Health Insurance FAQs

Health Insurance FAQs

1) What is health insurance?
Your health insurance protects you and your family from paying the full costs of medical services when you're injured or sick and in return buyer pays the premium for health insurance.

2) Who can all enroll for health insurance offered by 5paisa?
This health insurance is specially curated for 5paisa customer and their family. Only 5paisa customers can enroll for this health insurance and it is in collaboration with insurance company Go-digit.

3) What coverages are available under this policy?
Entry age (Min.)
18 Years
Entry age (Max.)
55 Years
Pre-policy Medical Check-up
No
Claims Servicing
TPA
Policy Tenure
1 Year
Claim Payment method
Cashless Or Reimbursement
Sum Insured
2,00,000/3,00,000/ 5,00,000/7,00,000
Patient Care/ Day Care Treatment
Up to the Sum Insured
Pre-hospitalization/ Post-hospitalization
30/ 60 days
Initial Waiting Period
30 Days (Except For Injuries/ Accident)
Named Ailments
2 Years
Pre-Existing Disease
4 Years
Room Rent Limit
Single Private Room, No Capping
ICU Charges
No Limit
Co-Payment
No Co-payment
Premium Payment
Annual
Domestic Road Ambulance
Up to INR 2,000 per claim
Organ Donor
Not Covered
 
4) Is there any age limit?
Min age 18 years and max age 55 years

5) What is the initial waiting period under this policy?
The initial waiting period would be 30 days.

6) What is the process of enrolling for health insurance?
One can enroll for health insurance by clicking on the insurance option present in financial products. Choose the desired health insurance plan, fill in the basic details, and pay the premium. A COI (certificate of insurance) will be forwarded over email immediately after successful payment. On T+2 day, an E-card will be issued by Go-digit and will be forwarded to the customer's email id.

7) How will I receive the policy document/E-card?
Policy copy/ COI/E-card will be forwarded over email.

8) What is an E-card?
An E-card is a card that can be displayed at a hospital for claiming insurance.

9) How do I make a claim?
Claims can be of 2 types-

1- Cashless claims: A cashless claim means you don’t pay anything from your pocket if you choose to get treated at any of the network hospitals of the insurer. As per your health insurance plan, your insurance provider will cover your treatments. However, do keep in mind that the extent of this will depend on your plan and coverage benefits.

Step 1: Please inform the insurer at least 2 to 3 days before any planned hospitalization or within 24 Hours of hospitalization in case of an emergency.
Step 2: Show your e-health card and ask for the pre-approval form at Medi assist help desk/insurance helpdesk at the hospital.
Step 3: Fill and sign the form and submit it at the helpdesk.
Step 4: If everything is ok, then you can go ahead with the treatment using the cashless facility. Make sure that the treatment is done within 15 days of approval. 
 
2- Reimbursement claims: Reimbursement claim is one of the most common types of health insurance claims. In this case, you can get treated at any hospital, whether it is a network hospital or not doesn’t matter. As per your health insurance plan and coverage benefits, you can apply for a reimbursement within 15 days of discharge. 
 
Step 1: You need to call the insurer within two days of your admission date. Post call, one link will be sent where soft copies of all original documents (bills, reports, etc) and bank details can be uploaded.
Step 2: Before uploading, you need to sign all the documents yourself. You also need to write ‘For Digit Insurance’ on them. Keep all originals handy as the insurer may ask for them if required.
Step 3: Upload the documents within 30 days from the date of discharge or when you receive the link.
Step 4: Insurer will keep you posted on any additional requirements.
Step 5: You will receive the payment within 30 days from the receipt of the last necessary claim document.
 
10) Will pre-existing conditions be covered under accidental expenses in this policy?
No, the pre-existing conditions will not be covered under an accidental expenses policy.

11) Can I cancel the insurance policy?
A health insurance policy can be cancelled within 15 days of booking the policy on a pro-rata basis.
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