United India Individual Health Insurance Policy
The long-term benefits of having a good health insurance policy cannot be stressed enough. One such plan is United India's Individual Health Insurance Policy that aids in carrying the burden of medical emergencies and health treatments. The policy comes with multiple features and benefits that aid to lessen the financial trauma one may encounter during a medical emergency.
What is the United India Individual Health Insurance Policy?
One of the most renowned policies of United India Insurance Company Ltd., the individual health policy, is a well-structured policy designed to cater to the insurance needs by offering benefits such as pre-hospitalization, post-hospitalization, in-patient hospitalization, expenses from organ donation, AYUSH benefit as well as domiciliary hospitalization cover etc. This policy is a blueprint of a typical health insurance plan with benefits like ambulance charges, daily cash allowance, ICU/ICCU charges, cumulative bonuses, and tax benefits.
The policy is designed in the form of three plans namely, Platinum, Gold, and Senior Citizen plan. Each plan is elected mainly based on the age of the applicant, which varies with each plan. True to its name, the policy is most-commonly purchased on an individual basis, but it also can be availed as family floater variant to cover the family members of the individual.
Key Features of United India Individual Health Insurance Policy
The highlights of the policy are listed below-
Policy Coverage Type: This United India Health Insurance policy offers coverage on both individual and floater basis. The individual plan provides insurance cover for a single person, whereas the family floater plan provides insurance to the individual and family members like Spouse, Children, Parents, Parents-in-law, and Grandparents.
- Policy Period: 1 year
- Sum Insured: The insurance sum provided by the policy ranges from Rs 2 Lakh to Rs 20 Lakh.
- Grace Period: The Plan provides a grace period of 30 days in case of due payment of the period. The policy is not terminated at the time of expiry.
- Free Look Period: The policy allows the applicant 15 days before officially starting the policy period, to let the individual read all terms and conditions carefully.
- Renewability: The plan offers lifelong renewals.
- Cashless hospitalization and Insurance cover for hospitalization as an in-patient for a period exceeding 24 hours.
- The day-care treatment benefit provides insurance coverage for over 140 procedures.
- Daily cash benefit of Rs 250 or Rs 500 for each daily period of hospitalization.
- The policy has a provision for hassle-free claim settlement.
- Waiting Period: In the case of pre-existing health conditions, the policy requires the completion of a waiting period of about 4 years, during which no insurance cover can be claimed for the medical conditions.
- Provision of coverage for certain critical medical conditions like cataracts, a hernia is available under the Gold, and Senior Citizen plans, which provides coverage of up to 25% of the sum insured with a limit of Rs. 40,000
- Coverage for Domiciliary Hospitalization where the treatment/procedure exceeds 3 days.
- Upon having a period of a minimum of 3 claim-free years, the policy provides free health check-up facility.
- Tax benefits to be availed under Sec 80D.
Benefits of United India Individual Health Insurance Policy
The benefits offered are in the form of coverage such as-
Hospitalization Benefits: Under the hospitalization benefit, the policy offers to cover the expenses due to hospitalization as an in-patient in a network or non-network hospital for 24 hours owing to any disease or injury. The benefit also covers expenses from hospital room rent and nursing to about 1% of the total sum insured, ICU/ICCU charges to 2% of the sum insured, organ donor expenses and miscellaneous expenses (surgeon, anesthetist, consultant, specialist fees, OT charges, X-ray or chemotherapy).
NOTE- The coverage for expenses such as treatment of hernia, cataract, hysterectomy is applicable for the Gold and Senior Citizen plan only.
Pre and Post Hospitalization benefit: This benefit helps cover the expenses before hospitalization as well as after being discharged. For pre-hospitalization, the coverage is offered for 30 days before the date of hospitalization and a cover for 60 days after discharge of the insured person from the hospital.
- Daycare Treatment Benefit: This benefit provides insurance coverage for cases involving a day-care treatment which does not exceed the 24 hours mark. It is, however, necessary for the individual to undergo treatment as an in-patient.
- Domiciliary Hospitalization Benefit: This benefit provides coverage for expenses related to the Domiciliary hospitalization of the insured person in case the treatment exceeds 3 days, and either if an individual is unable to get to the hospital, or there is no availability of rooms. A certificate from the treating doctor is necessary to claim the benefit.
- Ayurvedic Treatment Benefit: In case the person insured has to undergo treatment in any Ayurvedic hospital facility; the policy provides coverage for the expenses incurred during the treatment.
- Transport Benefit: This benefit includes the cover of the ambulance charges incurred the process of hospitalization having the maximum limit of Rs 2500. This benefit is part of the optional covers offered by the policy.
- Daily Hospital Cash Benefit: This benefit offers a cash allowance per day during the period of hospitalization of the insured person as an in-patient giving an allowance of Rs.250/500 per day. This benefit is available after an additional premium payment of about Rs 150/300. A maximum amount of Rs 2500/Rs 5000 will be used as an allowance under this benefit.
Exclusions of the United India Individual Health Insurance Policy
Exclusions under the policy apply differently among the plans. Some of the general policy exclusions which are common for all the three plans include:
- Any congenital disease or anomaly, whether it is internal or external.
- Any injury/illness/disease which has occurred as a direct result from untoward circumstances such as war, an act of revolt, invasion, or nuclear weapon.
- The process of vaccination is excluded unless an animal does the vaccination post accidental bite.
- Cosmetic surgery or plastic surgery until and unless is advised due to any accidental injury.
- No coverage is offered for accessory treatment aids like hearing aids, spectacles, or contact lenses.
- Dental surgery or treatment unless owing to accidental injury is excluded.
