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Mediclaim :

New guidelines of Health Insurance claims
*Rules and guidelines :

IRDA came out with *Health Insurance Regulations, 2016* for the entire medical insurance (mediclaim) industry. These regulations should benefit the over 20 crore citizens, who own a medical insurance (private and state) policy in India.

Main features of the Health Insurance Regulations (HIR), 2016
Related to Claims:

• *TPA is not permitted to settle/ reject/ repudiate claims*, as per Sec 33(c) of HIR 2016

• The claims settlement (rejection) letter should mention the specific *grounds for denial/ rejection of claim*, as per Sec 33(d)(iv) of HIR 2016

• Consumer will *get interest of 2% over the prevailing bank rates, on claims payment delayed beyond 30 days* and will have to mentioned in the policy document, as per Sec 28(iv) of HIR 2016

• The *claims payment* will be made from the Insurer’s bank account and *not the TPA’s*, as per Sec 32 of HIR 2016 Earlier claim cheques were issued to the customer by the TPA (Third party Administrator), but now the insurance company would have to write a claim cheque or ECS directly to the customer. This would eliminate the float that some of the TPAs were enjoying. Also, there was never any public audit of the claims funds sanctioned by the Insurance company v/s actual amount disbursed by the TPA.

• TPA has to electronically transfer the claims document to Insurer for a decision as per Sec 35(a) of HIR 2016

• The TPA will ask for claims related *papers in one time only*, and not in a piece meal manner as per Sec 27(ii) of HIR 2016

• Non-allopathic (AYUSH) treatments may be covered, as per Sec 18 of HIR 2016

• Fees to the TPA shall not be related to reduction of claims costs as per Sec 20(6) of Health Services Regulations for TPA, 2016

• Discounts offered by hospitals have to passed on to the policyholders, as per Sec 20(9) of Health Services Regulations for TPA, 2016

• Change of TPA will be intimated to the consumer in writing 30 days before hand as per Sec 34(a) of HIR 2016

Related to policy document:
• Premium for individual policies cannot be increased at renewals in an arbitrary way, especially after a claim is made, as per Sec 25(i) of HIR 2016.

• There will be no change in premiums in individual policies *for 3 years* after initial offering, as per Sec 10(c) of HIR 2016

• Cannot force consumer to shift to other product as per Sec 11(c) and 17 of HIR 2016

• All policies will be ordinarily renewable as per Sec 13 of HIR 2016

• Customer Information Sheet must be part of the policy document, as per sec 26 of HIR, 2016

• *ID card to have logo of Insurance company (not of TPA)* and the card may be permanent, as per Sec 30(f) of HIR 2016

• Policy is portable from one Insurer to another, 45 days prior to maturity of policy (including cumulative bonus would also be portable), as per Schedule I, Sec(1) & (18) of HIR 2016

• Free-look period is 15 days as per Sec 14 of HIR 2016

• Cumulative bonus amount to be clearly mentioned in the policy, as per sec 16(i) of HIR, 2016

• All disclosures as per the new regulations have to be included in the policy document, as per sec 28 of HIR, 2016

• For multiple policies, claims under other policy can be made after exhaustion of Sum Insured in the earlier policy, as per Sec 24 (ii)2 of HIR 2016. The option to chose will remain with the insured


Related to Senior citizens:

• Entry age is *up to 65 years* and there will not be any exit date for a policy as per Sec 12 of HIR 2016

• Premiums shall be fair, justified, transparent and duly disclosed upfront, as per Sec 23(i) of HIR 2016

• Separate claims & grievance cell, as per Sec 23(ii) of HIR 2016

Other regulations:
• Withdrawal of a product needs prior IRDA approval and atleast 3 months notice, as per Sec 5(ii) of HIR 2016

• Group Insurance cannot be offered to groups specifically formed to avail insurance, as per Sec 7(a) of HIR 2016

• Pre-insurance check-up cost included in premium as per Sec 15(i) of HIR 2016


Important precautions to be taken in case of claims:

• Best option for the consumer is to obtain Cashless facility i.e. the Insurance company pays the bills directly to the hospital. But the hospital must be part of their preferred network (PPN), which list should be available on the insurance company website.

