*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
Edelweiss health insurance fills the vacuum by providing innovative health insurance plans, to suit every individual profile and also covers for inflation driven healthcare expenses, which continuously experiences exponential growth. It is true in the present scenario when most individuals are vulnerable to lifestyle-induced ailments, exemplified by pervasive stress factors, deleterious food habits, coupled with sedentary existence in a more and more pollution ridden environment. Edelweiss health insurance policies are designed with Indian sensibilities in mind, in a wide range of options at extremely affordable cost, to suit every budget. In-depth knowledge about Edelweiss health insurance goes a long way in making an informed choice while purchasing a suitable health insurance plan.
Edelweiss Health Insurance is a non-life insurance product designed to provide maximum protection to the insured to tide over financial crises resulting from hospitalization treatment in case of accident or illness.
One of the latest to join the health insurance bandwagon in India only in March 2016, Edelweiss General Insurance Ltd. is a member company and the insurance arm of Edelweiss Financial Services, part of homegrown Multinational Corporation named Edelweiss Group. Headquartered in Mumbai, the insurer has charted its course when it comes to the health insurance protection of the insured in possibly the widest coverage with regards to members in a single policy whether Individual or Family Floater. Boasting of an impressive Claim Settlement and Claim Incurred ratios, it has a dedicated partner network hospital exceeding 2500 across the length and breadth of the country.
The bouquet contains three wise health insurance plans apart from the extremely affordable Arogya Sanjeevani sponsored by the insurance regulator IRDAI. Right from purchasing Edelweiss Health Insurance Policy to seeking medical assistance for any eventuality, the insurer promises a hassle-free seamless interaction in a technology-driven environment aimed at cutting down cumbersome processes. Regardless of the chosen plan, the policyholder is assured of some of the unique features not seen in the Indian health insurance firmament like:
That apart, Edelweiss Health Insurance has the broadest eligibility norm welcoming infants from 3 months, and one is not too old for an insurance cover. A wide range of relations and hefty cover up to Rs 1 crore makes the prospect of purchasing health insurance policy extremely lucrative.
The insurer provides comprehensive health insurance protection through amazingly attractive health insurance policies where anyone from three months to any age can enjoy the fruits of coverage. Some of the features are:
The redeeming features in Edelweiss Health Insurance Plans help the policyholder to reap maximum benefits, while financial protection for medical emergencies is the primary aim of these policies.
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.
* Tax benefit is subject to changes as per the prevailing tax laws.
To understand what defines the types of health insurance, one needs first to comprehend the two major health insurance categories- indemnity and defined benefit.
Edelweiss Health Insurance Policies are indemnity type, and the health insurance policies on offer are:
Comparison of Edelweiss Health Insurance Plans
Now that enough insight has been gained in the broad contours of Edelweiss Health Insurance Policies, it is not out of place to compare plans for a glance at all the features that make each plan unique and worthy of making an informed purchase, to not only protect the principal policyholder but also all the insurable members of the family who have been brought under the cover the health policy.
The first grid below is to compare plans on age parameters, which denotes the eligibility criteria for Edelweiss Health Insurance Plans.
Comparison of Edelweiss Health Insurance Plans defining eligibility |
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Insurance Policy |
Min Entry Age |
Max Entry Age |
Renewal |
Silver Plan |
3 months |
65 years |
Lifelong |
Gold Plan |
3 months |
65 years |
Lifelong |
Platinum Plan |
3 months |
Any age |
Lifelong |
Arogya Sanjeevani |
18 years |
65 years |
Lifelong |
Dependent children from 3 months to 25 years of age are covered in terms of family |
The second grid below is meant to be a comprehensive comparison involving a wide range of parameters which will enable the policyholder to afford at a glance view of different features of the listed Edelweiss Health Insurance Policies.
Comparison of edelweiss Health Insurance Plans |
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Parameters |
Silver |
Gold |
Platinum |
Arogya Sanjeevani |
Sum Insured |
Rs 1 to 5 lakh |
Rs 5 to 20 lakh |
Rs 15 lakh to 1 cr |
Rs 1 to 5 lakh |
Policy Term |
1,2 and 3 years |
1,2 and 3 years |
1,2 and 3 years |
1 year |
Premium Payment |
Single |
Single |
Single |
Instalment |
Option |
Individual, Family Floater |
Individual, Family Floater |
Individual, Family Floater |
Individual, Family Floater |
Hospital Expenses |
Up to Sum insured |
Up to sum insured |
Up to sum insured |
Up to sum insured |
Daycare |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
Room Rent Std Single Private |
SI above Rs 3 lakh |
No limit |
No limit |
2% of SI Rs 5000 max |
ICU Charges |
No capping |
No capping |
No capping |
5% of SI Rs 10000 max |
Pre Hospitalization |
Up to SI for 30 days |
Up to SI for 60 days |
Up to SI for 90 days |
Up to SI for 30 days |
Post Hospitalization |
Up to SI for 60 days |
Up to SI for 90 days |
Up to SI for 180 days |
Up to SI for 60 days |
Ambulance Cover |
Rs 1500 |
Rs 3000 |
Rs 10000 |
Rs 2000 |
Hospital Daily Cash |
Rs 500 |
Rs 1000 |
Rs 1500 |
NA |
Organ donor |
NA |
Max Rs 1 lakh |
Max Rs 2 lakhs |
NA |
Domiciliary Hospitalization |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
Ayush |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
Up to Sum insured |
No Claim Bonus |
Up to 50% |
Up to 100% |
Up to 100% |
Up to 50% |
Health Check-Up |
Every Claim Free Year |
Every Claim Free Year |
Every Claim Free Year |
NA |
Maternity Benefit |
NA |
Rs 50000 |
Rs 2 lakh |
NA |
Critical Illness |
NA |
50% of SI |
100% of SI |
|
Recovery Benefit |
NA |
Rs 1000 / day |
Rs 1500 / day |
NA |
Shared Accommodation |
Rs 800 / day max Rs 4000 |
Rs 1000 / day max Rs 5000 |
Rs 1200 / day max Rs 6000 |
NA |
Restoration |
NA |
100% |
100% |
NA |
Recharge |
NA |
100% |
100% |
NA |
Compulsory Co-pay (above 60 years) |
20% |
20% |
20% |
5% flat on all expenses |
Voluntary Co-pay (below 60 years) |
10 to 20% |
10 to 20% |
10 to 20% |
NA |
Initial Waiting |
30 days |
30 days |
30 days |
30 days |
Pre-existing Diseases |
48 months |
36 months |
24 months |
48 months |
Waiting Periods
While at a glance view of different features serve the purpose of imparting knowledge to the policyholder, a detailed explanation clears ambiguities, helping to arrive at an informed decision. Accordingly, all Health Insurance Plans have been discussed below for better comprehension. But, before that, there are certain exclusions in the Edelweiss Health Insurance Policies which are applicable across the board in all the plans.
