Health Insurance in Odisha

The people of Odisha face several unique challenges when it comes to accessing affordable medical care; below are a few reasons why:

• Natural Disasters: Odisha is prone to cyclones, floods, and other natural disasters, which can disrupt healthcare services. During such emergencies, access to medical facilities becomes even more challenging, and the demand for healthcare services often surges.

• Socio-economic Factors: A significant portion of the population in Odisha faces economic challenges, with many belonging to lower-income groups. Affordability becomes a substantial barrier to accessing medical care, as out-of-pocket expenses for treatments, medications, and hospital stays can impose a significant financial burden on families.

• Geographical Disparities: Odisha is characterised by a mix of urban and rural areas, with many remote and underserved regions. Reliable access to optimum healthcare facilities is often limited in these areas due to transportation issues, a lack of infrastructure, and a shortage of healthcare professionals.

• Limited Preventive: Preventive healthcare measures, such as regular check-ups and time-to-time screenings, are crucial for the early detection of diseases. However, in Odisha, there is often a need for more awareness about preventive healthcare, and many individuals may not prioritise routine health examinations.

Another crucial element in health insurance pertains to the categorisation based on zones. Insurance companies have divided Indian cities into three tiers based on their population.

The three zones are A, B, and C. Zone A includes Delhi and Mumbai; Zone B includes cities like Hyderabad, Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, Chennai, Pune, and Surat. Zone C includes Odisha and all the other cities, excluding the ones mentioned in Zones A and B.

Recognising the diverse healthcare needs of potential policyholders, health insurance companies in Odisha have designed a variety of healthcare plans:**

• Individual Plans: These insurance policies cater to single individuals. The premium is determined based on facets such as the individual's age, medical history, and the chosen sum insured.

• Family Floater Health Plans: This type of health insurance extends coverage to an entire family under a single policy. When seeking the best mediclaim policy for a family in Odisha, it is advisable to choose a plan that takes into account each family member's healthcare requirements.

• Senior Citizens’ Health Insurance: Tailored for individuals aged 60 and above, these healthcare plans acknowledge the elderly's increased susceptibility to illnesses. Consequently, the premiums for this category of insurance are relatively higher, reflecting the more significant healthcare needs of senior citizens.

• Critical Illness Insurance: This insurance provides coverage against life-threatening diseases such as kidney failure, cancer, and stroke, among others. In the unfortunate event of a covered critical illness, the final sum assured is paid out as a lump sum, offering financial support to cover the costs associated with recovery and treatment.

In your search for the best health insurance in Odisha, it is essential to choose a policy tailored to address your particular health needs. To assist you in making a well-informed decision and identifying the best Mediclaim policy in Odisha, we have detailed the prevalent inclusions and exclusions:**

Medical Insurance Inclusions in Odisha

• Domiciliary Treatment: The insurance policy offers coverage for at-home treatments in situations where hospital beds are unavailable, or the insured member has a specific medical condition that warrants domiciliary care.

• Pre- and Post-Hospitalisation: The insurance policy provides coverage for pre-hospitalisation expenses for 30 to 60 days. This includes costs for consultations, diagnostic tests, prescribed medications, and other preparatory measures.

• AYUSH Treatment: In addition to conventional medical treatments, the best medical insurance in Odisha extends coverage to alternative medicine practices collectively known as AYUSH. This includes Ayurveda, Yoga, and Naturopathy, providing policyholders with a broader spectrum of treatment options.

• In-Patient Hospitalisation: When an insured member is duly admitted to the healthcare facility for a minimum of 24 hours, their insurance extends to cover in-patient expenses. This encompasses room rent, ICU treatment, prescribed medicines, diagnostic tests, consultations, and other associated costs.

• Mental Health Cover: Following the mandate by the Insurance Regulatory and Development Authority of India (IRDAI), medical insurance plans now encompass coverage for mental illnesses. Conditions such as bipolar disorder, depression, dementia, and others fall under this coverage, ensuring a more comprehensive approach to mental health. And others fall under this coverage, ensuring a more comprehensive approach to mental health.

• Daycare Treatments: Health conditions that necessitate medical attention but don't require a hospital stay exceeding 24 hours are covered under health insurance. This ensures that the costs associated with daycare treatments, such as minor surgeries or procedures, are included in the policy.