• If you wish to take treatment in a hospital, which is not on the PPN cashless list, then make sure you intimate the Insurance company/ TPA within 24 hours of admission in any hospital.

• In case of a pre-planned surgery, it is better to inform the Insurance company/ TPA much earlier.

• As per IRDA’s guidelines to the Insurance companies, *the consumer cannot be forced to sign the discharge or Settlement Intimation voucher*. Signing the discharge voucher does not mean that the Insurer’s liability is over.


Disputes resolution, especially Claims processing

For claims-related complaints, consumers can write to the Grievance cell of the Insurance company. As per IRDA guidelines, grievances must be acknowledged by the Insurance company in 3 working days and it must be *resolved in 15 working days*. If there is no response to the letter, you can file a Right to Information (RTI) application with the Grievance Officer.
The *IRDA Call Centre (toll-free at 155255*) also offers an alternative channel for policyholders, serving from 8 AM to 8 PM, Monday to Saturday in Hindi, English and various Indian languages.

You can also write to *[email protected]* or online or through post at:
Consumer Affairs Department
Insurance Regulatory and Development Authority (IRDA)
3rd floor, Parishram Bhavan,
Basheer Bagh, Hyderabad

For still unresolved disputes of *less than Rs 20 lakhs* pertaining to claims settlement or regarding premiums paid/ payable and non-issue of insurance documents, the *Insurance Ombudsman* can be approached. The written complaint with the relevant claim papers can be send by the customer himself (*no lawyer is required*), within 1 year of dispute. After registering with the Ombudsman office, attach this application document.
Contact details of Insurance Ombudsmen in India

*Contact Details*
Jurisdiction
MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai – 400 054.
Tel.:- 022-26106928/360/889
Fax:- 022-26106052
Email:- *[email protected]* or
[email protected]

States of Maharashtra and Goa.
AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:- [email protected]

State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu.
BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar,
Opp.Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- [email protected]

States of Madhya Pradesh and Chattisgarh.
BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.:- 0674-2535220/3798/1607
Fax:- 0674-2531607
Email:- [email protected]
State of Orissa.

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd
Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.:- 0172-2706196/5861/6468
Fax:- 0172-2708274
Email:- [email protected]

States of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh.
CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai,
Teynampet,
CHENNAI – 600 018.
Tel.:- 044-24333678/664/668
Fax:- 044-24333664
Email:- [email protected]

State of Tamil Nadu and Union Territories – Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry).
DELHI
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:- [email protected]

States of Delhi and Rajasthan.
GUWAHATI
Office of the Insurance Ombudsman,
‘Jeevan Nivesh’, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.:- 0361-
2132204/2131307/2132205
Fax:- 0361-2732937
Email:- [email protected]

States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura.
HYDERABAD
Office of the Insurance Ombudsman,
6-2-46, 1st floor, “Moin Court”
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad – 500 004.
Tel.:- 040-23325325/23312122
Fax:- 040-23376599
Email:- [email protected]

States of Andhra Pradesh, Karnataka and Union Territory of Yanam – a part of the Union Territory
of Pondicherry.
KOCHI
Office of the Insurance Ombudsman,
2nd Floor, CC 27 / 2603, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam – 682 015.
Tel.:- 0484-2358734/759/9338
Fax:- 0484-2359336
Email:- [email protected]

State of Kerala and Union Territory of (a) Lakshadweep (b) Mahe-a part of Union Territory of Pondicherry.

