of the operation theatre.
- Anaesthesia, blood, oxygen, all medical instruments used, medications, prosthetic device costs, laboratory testing, X-rays, Costs of artificial limbs, infra-red cardiac valve replacements, vascular stents, diagnostic testing, and similar medical costs associated with the therapy.
- For cataracts: 10% of the sum insured is subject to a maximum of Rs.25,000.
- For hernia: 10% of the sum insured is subject to a maximum of Rs.25,000.
- For Hysterectomy: 20% of the sum insured subject to a maximum of Rs.50,000.
- Mental illness coverage limit: In case of mental illness such as Schizophrenia, Bipolar Affective Disorders, Depression, Obsessive Compulsive Disorders, and Psychosis the actual in-patient hospitalization expenses will be covered up to 25% of the sum insured subject to a maximum of Rs. 3,00,000 per policy year
- Day Care Procedures: The company will pay for the Insured Person’s Day Care Treatment during the Policy Period after an Illness or Injury that occurs during the Policy Period, provided that the Medical Expenses are incurred in case of Day Care Treatment or Surgery undertaken for the Condition/Illness covered under Base Cover that requires less than 24 hours Hospitalization due to advancement in technology, including for any procedure which requires a period of specific duration. As stated in the insurance, all daycare treatments are covered.
Even if converted to in-patient status in the hospital for more than 24 hours or performed in daycare centers, procedures, and treatments that are typically performed on an out-patient basis are not covered by the insurance. Furthermore, this benefit does not cover diagnostic services.
- Pre and Post–hospitalization Expenses: Subject to a maximum of 10% of the sum insured, the company will pay the insured person’s pre-hospitalization medical expenses incurred due to an illness or injury that occurs during the period up to 30 days prior to hospitalization as well as post-hospitalization medical expenses incurred due to an illness or injury that occurs during the period up to 60 days after the hospital discharge.
- Ayurvedic/Homeopathic/Unani treatment in government hospitals.
- Donor Expenses Cover: Up to the Sum Insured, the plan will pay the In-patient Hospitalization Medical Costs paid for an organ donor’s care during the Policy Period for the purpose of harvesting the donated organ.
Either the organ donor’s pre-hospitalization or post-hospitalization medical costs; the cost of the organ donor’s screening; the expenses involved in directly or indirectly acquiring the donor’s organ; any organ or tissue transplant that involves an experimental or research procedure; costs associated with preserving or transporting organs; any additional medical care required for the donor following harvesting, or any complications are not covered.
- Organ Donor Benefit- When the Insured Person is the.Donor: The insured person who donates an organ is entitled to a lump sum payment of 10% of the amount covered to cover medical and other incidental costs as long as the donation complies with the Transplantation of Human Organs Act 1994.
- Road Ambulance Cover: The budget will pay for expenses spent up to:
Transporting the insured person by road ambulance to a hospital in an emergency following an illness or injury that happens during the policy period will cost 0.5% of the Sum Insured up to a maximum of Rs. 2500 per event and 1% of the Sum Insured up to a maximum of Rs. 5000 every policy period.
- Cost of Health Check-up: If the health check-up is completed at network hospitals or diagnostic centers that have our approval within a year of the date it became due and the policy is in force, we will pay up to 1% of the average Sum Insured of the three years prior, up to a maximum of Rs. 5000 per person for policies issued on an individual basis and Rs. 10,000 per policy period for policies issued on a floater basis. Payment made under this benefit is not included in the amount covered and has no bearing on the Bonus.
- Modern Treatment Methods & Advancement in Technology
Expenses incurred on the following procedures either as an in-patient or as part of daycare treatment in a hospital, shall be covered:
- Uterine Artery Embolization & High-Intensity Focused Ultrasound (HIFU): For claims involving uterine artery embolization and high-intensity focused ultrasound, up to 20% of the insured amount, up to a maximum of Rs. 2 lacs per insurance period.
- Balloon Sinuplasty: For claims involving balloon sinuplasty, up to 10% of the Sum Insured, but no more than Rs. 1 Lac each coverage period.
