At times, one may find that the sum insured in a health insurance plan gets exhausted during hospitalisation. The out-of-pocket expense may be substantial if the medical bill is large and your sum insured is low. A new health insurance plan has been launched that even bears the additional cost provided the policyholder bears a portion of that additional expense. Bajaj Allianz General Insurance has launched ‘Health Infinity’, which according to the insurer is the industry’s first individual health insurance policy that provides unlimited Sum Insured (SI).
Under Health Infinity, a person can choose coverage limit according to the per day room rent options which range between Rs. 3, 000 – Rs. 50,000. Based on the chosen option, the policyholder will be indemnified 100 times of the per day room rent limit. In other words, if one chooses Rs 4,000 as the per day room rent, the coverage will be up to 100 times i.e. up to Rs 4 lakh. However, coverage and the claim amount doesn’t end there. Beyond, the limit of 100 times, if the claim amount exceeds, a co-payment of 15 per cent, 20 per cent, or 25 per cent is applicable as opted by the customer at the time of purchasing the policy. This co-payment is applicable only on the claim amount which exceeds 100 times room rent and not on the total claim amount.
This policy covers in-patient hospitalization treatment without any sub-limit and can be bought for a period of 1 year, 2 years or 3 years. The premium of this policy will vary depending on the age of the proposer, per day room rent opted and the co-payment option availed. As per the insurer, for a 40-year-old person, the premium for Rs.10,000 per day room is approx. Rs. 14,600 excluding tax.
Health Infinity will cover pre-hospitalization medical expenses of 60 days, post-hospitalization of 90 days, road ambulance expenses up to Rs. 5000 per hospitalisation and daycare procedures as listed in the policy document. The policy offers wellness discount, family discount and long term policy discount depending on policy terms and conditions.
Through this policy, you could also opt for individual sum insured for your spouse, dependent children and parents as per applicable premium rate based on age of each family member. The entry age for this policy is 18 years – 65 years and for dependent children, it’s 3 months – 25 years.
Pre-existing diseases are covered after 36 months. Under Health Infinity, insured can avail preventive health check-up at the end of every 3 consecutive policy years. Moreover, no pre-policy medical tests are required for up to 45 years of age in case of a clean proposal form.
Here’s an illustration explaining the co-payment if claim amount exceeds per day room rent limit:
Amit has opted the policy with room rent limit of Rs. 5000 per day with 20 per cent co-payment option. He meets with an accident and incurs expenses of Rs. 750,000 during the hospitalization. He has opted for a private room with per day room rent of Rs. 4000, which is within the room rent limit opted.
As per the policy condition, there is no co-payment up to 100 times of room rent limit, in this case, there is no co-pay up to Rs. 500,000.
Over and above Rs. 500,000, 20% co-payment ( Rs 50,000) would apply for additional claim amount of Rs. 250,000.
Total amount payable by the insurer is Rs. 7 lakh.
The plan needs you to choose the per day room rent and the co-payment option. However, the co-payment option comes into play only when the hospitalisation cost exceeds the limit of 100 times of per day room rent. The Health Infinity is not a plain-vanilla health insurance policy as far as its working is concerned. It’s better to discuss with the insurer about its claim process, inclusions and exclusions before taking a call.
Main Source - Financialexpress