KOLKATA
Office of the Insurance Ombudsman,
North British Bldg., 3rd Floor,
29, N. S. Road,
Kolkata – 700 001.
Tel.:- 033-22134869/67/66
Fax:- 033-22134868
Email:- [email protected]
States of West Bengal, Bihar, Sikkim, Jharkhand and Union Territories of Andaman and Nicobar Islands.

LUCKNOW
Office of the Insurance Ombudsman,
6th Floor, Jeevan Bhawan,
Phase-II, Nawal Kishore Road,
Hazratganj,
Lucknow-226 001.
Tel.:- 0522-2201188/31330/1
Fax:- 0522-2231310.
Email:- [email protected]
States of Uttar Pradesh and Uttaranchal.

Other general guidelines:

• Generally *Family floater policy* is cheaper than buying individual policies for family members.

• Generally *bed charges are 1-2%* of the sum assured, depending on your Insurance carrier. All other charges like doctor visit etc. are often related to this bed charge, so it is important to be within these limits.

• Co-Pay means that a certain percentage or a certain fixed amount of the claim has to be borne by the policyholder. If co-pay is 15%, then whatever is the hospital bill you will have to pay the 15% and balance 85% only will be paid by the Insurance company.

• Generally *exclusions and pre-existing diseases* are not covered by a medical insurance policy (as specified in their policy document). Generally these *could be covered after 2 years of holding the policy*. Consumer must be honest in disclosing pre-existing ailments, if any.

• Policy can be *renewed within 15 days grace period* after expiry of the policy. However coverage is not available for the days for which the premium was not received by the Insurance company.

• One can transfer the policy from one Insurance company to another and the credits (including cumulative bonus) would also be portable.

• New policy should be issued within 15 days of submission of proposal

• To keep a check that people don’t try to take a policy where they have been diagnosed with some illness and they require immediate hospitalization, a *30 day waiting period* is kept, where Insurance Company will not pay any kind of claim within the first 30 days of taking the new policy, (*exception is that if policyholder meets an accident* then the claim is payable).

• Under Section 80D, *annual deductions* upto Rs 25,000 can be availed of (Rs 30,000 for senior citizens)

*50 Financial Mistakes and Illusions*
( Which ones are you guilty of ?)

1. Just can’t manage to fit our Expenses within our Income. And, even when the income increases, the expenses invariably rise much faster.

2. Generosity is in our blood. We happily pay 30-50% p.a. as interest charges to the Credit Card companies.

3. We respect our culture and old customs. We keep our money in the OUTDATED Bank Fixed Deposits.

4. Another example of respect for our tradition… creating a huge pile of (useless) gold jewellery.

5. Yet another example of holding our customs in high esteem… feeling proud if we can leave behind a "20-25 year old dilapidated property" for our children as a legacy [and not a "20-25 year old equity mutual fund portfolio"].

6. Spent more than half a lakh of rupees on a top-end smartphone — just to show off (even though we will not use even one tenth of its smart features).

7. Replaced the same top-end smartphone in just 6 months? Oops... wasn’t it smart even after paying all that money? (Psst... the new model is no different from the previous one, except for some minor tweaks).

8. Haven’t read the blog post ‘My name is Insurance and I am not an investment’.

9. More than 50-60% of the monthly take-home pay is gobbled up and devoured by various loan EMIs.

10. Hotel and restaurant owners love you. You are found at these places, far more than even their most regular staff members.

11. For you (financial) PLAN is a four-letter insulting and derogatory word.

12. Believing that “budget” is only the Finance Minister’s job, not ours.

13. Believing that “managing inflation” is RBI’s problem, not ours.

14. Financial lethargy... not paying the bills by the due date (often resulting in late fees and penal interest).

15. Financial shortsightedness... thinking only of today or tomorrow; and not the next year or next decade.

16. Still waiting for the so-called BEST DAY to invest in equity mutual funds.

17. Never seen our Credit Report, even though it is now available free of cost... forget about working to improve the Credit Score.

18. The Emergency Fund account shows a Zero Balance.

19. 99% focus on earning money. Mere 1% attention on managing the same.