- Deep Brain Stimulation: For claims involving deep brain stimulation, up to 70% of the Sum Insured each coverage period.
- Oral Chemotherapy: For claims involving oral chemotherapy, up to 20% of the insured sum, up to a maximum of Rs. 2 lacs per insurance period.
- Immunotherapy- Monoclonal Antibody to be given as an injection: Up to 20% of the Sum Insured subject to a maximum of Rs. 2 Lacs per policy period
- Intra vitreal Injections: 10% of the amount insured, up to a maximum of one lakh rupees every insurance period.
- Robotic Surgeries (including Robotic Assisted Surgeries): For claims involving robotic surgery, up to 75% of the Sum Insured per coverage term for the treatment of any condition of the central nervous system, regardless of cause; Malignancies and for claims involving robotic surgery for other conditions, up to 50% of the Sum Insured per coverage period is available.
- Stereotactic Radio Surgeries: For claims involving stereotactic radiosurgeries, up to 50% of the Sum Insured each coverage period.
- Bronchial Thermoplasty: For claims involving bronchial thermoplasty, up to 30% of the Sum Insured, up to a maximum of Rs. 3 Lacs per insurance period.
- Vaporisation of the Prostate (Green laser treatment or holmium laser treatment): Upto 30% of Sum Insured subject to a maximum of Rs. 2 Lacs per policy period
- Intra Operative Neuro Monitoring (IONM): Upto 15% of Sum Insured per policy period for claims involving Intra Operative Neuro Monitoring
- Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered only: No additional sub-limits.
Optional or additional coverages
- Restoration of the sum insured: In the event that the basic sum insured was used up due to further claims filed during the policy year, this add-on provides a restore of the sum insured equivalent to 100% of the base sum insured. For a specific policy term, you will automatically and instantly get the benefit in accordance with the terms and conditions outlined in the policy document.
- Daily cash allowance on hospitalization: For the added benefit of daily cash for each continuous and finished period of 24 hours of hospitalization, you can purchase this add-on. The benefit will be Rs. 500 per day up to Rs. 5,000 per policy period for sums insured up to Rs. 5 lakh, Rs. 1,000 per day up to Rs. 10,000 per policy period for sums insured between Rs. 5 lakhs, and Rs. 15 lakhs, and Rs. 2,000 per day up to a maximum of Rs. 20,000 per policy term for sums insured between Rs. 15 lakh and Rs. 25 lakhs.
- Maternity expenses and new-born baby cover: With this add-on, you will have coverage for in-patient hospitalization costs associated with birth, including C-sections, or with a legal, medically-assisted termination of pregnancy during the policy’s term for up to two deliveries or terminations, or for either throughout the insured’s lifetime. However, keep in mind that you can only take advantage of this benefit if you choose a policy with an insured amount greater than Rs. 3 Lakh. Additionally, it pays for in-patient hospital charges for newborn babies from the first day of life to 90 days of age, subject to the terms and circumstances.
What are the exclusions in United India Family Medicare Plan coverage?
- War & War operations and health issues arising due to nuclear weapons.
- Injury or Disease due to nuclear weapon/materials
- Stem cell implantation/surgery/therapy, harvesting, and storage except for Hematopoietic stem cells for bone marrow transplant for haematological conditions
- Congenital external disease or defects or anomalies
- Expenses related to Sterility and infertility
- A. Treatment traceable to childbirth except for ectopic pregnancy
- B. Expenses towards miscarriage and lawful medical termination of pregnancy
- Investigation & Evaluation
- Treatments for HIV and AIDS.
- Expenses related to any unproven treatment/ services
- Cosmetic or plastic surgery or any treatment unless as a part of medically necessary treatment
- Expenses related to the surgical treatment of obesity that does not fulfil all the specified conditions in the policy.
