Health Insurance in Maharashtra

Without a health insurance policy, it is exceedingly challenging to access quality healthcare services. Acknowledging this, health insurance companies in Maharashtra offer affordable medical insurance.

The premiums for your health insurance plan rely on several factors including pre-existing diseases, sum assured, age, smoking, and even your place of residence. The city where you reside plays an important role in the cost of your medical insurance. This categorisation is called zone-based health insurance. It segregates Indian cities into three zones:

Cities in Zone A have the highest insurance price whereas cities in Zone C have the lowest. This is because healthcare services are more expensive in metropolitan cities, further necessitating the importance of a reliable health insurance policy.

Healthcare needs vary among individuals. Acknowledging this, health insurance companies in Maharashtra have designed different types of plans so insurance seekers can find the best health insurance in Maharashtra for themselves and their loved ones. Without further ado, here are the types of health insurance:

Individual Health Insurance: Individual health insurance offers coverage for a single individual covering hospitalisation, daycare procedures, hospital room rent, etc. The premium for this plan is based on age, health, medical history, sum assured, add-ons, etc.

Family Floater Health Insurance: Under this policy, one can secure their entire family. Family insurance is more affordable than buying individual insurance for each member as the sum assured is shared equally among all members. The best Mediclaim policy for a family in Maharashtra is one that considers the healthcare needs of every member.

Senior Citizens Health Insurance: Senior citizens above the age of 60 will need this plan to cover their healthcare needs. As older individuals are more vulnerable to diseases, the premiums for this policy are comparatively higher.

Critical Illness Health Insurance: Life-threatening diseases such as cancer, stroke, paralysis, etc., are covered under critical illness insurance. It is a highly advised add-on to your basic health insurance as the exorbitant treatment costs of critical illnesses can significantly drain your savings.

When analysing a health insurance plan, knowing the policy inclusions and exclusions is crucial. Let’s learn about some common inclusions and exclusions in some of the best health insurance policies.

Inclusions:

Pre- and post-hospitalisation: All medical expenses including pre- and post-hospitalisation, doctor’s fees, medical expenses, follow-up treatments, etc., are covered by health insurance.

Annual health check-ups: Preventive care in the form of annual health check-ups is covered under your health insurance plan.

Daycare treatments: Some health conditions do not need hospitalisation for more than 24 hours to seek treatment. Even so, the treatment for these ailments is covered under your medical insurance.

Cashless treatment: Under the “Cashless Everywhere” initiative introduced by the General Insurance Council, policyholders have the option of securing cashless treatments at authorised healthcare facilities.

Exclusions:

Pre-existing Diseases: Pre-existing health conditions are not covered under health insurance before a predefined waiting period.

Cosmetic Surgery: Beautification treatments such as Botox, lip augmentations, implants, etc., are not covered under health insurance.

Outpatient treatments: Outpatient surgeries such as dental or ENT treatments are not covered under health insurance.

Specific Diseases: Certain specific diseases such as genetic disorders, Sexually Transmitted Diseases (STDs), joint disorders, etc., are not covered under a health insurance policy.

Diagnostic charges: Doctor’s consultations, tests, and other procedures, are not included in your policy coverage.

Finding the best Mediclaim policy in Maharashtra is a combination of unique healthcare needs, finances, and accessibility possibilities. With that in mind, here are the essential factors to consider when looking for the best medical insurance in Maharashtra for yourself and your loved ones:

Coverage and Benefits: Medical insurance policies can comprise everything from the most fundamental forms of protection to inclusive offerings that cover hospitalisation, outpatient care, prescription medicines, etc. So, check the scope of coverage.

Waiting Period: A waiting period is generally for specific treatments such as maternity coverage, pre-existing illnesses, etc. Examine these durations and try to look for a shorter waiting period.

Sum Assured and Premiums: Sum assured is the maximum amount that your insurance will pay you for medical expenses. You must find a balance between the sum assured and the premiums payable.

Co-Payments and Sublimits: Some insurance policies will need you to pay a certain percentage of medical costs from your pocket. Additionally, there could be sub-limits for certain medical procedures and hospital room costs. Check these before investing in your policy.

Claim Process: During medical emergencies, your health insurance must have an uncomplicated claim settlement procedure.

Add-ons: Add-on covers can help strengthen your basic health insurance by adding an extra layer of protection. Analyse your healthcare needs to find appropriate add-on covers for an additional premium.

If you are looking for “health insurance near me” your best bet is to search for an insurance provider online. Here are some other benefits of looking for health insurance online:

Extensive Choices: You can find several options and easily compare different policies to find the best health insurance for yourself and your loved ones from anywhere.

Absence of Middlemen: As there are no agents involved when buying a policy online, you are not influenced by a specific sales tactic and can buy the best health insurance in Maharashtra in an unbiased manner.

Discounted Premiums: You reduce the operational costs of insurance companies by buying a policy online and they reward you with discounted premiums.

Instant Policy Issuance: With online premium payment, your medical insurance policy is issued almost instantaneously.

Online Services: You can avail of a host of services online including downloading policy documents, calculating the cost of your insurance using a health insurance premium calculator, policy renewal, raising a claim, etc.