20. Never heard of (or not knowing the meaning of) "delayed gratification".

wasteful-money-habits
You may be blowing away your money due to carelessness and stupidity.

21. Repeatedly falling below the minimum average monthly balance in one's Savings Account or conversely keeping large liquid funds in Savings accounts.

22. Making our neighbours jealous with our extravagant lifestyle is our life's primary goal.

23. Replace is our motto. We don’t believe in Repair and Reuse.

24. Blindly and needlessly chasing Maximum Returns from our investments.

25. You ask "what does this investment or financial product offer" instead of "how is this investment or financial product beneficial for me."

26. Investing in the world’s biggest con job — a scheme that has the word “child” in it.

27. Paying Rs.150-200 for a cup of coffee, when the same stuff is available at 1/4th the price.

28. You suffer from ‘investment paralysis’ due to Fear of Loss.

29. Not having a ‘professional’ financial mentor as your friend, philosopher and guide.

30. Blissfully unaware that Gym is an expensive fad. Running, walking, yoga are free and superior alternatives to remain as fit.

31. IRR, YTM, CAGR are bouncers that simply go over your head.

32. You think you can beat Roger Federer.

33. SIP, STP and SWP is all mumbo jumbo for you.

34. Hear the word RISK and your legs go jelly with anxiety.

35. Hear the word TAX and again your legs go jelly with anxiety.

36. Spending Rs.250 on a pizza every week? No issues at all. Buying a Rs.250 book on personal finance even once a year? No, that’s a waste of money.

37. In your opinion Stock Market is a Casino and buying equity shares is gambling.

38. If you think that ups and downs are good only at roller coaster rides; and not at the stock markets.

39. The word Pension is music to your ears.

40. Our portfolio is a carbon copy of Rakesh Jhunjhunwala.

41. The biggest gamble we play with our finances — no mediclaim policy.

42. THICK forms and FINE prints scare you.

43. Not yet realized that SUVs burn more fuel, burn more money, burn more environment (thus creating a hell for our children).

44. Not yet realized that Extended Warranties are almost always a waste of money.

45. You are more brand-conscious than price-conscious.

46. Pay for 400+ cable channels. Watch at most 10-12 of them (many of which are anyway free).

47. BUY TWO GET ONE FREE. One of the best ways to make money... for the mall owners.

48. We shamelessly (and foolishly) seek free financial advice and tips on hot stocks.

49. Buying lavish and luxurious Dream Homes, way bigger than our budgets (that often end up as bad dreams).

50. Our plate is often filled with pizzas, burgers, samosas, chips, colas and such other junk food.

51. We forget that “Trust” is an extremely rare commodity in the financial world.

This is a comparison of inflation, gold,f.d,sense,PPF,lic bonus

Simple calculation of taxation for all...

MOST IMPORTANT. Mediclaim: RULES ®ULATIONS

New guidelines of Health Insurance claims
*Rules and guidelines :

IRDA came out with *Health Insurance Regulations, 2016* for the entire medical insurance (mediclaim) industry. These regulations should benefit the over 20 crore citizens, who own a medical insurance (private and state) policy in India.

Main features of the Health Insurance Regulations (HIR), 2016
Related to Claims:

• *TPA is not permitted to settle/ reject/ repudiate claims*, as per Sec 33(c) of HIR 2016

• The claims settlement (rejection) letter should mention the specific *grounds for denial/ rejection of claim*, as per Sec 33(d)(iv) of HIR 2016

• Consumer will *get interest of 2% over the prevailing bank rates, on claims payment delayed beyond 30 days* and will have to mentioned in the policy document, as per Sec 28(iv) of HIR 2016

• The *claims payment* will be made from the Insurer’s bank account and *not the TPA’s*, as per Sec 32 of HIR 2016 Earlier claim cheques were issued to the customer by the TPA (Third party Administrator), but now the insurance company would have to write a claim cheque or ECS directly to the customer. This would eliminate the float that some of the TPAs were enjoying. Also, there was never any public audit of the claims funds sanctioned by the Insurance company v/s actual amount disbursed by the TPA.

