Untitled Page

Frequently Asked Questions

1. What are the types of benefits available under BANDHAN LIFE Health Plan?
a.	Life insured can claim benefits under:
i. Daily Hospitalization Cash Benefit (DHCB)
ii. Intensive Care Unit Benefit (ICUB)
iii. Surgical Benefit
iv. Critical Illness Benefit (CIB)

2. Can all the benefits be claimed together
a.	Yes, all the benefits can be claimed together.
b.	E.g. Insured has taken Silver plan and is hospitalised for a period of 60 days out of which 30 days were in ICU. During hospitalisation he has undergone a surgery from Grade 1 and is also diagnosed with covered critical illness. In this case, the benefits will be as below:
i. DHCB = 60 * 2000 = Rs.120,000
ii. ICUB = 30 * 2000 = Rs.60,000
iii. SURGICAL BENEFIT = Rs. 200,000
iv. CIB = Rs. 50,000
v. Total = Rs.430,000

3. How are the days limit calculated in case of DHCB & ICUB?
a.	Maximum number of days eligible for claim under DHCB + ICUB is 60 days.
b.	E.g. Insured has taken Silver Plan and is hospitalised for duration of 30 days out of which 10 days were in ICU. In this case the benefit paid will be as below:
i. DHCB = 30 * 2000 = Rs.60,000
ii. ICUB = 10 * 2000 = Rs.20,000
iii. Remaining days for this particular year would be 60 – 30 = 30 days remaining.

4. What is the claims trigger for payment of ICUB?
a.	ICUB will be paid on happening of the following events:
i. Continuous stay in ICU for a period of 8 hours &
ii. That day being eligible for DHCB

5. How many surgeries are covered under SURGICAL BENEFIT? Does it also include Day Care Procedures?
a.	There are 849 surgeries which are present in defined list of surgeries.
b.	Out of these 849 surgeries 241 are day care procedures.

6. What if the customer’s surgery is not part of the listed surgeries?
a.	We cover all the surgeries which are not listed in the 849 surgeries in the grade 6 of the surgical benefit table.

7. Is there any minimum hospitalisation criterion for claiming benefit under SURGICAL BENEFIT?
a.	24hrs hospitalisation is not mandatory for grade 1 to grade 5. However, a minimum hospitalisation of 24 hours is required for grade 6.

8. Can the insured make multiples claims under SURGICAL BENEFIT?
a.	Yes, multiple claims can be made under SURGICAL BENEFIT subject to the annual limit and lifetime limit.

9. Can unused benefits be carried forward to next policy year?
a.	No, unused benefits cannot be carried forward to next policy year.

10. What is congenital benefit mean?
a.	Congenital benefit will cover the listed Medically Necessary Surgical Procedures required to correct congenital defects in a child born to a mother who is continuously covered for a period of 9 months under the plan.

11. Does the policy cover surgeries to correct congenital benefits?
a.	Yes, the policy covers surgeries to correct congenital defect. The list of surgeries to correct congenital defects is available separately on our website.

12. Are there any conditions to get the congenital cover?
a.	Yes, Mother should have been covered under the plan for a minimum period of 9 months.
b.	Adopted children would also be covered provided that the claim is made within 12 months from the date of birth.

13. Does the benefit paid under congenital cover over and above the benefit paid under SURGICAL BENEFIT?
a.	No, the benefit paid under congenital cover falls under the annual and lifetime limit of SURGICAL BENEFIT.

14. How many critical illnesses are covered under this policy?
a.	There are 10 critical illnesses which are covered under this policy.

15. What is the benefit under CIB? Does the benefit paid forms a part of any other benefit?
a.	On diagnosis of a covered CI, a fixed benefit amount is paid based on the plan opted for. For Example: Under Silver plan, the CIB is Rs.50,000
b.	The benefit paid under CI is over and above the benefits paid under SURGICAL BENEFIT + DHCB/ICUB.

16. How many times can the insured make claims under CIB
a.	On diagnosis of any of the covered CI, the benefit would be paid and this benefit will terminate thereafter for the whole life. Therefore, this benefit can be availed only once during the whole life.

17. Is CIB available to insured under 18 years of age?
a.	CIB is only available to insured that are over and above 18 years of age
b.	However, if during the term of the policy, child attains 18 years of age then this benefit would be made available to the child

18. Is there survival period for claiming CIB?
a.	Yes, survival period of 30 days is required post diagnosis of the covered CI.

19. What is No Claim Bonus?
a.	In case of any claim free year, all the benefits (DHCB / ICUB / SURGICAL BENEFIT) will increase by 10% for the subsequent year. This is called as No claim Bonus

20. Is there any maximum cap on the % of No Claim Bonus?
a.	IYes, the benefits will increase by 10% every claim free year subject to maximum of 50% during the whole life.

21. Who all can be covered under this policy?
a.	Self, spouse and upto 3 dependent children can be covered under this policy.

