Edelweiss Health Insurance

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. 

What is Edelweiss Health Insurance?

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. 

Why Choose Edelweiss Health Insurance?

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:

• Medical Referral
• Medical Monitoring
• Medical Repatriation
• Emergency Medical Evacuation
• Return of Mortal Remains
• Second Medical Opinion
• Compassionate Visit

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. 

Features of Edelweiss Health Insurance

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:

• Sum Insured up to Rs 1 crore
• The policy term available are 1, 2 and 3 years
• Cashless in-patient treatment in 2500+ network hospitals spread across the country
• No capping of expenses related to ICU charges in hospital
• Pre and post-hospitalization medical expenses cover for the longest period among peer health insurance policies
• Cover for daycare procedures and domiciliary hospitalization up to the value of sum insured
• Ambulance evacuation facilities up to limits specified in the policy schedule
• AYUSH cover as an alternative treatment
• Cover for expenses related to Bariatric Surgery up to 10% of sum insured in Gold and Platinum Plans
• Organ donor expenses are covered subject to monetary specified limits.
• No claim bonus redeemed on Edelweiss Health Insurance Renewal at defined percentages
• Health check-up from every claim-free year for policyholders above 18 years of age
• Pre policy medical checkup based on age and sum insured
• Maternity benefit in select plans up to defined monetary limits, but after a waiting period of 4 years
• Critical illness cover specified or in-built in select plans
• Restoration and recharge benefit in select plans up to defined monetary limits
• Voluntary co-payment for policyholders above 60 years of age

Benefits of Edelweiss Health Insurance

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.

• Renewal: With Edelweiss Health Insurance Policies the policyholder can enjoy lifelong renewability.
• Free-look Period: All plans come with a free-look period of 15 days from the receipt of the policy document for cancellation and refund in case of dissatisfaction.
• Health 241 Benefit: It is an add-on defined as two for one, where the policyholder pays a premium for one year but enjoys cover for two years.
• Savings on Premium: There are several savings options on the purchase of Edelweiss Health Insurance Plans, some of the major being:
  • Family: 5% if two or more family members are insured under a single policy
  • Single-Premium: 7.5% for a 2-year term and 10% for a 3-years term
  • Voluntary Co-payment: It applies only to policyholders above 60 years. 5% on 10% co-payment and 10% on 20% co-payment.
  • Online Purchase: 15% through the portal or direct purchase.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

• Tax benefit: Premium paid for Edelweiss Health Insurance enjoys tax deductions under Section 80D of the Income Tax Act, 1961. Prudent management and age factors can benefit the policyholder up to Rs 1 lakh in a financial year.

* Tax benefit is subject to changes as per the prevailing tax laws. 

Types of Edelweiss Health Insurance

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:

• Silver Plan
• Gold Plan
• Platinum Plan
• Arogya Sanjeevani 

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. 

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.  

Waiting Periods 

• Initial Waiting Period: A uniform waiting period of 30 days is applied to all plans for the commencement of treatment, excluding accidental injury. In the case of policyholders who have critical illness cover, the first diagnosis of the listed critical illness within the first 90 days is disallowed.
• Specific Waiting Period: This applies to a few specific diseases listed by the insurer, treatment of which shall be admitted only after a waiting period of 24 months. It is imperative to ascertain the diseases listed by the insurer.
• Pre Existing Diseases: It applies to diseases stated in the proposal form, and the waiting period varies as per the provisions of an individual plan.
  • Silver Plan: 48 months
  • Gold Plan: 36 months
  • Platinum Plan: 24 months
  • Arogya Sanjeevani: 48 months
• Maternity: First consecutive 48 months, when any maternity claim is not admissible.

Edelweiss Health Insurance: Permanent Exclusions

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.