• TPA has to electronically transfer the claims document to Insurer for a decision as per Sec 35(a) of HIR 2016

• The TPA will ask for claims related *papers in one time only*, and not in a piece meal manner as per Sec 27(ii) of HIR 2016

• Non-allopathic (AYUSH) treatments may be covered, as per Sec 18 of HIR 2016

• Fees to the TPA shall not be related to reduction of claims costs as per Sec 20(6) of Health Services Regulations for TPA, 2016

• Discounts offered by hospitals have to passed on to the policyholders, as per Sec 20(9) of Health Services Regulations for TPA, 2016

• Change of TPA will be intimated to the consumer in writing 30 days before hand as per Sec 34(a) of HIR 2016

Related to policy document:
• Premium for individual policies cannot be increased at renewals in an arbitrary way, especially after a claim is made, as per Sec 25(i) of HIR 2016.

• There will be no change in premiums in individual policies *for 3 years* after initial offering, as per Sec 10(c) of HIR 2016

• Cannot force consumer to shift to other product as per Sec 11(c) and 17 of HIR 2016

• All policies will be ordinarily renewable as per Sec 13 of HIR 2016

• Customer Information Sheet must be part of the policy document, as per sec 26 of HIR, 2016

• *ID card to have logo of Insurance company (not of TPA)* and the card may be permanent, as per Sec 30(f) of HIR 2016

• Policy is portable from one Insurer to another, 45 days prior to maturity of policy (including cumulative bonus would also be portable), as per Schedule I, Sec(1) & (18) of HIR 2016

• Free-look period is 15 days as per Sec 14 of HIR 2016

• Cumulative bonus amount to be clearly mentioned in the policy, as per sec 16(i) of HIR, 2016

• All disclosures as per the new regulations have to be included in the policy document, as per sec 28 of HIR, 2016

• For multiple policies, claims under other policy can be made after exhaustion of Sum Insured in the earlier policy, as per Sec 24 (ii)2 of HIR 2016. The option to chose will remain with the insured


Related to Senior citizens:

• Entry age is *up to 65 years* and there will not be any exit date for a policy as per Sec 12 of HIR 2016

• Premiums shall be fair, justified, transparent and duly disclosed upfront, as per Sec 23(i) of HIR 2016

• Separate claims & grievance cell, as per Sec 23(ii) of HIR 2016

Other regulations:
• Withdrawal of a product needs prior IRDA approval and atleast 3 months notice, as per Sec 5(ii) of HIR 2016

• Group Insurance cannot be offered to groups specifically formed to avail insurance, as per Sec 7(a) of HIR 2016

• Pre-insurance check-up cost included in premium as per Sec 15(i) of HIR 2016


Important precautions to be taken in case of claims:

• Best option for the consumer is to obtain Cashless facility i.e. the Insurance company pays the bills directly to the hospital. But the hospital must be part of their preferred network (PPN), which list should be available on the insurance company website.

• If you wish to take treatment in a hospital, which is not on the PPN cashless list, then make sure you intimate the Insurance company/ TPA within 24 hours of admission in any hospital.

• In case of a pre-planned surgery, it is better to inform the Insurance company/ TPA much earlier.

• As per IRDA’s guidelines to the Insurance companies, *the consumer cannot be forced to sign the discharge or Settlement Intimation voucher*. Signing the discharge voucher does not mean that the Insurer’s liability is over.


Disputes resolution, especially Claims processing

For claims-related complaints, consumers can write to the Grievance cell of the Insurance company. As per IRDA guidelines, grievances must be acknowledged by the Insurance company in 3 working days and it must be *resolved in 15 working days*. If there is no response to the letter, you can file a Right to Information (RTI) application with the Grievance Officer.
The *IRDA Call Centre (toll-free at 155255*) also offers an alternative channel for policyholders, serving from 8 AM to 8 PM, Monday to Saturday in Hindi, English and various Indian languages.

