Family Floater Health Insurance

Introduction

For the first time in India, one single policy takes care of the hospitalisation expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.

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Key Benefits :

One Policy – One Premium for the entire family. The floater health plan covers your entire family under one policy with one sum insured and one premium. This takes care of hospitalisation expenses in case of a sudden illness, accident or planned surgery of the entire family.
Income Tax benefit under Section 80D
5% discount on premium for every claim free year
No health check up required
Hassle free claims procedure
Cashless claim facility available at over 3,500 network hospitals in more than 175 cities across India

Additional Benefits:

Up to 2-year Cover - We offer a continuous 2-year protection with no increase in premium in the second year. This one time payment of premium for 2 years takes care of your renewal hassels next year. Option for 1 year cover also available.
Single Policy- Single document, single premium, and single date to track. No need for separate policy for family members

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What is Covered :

The policy covers medical expenses:

Incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor/ surgeon's fee, medicines, etc.
30 days prior to hospitalisation.
60 days post hospitalisation.
Day Care expenses incurred on advanced technological
surgeries and procedures like Dialysis, Radiotherapy, and Chemotherapy, requiring less than 24 hours of hospitalisation.
Pre-existing disease can be covered after the 4th year provided the policy is renewed with us for four

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Eligibility :

The enrolment age of senior most family member for a Family Floater Health Plan at entry level is between 19 years to 60 years. However, other members in the plan can be less than 19 years of age (upto 91 days). The customer may decide to buy the policy only for his family (defined as self, spouse, dependent children & dependent parents for exemption u/s 80D) as a proposer and exclude himself from the plan.

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Claim Process :

Cashless Claims | For Reimbursement Settlement | Documents Required

Cashless Claims

Cashless claims facility is available only at our network hospitals. This list of network hospitals is enclosed with your policy. Under this facility you just sign the bills at the time of your discharge and we shall settle the amount directly with the hospital.

Under cashless facility, claims can be of two types:
Planned: Where the customer or covered family member(s) is aware of the hospitalization 2-3 days in advance.

Contact our Third Party Administrator (TPA) TTK Health Services help-line at 1600 42 58885 / 1600 42 57878. You can also fax them at 1600 425 2626 and call at their landline number 080 2520 3771. The same is mentioned on the Health Identity Card.
Fax / submit the pre-authorization form to TPA with doctor’s comments. This form is available with all network hospitals.
The TPA faxes pre-authorization form with approval within 2-3 hours.
Avail the health treatment.
On your discharge, the TPA settles bills with the hospital.

Emergency: Where the customer or covered family member(s) meets with a sudden accident or suffers from a bout of illness that requires immediate admission to the hospital.

In case of planned hospitalisation

Rush the patient to the hospital.
Patient avails the treatment.
Family contacts TPA help-line at 1600 42 58885 / 1600 42 57878 as mentioned on the health card. You can also fax them at 1600 425 2626 and call at their landline number 080 2520 3771.
Family submits the pre-authorization form to TPA with doctor’s comments. This form is available with all network hospitals.
The TPA faxes pre-authorization form with approval within 2-3 hours.
On discharge, the TPA settles bills with the hospital.

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All India Cashless Hospital List

For Reimbursement Settlement:

Reimbursement claims facility is available at both the network and non-network hospitals. The reimbursement claims process is as follows:

Patient avails the treatment.
Settle the hospital bills directly by paying the relevant charges.
Call our TPA at toll free number 1600 42 58885 / 1600 42 57878 and inform about the hospitalization. You can also fax them at 1600 425 2626 and call at their landline number 080 2520 3771.
Submit the relevant bills / documents for the claimed amount to the TPA.
The claims will be settled in 7 working days, from the time of submission of bills.
For any assistance before, during or after the claim, call our TPA at the toll free numbers 1600 42 58885 / 1600 42 57878. You can also fax them at 1600 425 2626 and call at their landline number 080 2520 3771.

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Documents required:

Duly completed claim form (available with all network hospitals).
Original bills, receipts and discharge certificate / card from the hospital.
Bills from chemists supported by proper prescription.
Investigation test reports and payment receipts, supported by the note from attending medical practitioner / surgeon prescribing the test.
Doctor’s referral letter advising hospitalization in non-accidental cases.
Nature of operation performed and surgeon’s bill and receipt.
Any other documentation / information as required by the TPA.

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What is not Covered

All health policies have following set of temporary and permanent exclusions:

30 Days exclusion
Medical charges incurred, except those arising out of accidental injuries, within the first 30 days from the start date of the policy are not covered. This clause does not apply for subsequent renewal (without a break) of this policy with us.

2 Years exclusions
Expenses incurred on treatment of following diseases within the first two years from the start date of the policy are not covered:

Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy unless because of malignancy
Hernia, Hydrocele
Fistula in Anus, Piles
Arthritis, Gout, Rheumatism
Joint replacement, unless due to accident
Sinusitis and related disorders
Stone in the urinary and biliary systems
Dilatation & Curettage
Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
Dialysis required for chronic renal failure
Surgery on tonsils and sinuses
Gastric and duodenal ulcers

These above diseases are covered from third year, if the policy is renewed with us for two consecutive years (4 years, if these are pre-existing diseases at the time of inception of the policy).

Permanent

Any internal congenital illness.
Non-allopathic treatment, pregnancy and childbirth related diseases, cosmetic, aesthetic and obesity related treatment.
Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury.
War, riots, strike, terrorism acts, nuclear weapon induced treatment.

For more details, kindly refer to the Policy Wording.

Family Floater Product Code: Misc 34E

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FAQ's

Why do I need health insurance?
Where can I obtain health insurance?
What is a floater?
What is a health card?
Given a health card, do we have to pay once admitted in a hospital?
What are the benefits of the health card?
What do terms 'Cashless Facility' and 'Claim Reimbursement' mean?
Which are the networked hospitals you have tie-ups with?
What are the features of the health cover?
What do you mean by Pre-existing condition / illness?
Are there any preliminary checks to be done?
What is a waiting period?
Why are the premiums on the higher side when compared to the rates of the public sector companies? What are the extra benefits that are being provided?
What are the exclusions of the policy?
When does the cover start?
Am I covered if I am abroad and need medical assistance overseas?
What do you mean by Pre and Post hospitalisation?
What if I have more than one health policy?
What are the first 2-year exclusions?
What modes of payments are available to make the payments?
Is it necessary that I use my own credit card or net banking account or current/ saving bank account to make the payments?
What do I do in case of a claim?
What is the claim procedure?
What are the documents required for filing a claim?
What is a TPA? Who is the TPA in this case?
How much time does it take to settle the bills?

Why do I need health insurance?

We understand the importance of health insurance only when we are hospitalised due to an injury or illness. Health insurance helps to ensure that you and your family are protected against the financial adversity resulting from medical and hospitalisation expenses.