• Any medical expenses incurred for a newborn under 91 days
• All STD and diseases like HIV, AIDS, etc.
• Treatment-related to sleep disorder
• Cosmetic or Plastic Surgery, until caused by accident or medically required
• Treatment of congenital disorders
• Such therapy as Acupressure, Acupuncture, etc.
• Expenses incurred on external prosthetics and corrective devices like contact lenses
• Sex change, circumcision, and artificial life maintenance
• Self-medication and mental disorder
• Treatment expenses for self-inflicted injuries attempted suicide, etc.
• Medical conditions as an outcome of illegal and criminal activities
• Nuclear, Biological, or Chemical contamination triggered medical conditions
• Indulgence in extreme and adventure sports prone to accidental injuries
• Intoxicant or drug abuse 

*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.

Edelweiss Health Insurance Plans Explained

Edelweiss Health Insurance – Silver Plan

The plan offers a modest sum insured from Rs 1 lakh to Rs 5 lakh and is suitable for budget-conscious individuals.

Features

• Anyone from 3 months to 65 years of age is eligible to purchase this health insurance plan.
• The choices of the policy term are 1, 2, and 3 years.
• In the family floater option, maximum 2 adults and 3 children can be covered.
• In the individual option, up to 8 insurable persons are covered in a single policy.
• Room rent up to Rs 2 lakh sum insured is limited to 1% and ICU 2%, whereas above the sum, entitlement is Single Private Room, while there is no capping of ICU charges.
• Inpatient hospital and daycare treatment is covered up to the full amount of sum insured.
• Domiciliary hospitalization, pre and post hospitalization are covered up to sum insured for 30 and 60 days, respectively.
• Ambulance cover up to a maximum of Rs 1500 per hospitalization
• Cover for Ayush treatment up to the full sum insured
• Free health check-up for policyholders above 18 years of age for every claim-free year
• No claim bonus for every claim-free year up to 50% of sum insured
• Reimbursement of shared accommodation at Rs 800 per day, subject to a maximum of Rs 4000
• Compulsory co-payment of 10 or 20% for policyholders above 60 years of age
• 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. 

Edelweiss Health Insurance – Arogya Sanjeevani Policy

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

• Sum insured from Rs 1 lakh to Rs 5 lakh.
• Premium payment in half-yearly, quarterly or monthly instalments
• Anyone from 18 to 65 years of age is eligible to purchase this health insurance plan.
• The choice of the policy term is 1year.
• In the Family Floater option, self, spouse, dependent children between 3 months to 25 years, Parents, Parents-in-Law can be covered.
• In the individual policy option, up to 8 insurable persons are covered in a single policy.
• Room rent entitlement is 2% of sum insured and maximum amount of Rs 5000 per day, while ICU charges are 5% of sum insured subject to a maximum of Rs 10000 per day.
• Inpatient hospital and daycare treatment are covered.
• Pre and Post-hospitalization covered up to sum insured for 30 and 60 days, respectively.
• Ambulance expenses to a maximum of Rs 2000 per hospitalization are offered.
• Cover for Ayush treatment up to limit of sum insured is guaranteed.
• Cataract treatment up to 25% of sum insured, maximum Rs 40000 is provided.
• Dental and Plastic surgery needed due to the outcome of disease or injury
• Pre policy medical test is required if the insured age is 61 years and above.
• Cumulative bonus of 5% for every claim-free year up to 50% of the sum insured.
• Compulsory co-payment of 5% for all medical expenses.
• Loss sharing up to 50% of the sum insured for modern treatment methods and use of advanced technology.