You can also write to *[email protected]* or online or through post at:
Consumer Affairs Department
Insurance Regulatory and Development Authority (IRDA)
3rd floor, Parishram Bhavan,
Basheer Bagh, Hyderabad

For still unresolved disputes of *less than Rs 20 lakhs* pertaining to claims settlement or regarding premiums paid/ payable and non-issue of insurance documents, the *Insurance Ombudsman* can be approached. The written complaint with the relevant claim papers can be send by the customer himself (*no lawyer is required*), within 1 year of dispute. After registering with the Ombudsman office, attach this application document.
Contact details of Insurance Ombudsmen in India

*Contact Details*
Jurisdiction
MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai – 400 054.
Tel.:- 022-26106928/360/889
Fax:- 022-26106052
Email:- *[email protected]* or
[email protected]

States of Maharashtra and Goa.
AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:- [email protected]

State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu.
BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar,
Opp.Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- [email protected]

States of Madhya Pradesh and Chattisgarh.
BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.:- 0674-2535220/3798/1607
Fax:- 0674-2531607
Email:- [email protected]
State of Orissa.

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd
Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.:- 0172-2706196/5861/6468
Fax:- 0172-2708274
Email:- [email protected]

States of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh.
CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai,
Teynampet,
CHENNAI – 600 018.
Tel.:- 044-24333678/664/668
Fax:- 044-24333664
Email:- [email protected]

State of Tamil Nadu and Union Territories – Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry).
DELHI
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:- [email protected]

States of Delhi and Rajasthan.
GUWAHATI
Office of the Insurance Ombudsman,
‘Jeevan Nivesh’, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.:- 0361-
2132204/2131307/2132205
Fax:- 0361-2732937
Email:- [email protected]

States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura.
HYDERABAD
Office of the Insurance Ombudsman,
6-2-46, 1st floor, “Moin Court”
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad – 500 004.
Tel.:- 040-23325325/23312122
Fax:- 040-23376599
Email:- [email protected]

States of Andhra Pradesh, Karnataka and Union Territory of Yanam – a part of the Union Territory
of Pondicherry.
KOCHI
Office of the Insurance Ombudsman,
2nd Floor, CC 27 / 2603, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam – 682 015.
Tel.:- 0484-2358734/759/9338
Fax:- 0484-2359336
Email:- [email protected]

State of Kerala and Union Territory of (a) Lakshadweep (b) Mahe-a part of Union Territory of Pondicherry.

KOLKATA
Office of the Insurance Ombudsman,
North British Bldg., 3rd Floor,
29, N. S. Road,
Kolkata – 700 001.
Tel.:- 033-22134869/67/66
Fax:- 033-22134868
Email:- [email protected]
States of West Bengal, Bihar, Sikkim, Jharkhand and Union Territories of Andaman and Nicobar Islands.

LUCKNOW
Office of the Insurance Ombudsman,
6th Floor, Jeevan Bhawan,
Phase-II, Nawal Kishore Road,
Hazratganj,
Lucknow-226 001.
Tel.:- 0522-2201188/31330/1
Fax:- 0522-2231310.
Email:- [email protected]
States of Uttar Pradesh and Uttaranchal.

Other general guidelines:

• Generally *Family floater policy* is cheaper than buying individual policies for family members.

• Generally *bed charges are 1-2%* of the sum assured, depending on your Insurance carrier. All other charges like doctor visit etc. are often related to this bed charge, so it is important to be within these limits.

• Co-Pay means that a certain percentage or a certain fixed amount of the claim has to be borne by the policyholder. If co-pay is 15%, then whatever is the hospital bill you will have to pay the 15% and balance 85% only will be paid by the Insurance company.

