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In any health insurance policy, the amount settled by the insurance company would be the claim amount incurred or the sum insured mentioned in the policy whichever is less. The maximum liability of the insurance company in case of claim would be the sum insured mentioned in the health insurance policy copy. There are certain expenses which are incurred during hospitalization such as Laundry expenses, food expenses which are not paid by the insurance companies. Consumables expense is paid by certain health insurance policies, consumables include gloves, hand wash, sanitizers etc. The claim amount paid by the insurance company varies from case to case and it can neither be agreed nor denied that the entire claim amount being paid in case of hospitalization.
You can claim any number of times in your health insurance policy as long as the sum insured is not exhausted. The sum insured in your policy is the maximum limit which can be utilised by you for claiming any number of times. There is no limit on the number of claims that can be made in your health insurance policy.
Health insurance premium are dependent on the age of the prospect and the coverage selected. But in some cases the health insurance premium could be increased at the time of renewal due to the heavy claim ratio that the insurance company has incurred over the past year. It means that the claims paid exceed the premium collected by the insurance company.
A top up policy is an additional coverage for people already having an individual health insurance plan or employer health insurance policy. It is useful in case of a single illness which consumes the entire sum insured in the base policy. The top up policy triggers only after the sum insured in the base policy is exhausted and the deductible under the top up is crossed due to hospitalization. Having a top up policy without a base health insurance policy is like having a bike without an engine. A top up policy has a deductible amount which would be almost 20% of the top up policy sum insured. For example let us take a base policy with Rs.2 Lacs and Top up policy with Rs.5 Lacs, in case of hospitalization first the base policy sum insured will be utilised and then the top up policy kicks in.
To claim medical insurance, follow these general steps:
The claim ratio in health insurance is calculated by dividing the total claims paid by the insurance company during a specific period by the total premiums collected from policyholders during the same period.
The claim ratio is an important metric to assess the performance and sustainability of a health insurance provider. A higher claim ratio indicates that a larger portion of premiums collected is being paid out as claims, which may impact the insurer's profitability.
On the other hand, a lower claim ratio may indicate that the insurer can manage claims efficiently and retain more premiums as profit. It's important to review the claim ratio in conjunction with other factors such as policy features, coverage, premium, and customer reviews to make an informed decision while choosing a health insurance provider.
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