Tata AIG endeavours to ensure the best health insurance experience with easy insurance purchases, swift and seamless settlements, unique add-on covers, etc. Here are some additional factors that make us special:

Consumables cover: Expenses for surgical and medical supplies beyond the cost of hospitalisation are taken care of under this cover.

Global coverage: Policyholders have the option of seeking medical treatment abroad for their specific health condition.

Maternity cover: Insurance seekers can opt for a maternity cover (that comes with a four-year waiting period) to tackle maternity expenses up to ₹50,000 per policy year. If the newborn is a baby girl, this coverage is extended by an additional ₹10,000.

Newborn cover: In the case of complications during delivery, policyholders will receive an additional ₹10,000 to seek necessary treatment.

OPD cover: With our OPD cover, medical consultation and medication costs of up to ₹5,000 can be offset after a two-year waiting period.

Seamless process: With more than 650 claim experts our claim settlement process is seamless and customer-centric

Automatic restoration: With this cover, policyholders get automatic restoration of the sum assured to take care of medical emergencies. If you exhaust your coverage in a year, it gets replenished.

Cumulative bonus: Policyholders can earn up to 50% cumulative bonus for claim-free years. Associated benefits include cashless treatments, tax benefits, and more, all curated to meet specific healthcare requirements.

At Tata AIG our policy is designed to ensure superior features that enable access to good quality healthcare without the worry of soaring medical bills. Some key features of our policy include:

• The liberty to remove the cap on hospital room rent expenses (as long as it falls under your sum insured) to ensure quality treatment without the worry of out-of-pocket expense.

• Coverage for pre-hospitalisation expenses 30-60 days before admission and post-hospitalisation expenses 60-90 days after discharge.

• Coverage for pre-existing health conditions after a waiting period of two to five years

• Cashless claim settlement at any hospital across India, provided it is authorised by Tata AIG.

• Tax benefits under section 80D of the Income Tax Act, 1961

• Coverage for the cost of ambulance

• NCB for not raising a claim during one whole policy year

• Coverage for AYUSH treatments

• Coverage for daycare processes that take less than 24 hours

• COVID-19 coverage

With online services, it is extremely easy to buy and renew your medical insurance coverage.

Documents Required to Buy Health Insurance

A properly filled out application form

Age proof (birth certificate, 10th or 12th mark sheet, Aadhar card, etc.)

Address proof (passport, utility bills, driver’s licence, etc.)

ID proof (PAN card, Aadhar card, Voter ID, etc.)

Medical reports

Passport-size photographs

A cancelled cheque

Process to Buy Health Insurance Online:

Visit the official Tata AIG website and select “Health Insurance.”

You can buy a health insurance plan for several members. You will only need to add their ages.

Share your contact information, medical history, and pre-existing illness (if any).

Choose the medical insurance policy that is aligned with your healthcare requirements.

Pay for the policy online using your preferred mode of digital payment and your coverage will be issued instantaneously.

Process to Renew Health Insurance Online:

Visit the Tata AIG website, click on “Renew” and then select “Health.”

Share your contact information along with your policy number and other essential details

Select the policy you wish to renew. You can even strengthen your policy with add-ons, however, this will slightly increase your premium.

Once you successfully clear the premium payment, your policy will be renewed.

There are two kinds of claim settlement processes: cashless and reimbursement. Cashless claims can be availed of at network or authorised hospitals. If you don’t meet the criteria to avail of cashless claims you can even opt for a reimbursement of your medical bills from your insurer.

Documents Required for a Health Insurance Claim

In-patient hospitalisation bills attested by the insured under the medical insurance

The discharge card signed by the authority at the hospital/network hospital.

Claim form containing the insured’s signature

A valid medical investigation report

The medical store receipts and the doctor’s prescription

List of hospital consumables prescribed by the doctor with all details

The present year’s copy of the third-party administrator’s (TPA) ID card

Copies of the health insurance policy from the previous year

Any other document as required by TPA

Bills and receipts of doctor’s consultation

Reimbursement Claim Settlement Process:

Inform us about when and where you intend to receive your medical treatment

After you are discharged from the hospital, pay for the medical treatment costs upfront

Visit our Claims page and file for a reimbursement claim by filling out the form and submitting all invoices, medical bills, prescriptions, and other important documents.

Once the claim and the documents are verified, the process for reimbursement is initiated.

Cashless Claim Settlement Process:

Visit our Claims page to initiate a cashless claim or notify us over a call.

To avail of cashless claims, inform us 48 hours in advance in case of elective procedures and within 48 hours of admission in the case for emergency treatments.

Carry the policy documents of the insured patient and submit them at the hospital’s insurance desk with their ID and submit a pre-authorisation form.

Once the application is approved you are eligible to receive cashless service at the hospital.

Under the “Cashless Everywhere” initiative by the General Insurance Council (GIC) and the Insurance Regulatory and Development Authority of India (IRDAI), insurance holders can seek treatment at any authorised hospital of their preference in Maharashtra and the rest of the country.

With Tata AIG health insurance in Maharashtra, you can now avail of cashless treatment at any hospital of your choice by following a simple and straightforward claim settlement process. However, if they visit a network facility, the documentation and process for cashless claims in a health insurance policy may be more streamlined as the insurer already has a tie-up with the hospital. Nevertheless, with us, you have a choice of getting cashless treatment in Maharashtra at a hospital you trust.