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What is covered in your Standard Health Insurance Policy & what is excluded?

Insurance policy is for the protection of the insured against unforeseen circumstances, which in Health Insurance primarily covers hospitalisation for illness / injury / diseases taken in any hospital as an inpatient anywhere in India. The requirement is that the ailment should have been contracted or the injury sustained only during the currency of the policy and they should not fall under any of the specified exclusions.

Please note, this is only an extract of a standard policy. The coverage, the Exclusions as well as the Terms and Conditions would vary from Insurer to Insurer and product to product. All terms and conditions as per the policy document issued to you by your insuring Insurance Company is final for all purposes.

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2. Any disease other than those stated in the third exclusion below contracted by the insured person during the first 30 days from the commencement date of the policy. This exclusion shall not however apply if in the opinion of the Panel of Medical Practitioners constituted by the Company for this purpose, the insured person could not have known of the existence of the disease or any symptoms or complaints thereof at the time of making the proposal for insurance to the Insurance company. This condition shall not however apply in case of the insured person having been covered under this scheme or group insurance with any of the India Insurance companies for a continuous period of preceding 12 months without any break.

3. During the first year of the operation of Insurance cover, the expenses on treatment of disease such as Cataract, Benign Prostate Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal disease/defect, Fistula in anus, piles, Sinusitis and related disorders are not payable. If these diseases (other than congenital internal diseases/defect) are pre existing at the time of proposal they will not be covered even during subsequent period of renewal. If insured is aware of the existence of congenital internal diseases/defect before inception of policy it will be treated as pre-existing. Sometimes the policies exclude some of the diseases/ procedures for a period longer than 1 year like Knee Replacement/ Hip Replacement for 4 years.

Please note, the above are Standard exclusions only. Please contact the local Vidal Health TPA office or your Insurance Agent/Company for details on Specific exclusions along with your policy copy.

Jaume is a Political Science graduate, specialising in International Relations, with a 15-year strong career on public health issues. His particular area of interest is the intersection between intellectual property rights, innovation, access to health technologies and human rights. His professional experience includes roles in various international organisations, think tanks and non-government organisations.

The Insurance Repository will provide policyholders the facility to keep insurance policies in electronic form reducing the need for safekeeping a document. It will act as a single platform for making any changes in the same.

In a dramatic reversal of the trend that existed just three years ago, big corporate hospitals today charge health insurance card holders much less than those paying in cash for the same procedures. Those paying out of their pockets are now billed anywhere between 25% and 60% more than those with cashless health insurance schemes.

Reimbursement of the hospitalization expenses can be claimed where Cashless Hospitalisation facility is not availed or treatment is availed in a Non-network Hospital. You will have to settle the hospital bill, collect all original hospitalisation documents and submit the documents to our office for their scrutinizing the same in terms of the policy and check the admissibility or otherwise of the claim/ expenses.

FOCUS

Cristina believes in building systems that uplift the dignity, ingenuity, and health of communities. Disadvantaged rural and unincorporated communities are often excluded from policymaking consideration due to their low numbers and limited influence, despite their ability to remain resilient with limited resources. Her research is focused on examining how government systems and participatory processes either enable or restrain small population communities from accessing resources to address their health and well-being needs. This research promotes the development of more socially and politically inclusive systems.

Advances in population health outcomes risk being slowed-and potentially reversed-by a range of threats increasingly presented as 'fragility'. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of 'fragile and conflict-affected states'. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.

REMEMBER! - Vidal Health Insurance TPA Health Card issued to you is NOT a Credit Card, it is just complementary to your Mediclaim policy, and only on verification of your coverage, will you be given CASHLESS treatment Your cashless treatment will begin at the hospital, only after the hospital receives Authorisation confirming the same.

(1) Claim Intimation/Notification

Under Mediclaim, in case of hospitalisation, the policy holder should primarily ensure that the Vidal Health Insurance TPA Pvt. Ltd. is informed within 7 days of the hospitalisation. This preliminary notice should be submitted to Vidal Health Insurance TPA Pvt. Ltd. prior to the claim and the same should contain the following particulars:

Information is the first step towards staying healthy. This section would help you understand the ailment and the common symptoms associated with it and the most adept treatment mechanism to combat the same.

On the date of discharge hospital team have to send the final bill with break up and discharge summary to Vidal Health Insurance TPA Pvt Ltd. After the receipt, within 2 hrs the enhancement (as per policy limits) will be processed after deducting the non medical expenses (paid by the patient) and approval letter will be sent to hospital fax or email.

Note: - Co pay (if applicable) has to be paid by the Policy holder

Some of the Hospitals are Preferred Provide Network (PPN), Gipsa and Hospital tariff, if cashless is taken in those hospitals the final approval will be as per the respective tariff.

Minimum 24 hours of hospitalization (if not day-care) with active line of treatment is required for cashless treatment

However, there are a few specific ailments specified in the policy which can be covered even though the period of hospitalization is less than 24 hours. Such as

Dialysis, Chemotherapy, Radiotherapy, Eye Surgery etc.,

Vidal Health Insurance TPA Pvt. Ltd. will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected.

Vidal Health Insurance TPA Pvt. Ltd. will correspond with you within 7 days of Claim receipt -

If Documents are not completed then Vidal Health insurance TPA Pvt. Ltd. will request for the shortfall documents

Vidal Health Insurance TPA Pvt Ltd was established in March 2002 with the mission to provide top quality TPA services to Health Insurance policyholders and be the most preferred TPA in India We are licensed by IRDA (Insurance Regulatory Development Authority License No 016 and have been empaneled by leading insurance companies, both public sector and private, across different regions of the country. 2351a5e196