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Health Insurance Policy Bond

 

An insurance policy bond is given to the insured after payment of premium as a proof of an insurance contract. It is a legal document stating terms and conditions of the insurance contract. Policy bond is given after the proposal is accepted.

Risk coverage commences after the acceptance of the proposal by the insurer. The insured in turn accepts all the terms and conditions of the policy. Thereafter a policy bond is issued.

Policy bond is an important document which is required even at the time of a claim. In a health insurance policy document, the policy must clearly state the details of policy coverage, sum insured, number of members covered etc. Let us look into the details of a policy document.

Details of a health insurance policy document

Health insurance policy bond has the following details imprinted in the bond.

·       The name of the policyholder

·       Address, contact details of the policyholder

·       Number of members covered under the policy

·       Type of cover; whether floater, individual etc.

·       Period of insurance

·       Previous policy details for continuity of cover

·       Sum insured opted

·       Any sub limits in sum insured

·       Deductibles: Voluntary or compulsory

·       Copay option: any limits for copay

Copay is the agreed percentage of risk between the insurer and the insured.

Ex: 80:20 and so on. This arrangement is for insureds who would like to reduce the premium by taking a part of the risk. Claim amount is shared between the insurer and the insured in the agreed ratio.

In this instance insurer pays 80% and insured bears 20% in the event of a claim. Ratio can vary according to the option of the insured.

Premium reduction for such voluntary option makes copay more attractive.

·       PED (preexisting disease)-any waiting period applicable

·       Any specially imposed waiting period

·       Cumulative bonus

·       Premium payment

·       Policy terms and conditions

·       Details of TPA, their address, toll free no website details etc.

·       Details of grievance redressal mechanism of insurer

·       Free look period facility and portability conditions

Free look period

This is the period allowed by the insurer to the insured, to rethink the policy provisions and its suitability to his present condition. Insured can cancel the policy in this period and premium refund will be made by the insurer after retaining minimum premium.

Portability of policy; policy may be ported to the nearest branch of the insurance company, which is near from the residence of the insured within the stipulated time for continuation of same benefits and service from the insurer. Policy can be ported between two insurance companies also.

·       Policy migration facility and relevant conditions

·       Provision for cancellation of policy

·       Renewal conditions, change in premium rate and plans as per age band

·       Standard exclusions

·       Specific exclusions

·       Address along with contact details, of the Ombudsman who has jurisdiction over the grievance cases

 

 

Insured has the responsibility to examine the policy bond and correspond with the insurer regarding any variations in the policy from the proposed policy. This is significant in view of the details being used in claims process when the claim arises.

Complete understanding of the policy is the key to clarity on policy wording and benefits.

 

We at Zen Insurance have the right expertise and can assist you in finalizing   a suitable policy that meets your requirements. Plan your insurance cover and contact us for assistance.

 Disclaimer:   

Zen Insurance is an IRDAI registered broker which facilitates quick & accurate insurance broking services. We deal with only regulator approved products of insurers. We do not underwrite the products.

 

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