- Treatment for, Alcoholism, drug or substance abuse, or any addictive condition
- 6. Treatments including Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, chondrocyte or osteocyte implantation, procedures using platelet-rich plasma, Trans Cutaneous Electric Nerve Stimulation; Use of oral immunomodulatory/ supplemental drugs
- Any expenses incurred on Outpatient Treatment
- Any expenses incurred on Domiciliary Treatment
- Treatments other than Allopathy and Ayurvedic, Homeopathic & Unani branches of medicine practiced in private institutions.
- Psychiatric disorders and Psychosomatic disorders.
- Dental care expenses.
The procedure of claiming United India Family Medicare Plan coverage
When submitting a health insurance claim, two things could happen. The cashless method of treatment enables the policyholder to receive care without having to pay anything upfront by using the insurance as money. The other scenario that is conceivable is when the treatment has already been provided and paid for but a claim settlement is necessary to allow the person to receive a refund of the treatment costs.
To claim for cashless treatment
Cashless therapy is primarily used for diseases or illnesses that are part of a group health insurance or that are covered by the insurer, including medical costs for the treatment but on an individual basis. On its website or in its policy pamphlet, United Health Insurance lists all of the network hospitals in which patients who need treatment can request a cashless facility.
Procedures for the cashless claims:
- Make contact with the affiliated hospital, confirm that you have the USGI health card, and ask to be admitted.
- A crucial step in the filing procedure for the cashless facility is notification. It is simple to complete. One only needs to call the helpline number for health insurance or the number on the card.
- One must contact the company two days before admittance in the event of a planned hospitalization.
- The hospital will then begin the process of verifying your credentials after receiving the health card and ID proof with a photo.
- A pre-authorization form must be filled out by the hospital with the necessary information once this procedure is finished. The attending physician must sign this document. If a patient is being admitted with a plan, an authorization letter must be submitted.
- After being fully completed, signed, and sealed, the pre-authorization form must be sent by the hospital together with the necessary information to the insurance company.
- After that, the insurance provider will get in touch with the relevant bank to let them know how the claim is progressing. The claim will either be approved or denied, and there may also be a request for more information or supporting evidence.
- As soon as the application is approved, New India Assurance pays the medical bills covered by the policy; however, any expenses not covered must be covered.
The claim process for the plan
The procedure for filing a claim with United India health insurance is as follows:
- The insurance company will next decide whether to accept it or reject it based on the current policy.
- Within 7 days following the patient’s or the insured person’s discharge, the claim must be registered. It must also be reported to New India Assurance very away.
- You must complete and submit the claims form along with a photocopy of a valid ID.
- After that, you must supply the necessary medical documentation, including doctor-signed diagnosis reports.
- For verification, you must send the original copies of all reports and the discharge summary.
Regarding the Reimbursement of Treatment Costs:
After obtaining the treatment and paying for it, the insured person can, in a few easy steps, request a refund for the costs expended for the therapy.
Procedure to file a claim
To submit a request for payment of medical expenditures through your Mediclaim, follow these steps:
- As soon as the person covered by the Mediclaim is admitted to the hospital, the insurance company must be notified.
- The policyholder is responsible for paying all hospital fees after the treatment is over and for maintaining any related bills and papers.
- Send the properly completed claims to form to United India Insurance for handling and payment. As long as all the information provided is accurate, the insurer will pay all the costs.
Documents required for the claim
The following documents need to be submitted to United India Health Insurance:
- Bills: All original hospital bills must be supplied, along with the hospital’s stamps and signatures.
- Claim form: The claim form that must be completed with all necessary information, signed, and then delivered.
Original Discharge Report: This report also has to be filed.
- All further original reports pertaining to the treatment, such as medical bills and inquiry reports, must be submitted.
- Sending the appropriate doctor’s follow-up appointments and the recommended course of treatment is also advisable.
Family Medicare Policy by United India is the best option if you’re looking for health insurance to protect you and your loved ones. It is a type of insurance coverage that covers hospitalization and medical costs resulting from a disease, accident, or injury. It is a one-for-all policy that can be purchased individually or as part of a family floater. You can get your family protected under a single sum insured with the policy in hand. The Family Medicare Policy, which is renowned for being inexpensive, is a choice for those seeking insurance without sacrificing the standard of care owing to a lack of funds.