Edelweiss Health Insurance – Gold Plan

 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

• Anyone from 3 months to 65 years of age is eligible to purchase this health insurance plan.
• The choice of the policy term is 1, 2, and 3 years.
• In the family floater option, a maximum of 2 adults and 3 children can be covered.
• In the individual option, up to 8 insurable persons are covered in a single policy.
• Room rent entitlement is Single Private Room, while there is no capping of ICU charges.
• Inpatient hospital and daycare treatment are covered up to the full amount of sum insured.
• Domiciliary hospitalization, Pre and Post-hospitalization are covered up to sum insured for 60 and 90 days, respectively.
• Ambulance cover to be availed up to a maximum of Rs 3000 per hospitalization.
• Cover for Ayush treatment up to the full sum insured amount is offered.
• Organ donor expenses cover for a maximum of Rs 1 lakh.
• Critical Illness cover commencing from the first date of diagnosis enhances the sum insured by 50%.
• Maternity benefit covers up to maximum Rs 50,000.
• Recovery Benefit of Rs 1000 per day commencing from the day of admission and payable from 11^th to the 20^th
• Restoration of the sum insured up to 100%, effectively doubling it.
• No claim bonus for every claim-free year up to 100% of sum insured.
• Free health check-up for policyholders above 18 years of age for every claim-free year.
• Reimbursement of shared accommodation at Rs 1000 per day subject to a maximum of Rs 5000.
• Compulsory co-payment of 10 or 20% for policyholders above 60 years of age.

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. 

Edelweiss Health Insurance – Platinum Plan

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

• Anyone from 3 months to 65 years of age is eligible to purchase this health insurance plan.
• The choice of the policy term is 1, 2 and 3 years.
• In the family floater option, a maximum of 2 adults and 3 children can be covered.
• In the individual option, up to 8 insurable persons are covered in a single policy.
• Room rent entitlement is Single Private Room, while there is no capping of ICU charges.
• Inpatient hospital and daycare treatment are covered up to the full amount of sum insured.
• Domiciliary hospitalization, Pre and Post-hospitalization are covered up to sum insured for 90 and 180 days, respectively.
• Ambulance cover up to a maximum of Rs 10000 per hospitalization.
• Cover for Ayush treatment up to the full sum insured amount
• Organ donor expenses cover for a maximum of Rs 2 lakh.
• Critical Illness cover commencing from the first date of diagnosis enhances the sum insured by 100%
• Maternity benefit covers up to maximum Rs 2 lakh.
• Recovery Benefit of Rs1500 per day commencing from the day of admission and payable from 11^th to the 20^th day
• Restoration of the sum insured up to 100%, effectively doubling it
• No claim bonus for every claim-free year up to 100% of sum insured.
• Free Health Check-up for policyholders above 18 years of age for every claim-free year
• Reimbursement of shared accommodation at Rs 1200 per day subject to a maximum of Rs 6000
• Compulsory co-payment of 10 or 20% for policyholders above 60 years of age
• Optional, voluntary Co-payment of 10% or 20% for 60 years and below with saving features.

*All the insurer provides savings as per the IRDAI approved insurance plan. Standard T&C apply.

How to Claim Edelweiss Health Insurance? 

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.

How to Buy Edelweiss Health Insurance?

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. 

• Offline Mode: One has to visit the office of the insurer to fill the Proposal Form, furnish the requisite documents, and pay the premium to complete the process. However, compliance of pre-policy medical screening as prescribed based on a combination of age and sum insured must be compiled before the proposal is accepted and policy document handed over.
• Online Mode: The option to the policyholder to get Edelweiss Health Insurance Online is open at the host of aggregators or simply visit Paisawiki.com. It also offers the opportunity to compare plans and work out the applicable premium range for arriving at a balanced and informed decision, considering all the pros and cons in harmony with the customer health profile.

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. 

Documents Required for Edelweiss Health Insurance

There are two aspects to the documentation at Edelweiss Health Insurance – at the time of application and when submitting a claim. 

• Purchase:
  • Identity proof through any valid Photo ID card
  • Age proof
  • Address proof
  • Income proof

• Claim:
  • Duly completed and signed Claim Form
  • Copy of Photo ID Card of the patient duly verified by the hospital
  • Hospital Discharge summary
  • The original pre-authorization request along with approval letter
  • Doctor’s reference slips
  • Original diagnostic and investigation reports, plates and films.
  • Hospital Bills along with the breakup of expenses
  • Pharmacy Bills
  • Bill payment receipt
  • Additional documents applicable:
  • Death Certificate
  • Medico-Legal Certificate
  • Copy of Police FIR
  • Copy of Post Mortem Report
  • Any other document, based on an emerging situation

Renewal of Edelweiss Health Insurance 

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.

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