• Pre-Existing Conditions: Health insurance offers coverage for pre-existing medical conditions, but this becomes effective after a waiting period of 2-4 years. During this period, the policyholder may not be eligible for claims related to pre-existing ailments.

• Annual Check-Ups: Policyholders are entitled to preventive annual health checkups as part of their health insurance benefits. These checkups serve as a proactive measure for early detection of potential health issues.

Medical Insurance Exclusions in Odisha

• Dental and Auditory: Insurance coverage does not extend to outpatient procedures such as dental and auditory treatments; these are typically excluded from the policy.

• Pre-existing conditions: Health insurance policies typically require policyholders to wait until the end of a waiting period before they can file a claim for a pre-existing health condition.

• Self-inflicted injury or suicide attempt: Treatment for injuries intentionally inflicted by the patient or any suicide attempts are not covered by insurance.

• Cosmetic surgery: Health insurance does not provide coverage for procedures considered cosmetic or hygiene-related, including cosmetic surgeries.

• Specific illnesses: Certain illnesses are explicitly excluded from insurance coverage, including congenital diseases, genetic disorders, sexually transmitted diseases (STDs), infertility treatments, voluntary abortions, and similar conditions.

Selecting the best health insurance company is paramount when seeking the finest mediclaim policy in Odisha. To assist you in making an informed choice, consider the following factors:

• Waiting Period: Pay attention to the waiting period associated with maternity expenses, pre-existing ailments, and specific health conditions. Understanding these waiting periods is crucial for effective planning and decision-making.

• Policy Coverage: The best Mediclaim policy in Odisha offers comprehensive coverage, addressing a wide range of health concerns. This includes provisions for pre- and post-hospitalisation, ambulance charges, cashless treatment, and more. If you are in search of the best Mediclaim policy for your family in Odisha, ensure that the policy is designed to cater to the diverse healthcare needs of every family member.

• Claim Settlement Ratio (CSR): The Claim Settlement Ratio (CSR) is a critical metric indicating the ratio of claims settled against those received. A higher CSR implies a higher likelihood of having your claims successfully settled, showcasing the reliability and efficiency of the insurance company.

• Lifetime Renewability: Health insurance costs tend to increase with age. Look for a policy that offers lifetime renewability, ensuring that you are covered well into your later years without facing excessive premium increases.

• Flexibility: A desirable policy should be flexible, allowing you to effortlessly add new family members without compromising on benefits. This adaptability ensures that your coverage can evolve with your family's changing dynamics.

• Co-Payment: Co-payment refers to the percentage of the total amount that the policyholder is required to pay from their pocket. A higher co-pay amount leads to lower policy premium but higher out-of-pocket expenses at the time of claim settlement.

If you're in search of "health insurance near me," opting for an online policy is the most convenient option. Here are some additional advantages of purchasing a medical insurance policy online:

• Convenience: Online insurance buying is not bound by time or location constraints. You have the flexibility to purchase insurance at your convenience, anytime and anywhere.

• Discounted Premiums: Acquiring a health insurance plan online reduces the operational costs for your insurance provider, leading to the benefit of discounted premiums for policyholders.

• Online Services: The online platform offers a range of services, including downloading policy documents, utilising a health insurance calculator to calculate premiums, renewing policies, initiating claims, and more.

• Varied Choices: Prospective policyholders can assess various plans based on benefits, coverage, premiums, claim processes, and more, which allows them to identify the most suitable health insurance option.

• Online Reviews: Accessing reviews from existing customers online provides valuable insights, aiding you in making a knowledgeable decision about the best health insurance for your needs.

• Time-Saving: Purchasing medical insurance online is a swift process that requires only a few clicks. Once the payment is made, the policy is promptly issued, saving you valuable time.

At Tata AIG, our dedication is unwavering in offering you the finest level of care. Here are some reasons why our health insurance policy is the ideal choice for you:

• OPD Cover: Following a two-year waiting period, the OPD cover allows offsetting medical consultation and medication costs up to ₹5,000.

• Consumables Cover: This feature addresses costs related to surgical and medical supplies that go beyond hospitalisation expenses.