• Generally *exclusions and pre-existing diseases* are not covered by a medical insurance policy (as specified in their policy document). Generally these *could be covered after 2 years of holding the policy*. Consumer must be honest in disclosing pre-existing ailments, if any.

• Policy can be *renewed within 15 days grace period* after expiry of the policy. However coverage is not available for the days for which the premium was not received by the Insurance company.

• One can transfer the policy from one Insurance company to another and the credits (including cumulative bonus) would also be portable.

• New policy should be issued within 15 days of submission of proposal

• To keep a check that people don’t try to take a policy where they have been diagnosed with some illness and they require immediate hospitalization, a *30 day waiting period* is kept, where Insurance Company will not pay any kind of claim within the first 30 days of taking the new policy, (*exception is that if policyholder meets an accident* then the claim is payable).

• Under Section 80D, *annual deductions* upto Rs 25,000 can be availed of (Rs 30,000 for senior citizens)

Dr Ramakant Mahawar Kolkata [email protected]
8981367505

*LIFE AFTER 45*
An interesting article.

*_Life can begin at 45*
It is all in your hands!
Many people feel unhappy, health-wise and security-wise, after 60 years of age, owing to the diminishing importance given to them and their opinions. But, it need not be so, if only we understand the basic principles of life and follow them scrupulously. Here are ten mantras to age gracefully and make life after retirement pleasant.

1. *Never say I am aged'* :
There are three ages, chronological, biological, and psychological. The first is calculated based on our date of birth; the second is determined by the health conditions; the third is how old we feel we are. While we don't have control over the first, we can take care of our health with good diet, exercise and a cheerful attitude. A positive attitude and optimistic thinking can reverse the third age.

2. *Health is Wealth:*
If you really love your kith and kin, taking care of your health should be your priority. Thus, you will not be a burden to them. Have an annual health check-up and take the prescribed medicines regularly. Do take health insurance coverage.

3. *Money is important:*
Money is essential for meeting the basic necessities of life, keeping good health and earning family respect and security. Don't spend beyond your means even for your children. You have lived for them all through and it is time you enjoyed a harmonious life with your spouse. If your children are grateful and they take care of you, you are blessed. But, never take it for granted.

4. *Relaxation and Recreation:*
The most relaxing and recreating forces are a healthy religious attitude, good sleep, music and laughter. Have faith in God, learn to sleep well, love good music and see the funny side of life.

5. *Time is Precious:*
It is almost like holding a horses' reins. When they are in your hands, you can control them. Imagine that everyday you are born again. Yesterday is a cancelled cheque. Tomorrow is a promissory note. Today is ready cash - use it profitably. Live this moment; live it fully, now, in the present time.

6. *Change is the only Permanent Thing:*
We should accept change - it is inevitable. The only way to make sense out of change is to join in the dance. Change has brought about many pleasant things. We should be happy that our children are blessed.

7. *Enlightened Selfishness:*
All of us are basically selfish. Whatever we do, we expect something in return. We should definitely be grateful to those who stood by us. But, our focus should be on the internal satisfaction and the happiness we derive by doing good for others, without expecting anything in return. Perform a random act of kindness daily.

8. *Forget and Forgive:*
Don't be bothered too much about others' mistakes. We are not spiritual enough to show our other cheek when we are slapped in one. But for the sake of our own health and happiness, let us forgive and forget them. Otherwise, we will be only increasing our blood pressure.

9. *Everything has a Purpose:*
Take life as it comes. Accept yourself as you are and also accept others for what they are. Everybody is unique and is right in his own way.

10. *Overcome the Fear of Death:*
We all know that one day we have to leave this world. Still we are afraid of death. We think that our spouse and children will be unable to withstand our loss. But the truth is no one is going to die for you; they may be depressed for some time. Time heals everything and they will go on.

*Pass to all 40 plus you may know* 🙏