22. Can the family members be added at any point of time?
a.	Yes, family members can be added at any point of time subject to the maximum allowable limits of family members under the policy

23. Does each family member have individual coverage?
a.	Yes. Each family member will have individual coverage and all the benefits will be paid on individual level.
b.	E.g. Husband takes the silver plan and adds his wife after 2 years and then adds his child after 8 months. In this case Husband, Wife and the Child will have individual sum assured of Rs.200,000 each.

24.Can family members be deleted?
a.	Yes, policyholder can request the company to delete family members at any point of time. Upon receiving the request, the family member will be deleted from the next premium due date.

25.How many members are required in order for the policy to continue?
a.	Oldest member of the family will be the Primary Life Insured.
b.	The spouse will be the Secondary Life Insured.
c.	There can be maximum of 3 children covered under the same policy
d.	In order for the policy to continue, either Primary Life Insured or Secondary Life Insured should be covered under the policy.
e.	In case the cover for Primary Life Insured or Secondary Life Insured is terminated then the whole policy will terminate immediately.

26.Can the policyholder change the plan under the policy?
a.	Yes, change in plan is allowed under the policy.
b.	Only increase in Sum Assured will be allowed.
c.	E.g. policyholder opts for Gold Plan and wants to upgrade to Diamond plan. This up-gradation would be allowed. However, if request for change in plan is from Gold Plan to Silver plan has come then this request will not be accepted.

27.Will the upgrade happen on the policy level or life level?
a.	Up-gradation will be applicable on life level.
b.	E.g. A family of 4 has taken Silver Plan and wants to upgrade to Gold Plan. However, due to underwriting decision, secondary Life Insured cannot be upgraded. In this case, the sum assured for Primary Life Insured and children will increase from Rs.200,000 to Rs.300,000 and the sum assured for the Secondary Life Insured will remain at Rs.200,000.

28.Will the No Claim Bonus be paid on policy level or life level?
a.	No claim bonus will be applicable on individual life level.

29.How will the cashless facility made available?
a.	Cashless facility will be made available if the hospitalisation is in any of the network hospitals.
b.	List of network hospital will be sent to you after the issuance of the policy along with your Health Card.
c.	In case of hospitalisation in the network hospital, the insured will need to fill in the authorization form (available at the hospital).
d.	After approval from the TPA (Third Party Administration), cashless will be made available subject to the benefit limits
e.	If the actual hospital bill is less than the benefit amount, then the hospital bill will be settled and TPA will pay the remaining amount directly to the Insured. No need for claiming that amount.
f.	If the actual hospital bill is more than the benefit amount, then the hospital bill will be settled to the extent of the benefit amount and the remaining amount needs to be borne by the insured.

30.What will happen if the hospitalisation is in non network hospital?
a.	If the hospitalisation is any of the non network hospital then the insured will need to settle the hospital bill.
b.	The insured will then claim the hospital bills from the Company and the same will be reimbursed.

31.What is Guaranteed Renewability and how is it applicable?
a.	Guaranteed Renewability means that after the expiry of the policy term, policyholder can give request (within 30 days from the date of expiry) to renew the contract. In this case the contract will be renewed without any underwriting and the all the terms & conditions will also remain same.
b.	Guaranteed Renewability is applicable till age of 85 years.

32.Are Pre existing conditions covered under this policy?
a.	Pre existing conditions should be mentioned in the proposal form.
b.	It is upto underwriting whether to accept those conditions (with waiting period / exclusion / both) or to reject them.
c.	If the pre existing conditions are accepted then the same will be communicated to the policyholder.

33.How is the premium calculated under this policy?
a.	Premium for Primary Life Insured and Secondary Life Insured is calculated based on the age of the Primary Life Insured irrespective of the gender.
b.	Premium for Child is constant till 18 years. After the child attains 18 years, the premium will be based on the age band of the attained age.
c.	Premium is guaranteed to remain same for a period of 3 years.
d.	Premium for the whole term will be based on the age at entry. However, after the expiry of the policy term, when the request for guaranteed renewability is received, premium will be based on the age at that point of time and will again be level for the next policy term.
e.	If the member is added later, then premium will be calculated on pro rata basis.

34.What is the policy term under the policy?
a.	Policy term for Regular Premium policies is 15 years.
b.	Policy term for Single Premium policies is 3 years.

35.What happens if the claim is received during grace period?
a.	If the claim is received during grace period then the outstanding premium will be deducted from the benefit amount.

36.What happens if the age declared in the proposal form is less than the actual age?
a.	If the age declared is less than the actual age then the benefit will be reduced corresponding to the correct age.

37.Domiciliary expenses are covered?
a.	The basic meaning of domiciliary hospitalization is when there is no bed available in any of the hospitals and the treatment taken at home. Many insurance companies do not cover this as this is not prevalent currently as the number of policies and bed availability has increased drastically

38.Pre and Post hospitalization is covered?
a.	This is a benefit which is provided part of the total sum assured in a mediclaim policy. However, claiming this is complicated as it requires extensive paper work, doctor authorization & prescriptions etc. With fixed benefit structure, like our plan, the overall benefit amount will be adequate to pay the expense for the surgery and also the pre & post hospitalization expenses.