- Conditions like venereal or any sexually transmitted diseases are excluded.
- No coverage is offered for treatment of infertility, sterility.
- Any illness/injury arising out of misuse or abuse of drugs/alcohol or the use of intoxicating substances cannot be used to claim the policy cover.
- Critical conditions resulting from an act of self-inflicted harm like suicide attempts.
- Expenses incurred from vitamins and tonics unless they form part of treatment for injury/disease.
- There is no provision of coverage for pregnancy or child-birth related conditions like miscarriage, abortions, c-section except a case of an ectopic pregnancy.
- Procedures such as stem cell implantation or surgery are excluded.
- The policy excludes non-medical expenses for personal items such as charges for television, telephone, private nursing, beauty services, etc.
Specific exclusions under the Gold and Senior Citizen Plans:
- The policy doesn't offer coverage for any pre-existing medical conditions until the waiting period of 48 months has elapsed from the start of the policy period.
- An individual cannot raise a claim for a medical emergency that arises during the first 30 days of commencement of the policy period.
- Cover for treatments like Cataract, Fibromyoma, Benign Prostatic Hypertrophy, Hernia, or fistula will be provided only after completion of a waiting period of 2 years. For other conditions like osteoarthritis or osteoporosis treatment require a waiting period of 4 years.
Eligibility Criteria to Claim United India Individual Health Insurance Policy
The age of eligibility of the individual or the family member varies with the type of plan selected.
- Platinum Plan- The required age of the applicant ranges from 18 years to 35 years. The plan also has insurance for children starting from the age of 90 days onwards provided either or both the parents have been covered under the policy.
- Gold Plan- The age for eligibility is between 36 years and 60 years.
- Senior Citizen- To buy this plan, the required eligibility age is from 61 years to 65 years.
Claim Process for the United India Individual Health Insurance Policy
United India Insurance Company offers both cashless claims as well as reimbursement claims. The claim steps for both are explained below:
Cashless Claim Process
- The insurance holder has to inform either the company directly or a third-party administrator regarding the hospitalization. If the hospitalization is planned, the intimation should be within 72 hours before admission, and in case of emergency hospitalization, the intimation should be within 24 hours of admission.
- The individual then has to fill the cashless request form by providing the health insurance ID and submitting it to the insurance provider/TPA.
- The claim request then undergoes verification by the TPA or insurance provider to look over the policy holder’s details and medical information.
- After the verification, the TPA and insurance company refer to the claim for approval or rejection.
- In case the claim is approved, the claim settlement is done at the time of discharge. The network hospital will send the complete bill along with the final payment request, and the insurance provider then pays the expenses.
Reimbursement Claim Process
- Like the cashless claim process, the policyholder has to inform the company directly or a third-party administrator regarding hospitalization. If the hospitalization is planned, the intimation should be within 72 hours before admission, and in case of emergency hospitalization, the intimation should be within 24 hours of admission.
- The individual can undergo treatment at the non-network hospital and pay the expenses incurred. He/she will collect the medical documents which are required to file a reimbursement claim.
- The required documents are submitted to the insurance company.
- The submitted documents are verified by the TPA or insurance provider and moved for approval or rejection.
- The claim request then undergoes settlement.
The required documents to claim United India Individual health insurance policy are:
- Claim form for either the cashless claim request or reimbursement claim
- Identification proof of age and address of the applicant
- Certificates showcasing the medical tests, diagnostic procedures undertaken
- The discharge certificate which is signed by the medical practitioner with the expense's bills and receipts
- The receipts of payment made to the doctor or surgeon for treatment
- Any documents which are mentioned by the TPA or insurance company
- If required, FIR or a Post Mortem Report can be submitted
How to Buy United India Individual Health Insurance Policy?
Any individual wishing to buy the policy can apply for it via either online or offline mode.
For offline mode- The applicant can buy the policy directly from the branch office of the insurance company or through an agent.
For Online mode- Online mode enables one to buy the policy either from the insurance company or from third party aggregator websites such as paisawiki.com, where the person can compare the policies available. The buying steps include:
- The applicant should visit the official website of paisawiki.com
- Select the type of policy that is to be purchased and fill in the personal details such as age, gender, and contact information.
- In case of family floater plans, select the number of family members that wish to be insured.
- Then download the proposal form and fill the required information.
- The applicant then has to submit the filled form along with any documents required.
- Make the premium payment either by credit/debit card or through net banking.
- A receipt of the payment will be sent to the registered email id.
Renewal Process of the United India Individual Health Insurance Policy
The policy can renew as well from Paisawiki.com. The easy renewal steps include:
- The applicant can visit the website of paisawiki.com and go to the ‘Renewal’ option.
- Select the policy which is due for renewal.
- Enter the policy holder's details like Name, Date, and policy number, etc.
- Select the premium which has to be paid.
- Pay the premium via credit/debit card or through net banking mode.
- A receipt of the payment will be sent to the registered email id.
United India Individual Health Insurance Policy FAQs
Ans: The insurance amount provided by the plan ranges from Rs 2 Lakh to Rs 20 Lakh.
Ans: No, the maternity and child-birth related expenses are excluded from the policy cover.
Ans: The policy has included two optional covers, namely, - Ambulance charges and the Daily hospital cash benefit, which require an additional premium payment to be included under policy tenure.
Ans: Yes, the policy includes coverage for regular health checkups for the person insured upon reaching a continuous period of three claim-free years, which is up to 1% of the total sum insured.
Ans: The United India Individual Health Insurance Policy's Senior Citizen Plan offers a savings option up to 5% on the premium, which is payable for a minimum of one more family member.
Written By: Paisawiki - Updated: 09 April 2021