|Step 1||For any planned hospitalization, kindly intimate to TPA and seek cashless authorization atleast 72 hours prior to the start of the hospitalization.|
|Step 2||For any emergency hospitalization, inform TPA within 48 hours of the hospitalization.|
|Step 3||TPA will check your coverage as per the eligibility and send a cashless authorization letter to the hospital within 3 hours post receipt of complete documents. In case there is any deficiency in the documents sent, the same will be communicated to the hospital within 3 hours of receipt of documents.|
|Step 4||Please pay the non medical and expenses which are not covered to the hospital prior to the discharge.|
|Step 5||In case the ailment/treatment is not covered under the policy, a rejection letter would be sent to the hospital Within 2 hours.|
|Reimbursement Claims Process|
|Step 1||In case of hospitalization notify Royal Sundaram within 24-48 hours of your admission in our network or non network hospital. After getting admitted settle bills directly to the hospital.|
|Step 2||On discharge, please ensure you collect all relevant documents, invoices, medical reports and discharge certificate from the Hospital in originals.|
|Step 3||Send these documents and the completely filled and signed claim form to us along with your valid ID proof and age proof. The claim form is available on the company website and in your policy document kit as well.|
|Step 4||We review your claim request and the supporting documents provided along with the claim form. Accordingly based on policy terms & conditions, Royal Sundaram will approve, query or reject the same.|
|Step 5||Subject to the claim being approved, Royal Sundaram will settle the claim (as per policy terms & conditions) and reimburse the approved amount to the insured.|
The earlier the better, typically, everyone should consider buying a health insurance policy in their early 20's and one has just started earning. Health insurance also helps in planning within a family to ensure there is financial coverage in case of an unexpected health emergency. It also offers wider coverage at a lower premium.
Looking at the healthcare inflation cost coupled with the lifestyle disease epidemic, health insurance is needed to help you pay for health care in the event of an unexpected illness or injuries. Health insurance covers medical uncertainties and ensures quality medical treatment at the time of need.
You can buy 2 years or 3 years policy in Lifeline. You get a discount of 7.5% for 2 year policy tenure and 12% for 3 year policy tenure.
|Age/Sum Insured||Sum Insured upto Rs.5lacs||Sum Insured Rs.10lacs, 15lacs & Rs.20lacs||Sum Insured above Rs.20lacs|
|Upto 5 years||No Check-up#||No Check-up#||No Check-up#|
|6 years to 18 years||No Check-up#||No Check-up#||MER|
|19 years to 45 years||No Check-up#||CBC, ESR, URA, MER, FBS/HbA1C,S Cholesterol, ECG, SGPT, S Creatinine||CBC, ESR, URA, MER, HbA1C, Lipid Profile, TMT or 2D Echo, LFT with GGT, RFT, HBsAg, S Creatinine|
|46 years and above||CBC, ESR, URA, MER, FBS/HbA1C, S Cholesterol, ECG, SGPT, S Creatinine||CBC, ESR, URA, MER, HbA1C, Lipid Profile, TMT or 2D Echo, LFT with GGT, RFT, HBsAg, S Creatinine||CBC, ESR, URA, MER, HbA1C, Lipid Profile, TMT or 2D Echo, LFT with GGT, RFT, HBsAg, S Creatinine|
Your ideal sum insured or total coverage would highly depend on factors such as your current age, lifestyle, medical history, income and place of residence. Looking at the medical inflation, most of our customers prefer a health insurance policy with a sum insured of 5 lacs and above.
If you ever exhaust your health cover due to claims in a given year and there is a further claim either by you for a different illness or your insured family member, we will reload the entire sum insured of your policy at no extra cost. Reloaded sum insured will help you to settle those claims. Reload of Sum Insured is triggered when the claim amount exceeds the available sum insured including the NCB for a different illness or different person. Restore will not be triggered for second claim (of different illness or different person) of Rs.1lac and only Rs.50,000 will be paid. Whereas, Reload will be triggered and entire Rs,1lac will be paid).
Lifeline offers 10% of Sum Insured upto a max of 50% of Sum Insured for Classic Plan and 20% of Sum Insured upto a max of 100% for Supreme and Elite plan. Unlike NCB offered by other policies, there is no penalty in case of claim. Thus NCB earned by you remains as is even if you claim. For eg, if you have a policy with SI of Rs.5lacs (Supreme Plan) and there has been no claim in the first year, then at the time of renewal you will get a NCB of 20% (Rs.1lac). In second year, if you claimed then on second renewal your NCB of Rs.1lac will remain intact and it will not be reduced.
Absolutely! With employee health cover the major drawbacks come in picture when you leave your job that's when your policy goes out of action and exposes you to health risks. Your new employer may or may not cover you sufficiently. Also, having your own policy means a better buying decision and complete control to buy a cover which suits your requirement from time to time.
Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.
No. There is no capping on room rent category and customer can choose from any of the room available in hospital.
Royal Sundaram has an extensive network of 5,000+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the hospital closest to them by going through the Royal Sundaram network hospital list available on https://www.eindiainsurance.com/royal-sundaram/health/
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.
A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.
It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.
Individual plan has to be separate for every individual. Floater covers all in family (max. 2 Adults and Children upto 25 years and Dependent parents) and provides one sum insured to all, hence there is saving of premium.
There is No maximum exit age for this policy.
The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!
The duration only after which a claim can be made is called the waiting period.
Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs
A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.
Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.
Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans..Click here to read more