• Cumulative Bonus: Earn an annual cumulative bonus of up to 50% for claim-free years. Avail of cashless treatments, tax benefits, and more, all designed to meet your evolving healthcare requirements.

• Global Coverage: Policyholders have the flexibility to seek treatment for health concerns abroad, ensuring comprehensive coverage.

• Automatic Restoration: Experience automatic restoration of the sum assured to address medical emergencies. Your coverage is replenished if exhausted within a year.

• Seamless Process: With a team of over 650 claim experts, Tata AIG ensures a smooth and efficient claim settlement process and offers support during challenging times.

• Newborn Cover: In instances of complications during delivery, policyholders are eligible for an additional ₹10,000 to cover necessary treatment for the newborn.

Tata AIG has streamlined the process for individuals seeking insurance by providing a convenient online platform for both purchasing and renewing insurance. Here's a breakdown of the process:

How to Buy Tata AIG's Health Insurance in Odisha

• Step 01: Navigate to the official Tata AIG website and choose the "Health Insurance" option.

• Step 02: Easily acquire a health insurance plan covering multiple members by providing their ages.

• Step 03: Submit your contact details, medical history, and details of any pre-existing illnesses, if applicable.

• Step 04: Select a medical insurance policy tailored to meet your specific healthcare needs.

• Step 05: Conveniently make the payment for the policy online using your preferred digital payment method, and your coverage will be swiftly issued.

How to Renew Tata AIG's Health Insurance in Odisha

• Step 01: Visit the Tata AIG website, click on "Renew," and then choose "Health."

• Step 02: Share your contact information, policy number, and other necessary details for renewal.

• Step 03: Opt for the policy you intend to renew and, if desired, enhance it with add-ons, albeit with a slight increase in premium.

• Step 04: Upon successful premium payment, your policy will be promptly renewed.

Documents Required for Health Insurance in Odisha

• A properly filled-out proposal form.

• Evidence of income (such as salary slips, bank statements, etc.).

• Proof of identity (Aadhaar card, PAN card, passport, etc.).

• Proof of address (Aadhaar card, utility bills, etc.).

• A cancelled bank cheque.

There are two types of claim settlement procedures:** reimbursement and cashless. In reimbursement claims, you cover the treatment costs initially and subsequently file for reimbursement.

On the other hand, in cashless claims, the insurer directly settles the payment by paying the hospital on your behalf. Here are the procedures to file a claim through these processes:**

How to File a Cashless Claim in Odisha

• Step 01: Initiate a cashless claim through our claims page or contact us via phone to notify us.

• Step 02: Choose a preferred hospital in Odisha and inform us within 48 hours of emergency hospitalisation or 48 hours before planned admission.

• Step 03: Submit the policy documents for the insured patient at the hospital's insurance desk.

• Step 04: Complete the pre-authorisation form.

• Step 05: Upon approval of your application, you can avail cashless treatment at the hospital.

How to File a Reimbursement Claim in Odisha

• Step 01: Initiate a reimbursement claim through our claims page.

• Step 02: Notify us about the needed medical treatment and the hospital where you will receive it.

• Step 03: After receiving the required treatment, personally cover the expenses.

• Step 04: Submit a reimbursement claim by completing the form and providing all invoices, medical bills, prescriptions, and essential documents.

• Step 05: Upon verification of your claims and documents, the reimbursement process will be initiated.

Documents Required for Reimbursement Claim in Odisha

• A claim form can be obtained upon request or downloaded from our website.

• Medical reports and comprehensive treatment details for the patient.

• All relevant medical invoices encompass consultation fees, pharmacy receipts, prescriptions, and any other payments related to the treatment.

• A certificate from the treating doctor providing a clear outline of the undertaken medical procedures.

• In the case of accidents or theft, a First Information Report (FIR) is required.

• A legible copy of your medical insurance policy.

• Bank details for the facilitation of reimbursement payment processing.

• Any additional documentation is necessary to substantiate your claim.

In its ongoing efforts to streamline insurance services for individuals, the IRDAI has introduced the provision for health insurance policyholders to avail themselves of cashless treatment at any authorised hospital nationwide, including Odisha.

With Tata AIG, you have the flexibility to select a network or non-network hospital in Odisha that aligns with your treatment requirements, and you can easily file your cashless treatment claim through a quick and uncomplicated process.