Health Assure Plans are pure protection health assurance plan that reimburse medical expenditure incurred in a hospital. A typical health assure plan has the following features.
Typically, Health Assure plans cover the following as part of the policy.
These are different things. When a policyholder is admitted for over 24 hours, the insurance company pays hospital benefit between Rs500 and Rs1,000 per day towards routine expenses. These are paid with settlement claim only. Wellness benefit is paid in the form of health check vouchers redeemable for free or discount. Most wellness benefits have a shelf life and you must use them inside that time. Wellness vouchers do not reduce your annual limit. Both cash benefits are wellness benefits are available to premium customers.
Multiplier benefit has to do with no claims bonus (NCB). For example, HDFC Health Assure multiple benefit is 50% after 1 year and 100% after 2 years of no claims. If you have a Rs10 lakh cover and don’t claim for 1 year, cover is enhanced to Rs15 lakhs and to Rs20 lakhs if no claims are made for second year. Star Health, where the maximum policy sum assured can go up to Rs2 crore, multiplier benefit varies between 10% and 20% only.
The rules are different for individual policies and group policies. If it is an individual health assure policy, then on the death of the policyholder the policy will automatically terminate. However, there is no refund of premiums paid, even if you have been covered only for a few months in the current year. However, in the case of a family floater, the policy will continue to be in force for other persons in the family floater. The eldest member becomes the nodal member and any adult surviving member can fill up the form for continuation of policy.
Waiting period is applicable for all members and for all health assure policies. Normally, for 30 days from the date of the policy issue, the insurance policy does not cover any disease. The only exception is injury due to accidents. There are a host of conditions that have a waiting period of 2 years or 3 years.
Normally, ENT, gynaecological, orthopaedic, gastrointestinal and skin related problems are not covered for 2 years and you can read the fine print on specific exclusions. In cases like maternity benefits and pre-existing conditions, there is a 3-year waiting period.
Grace period refers to the 30 days additional grace period given for payment of health assure premiums so they don’t lapse. It is advisable to pay premiums well in advance to get the maximum benefits of your health assure plans.