*The above list is only indicative. The policyholder must scan through the fine print of the policy document to obviate any complications during claim settlement.
The plan offers a modest sum insured from Rs 1 lakh to Rs 5 lakh and is suitable for budget-conscious individuals.
Features
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.
It is a standard health insurance policy designed by IRDAI to be rolled out by all insurers from April 1, 2020, pan India, to cut the clutter of confusion among policyholders for multiple plans.
Features
The plan offers sum insured from Rs 5 lakh to Rs 20 lakh and is suitable for individuals who look for value for money options.
Features
Optional, voluntary co-payment of 10 or 20% for 60 years and below with saving features
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.
The plan offers sum insured from Rs 15 lakh to Rs 1 cr and is suitable for discerning individuals who look for the top of the rung maximum health protection options.
Features
*All the insurer provides savings as per the IRDAI approved insurance plan. Standard T&C apply.
To register a claim under Edelweiss Health Insurance, the insured has to inform the insurer by contacting on the toll-free number. Depending on the type of claim, the insurer either reimburses the incurred money or directly settles the bills with the hospital authority. The duly filled claim form has to be submitted along with required document within a specific timeframe.
In case of a cashless claim, the insurer has to be informed prior to the 72 hours of hospitalisation if it is a planned hospitalisation and within 24 hours in case of emergency hospitalisation. The claim formalities are to be done through a TPA at the hospital desk and on approval from the insurer, cashless treatment can be availed.
In case of a reimbursement claim, the hospital bills are to be paid by the insured on his/her own first and register a claim later. The insurer after verifying the claim and documents, will settle the claim accordingly.
Edelweiss Health Insurance promotes a digital and paperless environment, which practically makes purchase and servicing of policies extremely simple and user friendly. Thus, dealing with the insurer does not entail a visit to their office or a pile of documents. However, the options open to the policyholder for the purchase of Edelweiss Health Insurance Policy is both offline and online. The customer can also call 1800-120-5698 to receive assistance from an expert to guide and navigate to a worthy purchase.
At the official portal of Paisawiki, the insurance seeker has to invoke the "Get Quote" button and proceed with the purchase; input starting with selecting the insurable and culminating with payment of premium after filling all the requisite details. Once the formalities are done, the proposal is approved and the policy document will be dispatched.
There are two aspects to the documentation at Edelweiss Health Insurance – at the time of application and when submitting a claim.
The simplest mode of Edelweiss Health Insurance Renewal is the online mode by visiting Paisawiki.com However, offline mode is also available at the branch offices of the insurer, where a renewal premium is to be paid.
For the online mode, the policyholder has to visit the Paisawiki online portal and invoke the "Renew" option displayed in the Dropdown Menu at the right-hand corner of the Home Page.
Enter the Policy Number and DOB and click "Proceed". The new tab displays the policy details and the premium payable. It is here that the policyholder is permitted to upgrade and redeem the bonus available to arrive at the sum insured and applicable renewal premium. Payment is digital in the secure gateway using the available options. Payment of the premium completes the process, and the Renewal Acknowledgement is generated. It is required to be downloaded and preserved for future reference.
A: Whether it is a planned hospitalization or emergency, the policyholder has to visit any of the Network Hospital and produce the Health Card to receive cashless services. Assistance can also be sought by calling 1800 12000.
A: Relevant renewal conditions are:
A: The grounds for denial of renewal of policy are fraud, misrepresentation and moral hazards.
A: Up to 8 members of the family comprising Self, Spouse, Dependent Children, Parents, Parents-in-Law, Brother, Sister, Grandparents and any other relation deemed insurable can be included in the insurance cover in a single policy.
A: Yes, a person can be included in the policy mid-term only upon Marriage or Childbirth, with adjustment of the differential premium on a pro-rata basis.
A: About 388 procedures are listed for cover in the policy, the details of which are available in the Prospectus or policy document.
A: Hospital Cash at specified rates will be paid for a maximum of 7 days only if the stay exceeds 3 consecutive days, applicable from 4th day to 10th day.
A: The inclusions are Open Chest CABG, Myocardial Infarction and Cancer of specific severity, Stroke resulting in Permanent Symptoms and Permanent Paralysis of Limbs.
A: The optional covers in select plans are:
A: The two claim modes are cashless and reimbursement, depending on the types of claim facility availed by the insured.