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Chola - An introduction to Chola Super Topup Insurance Content
An introduction to Chola Super Topup Insurance
The Chola Super Topup insuranceis a booster plan for your existing basic health insurance. It provides additional coverage for your medical expenses in addition to the existing sum insured. When your medical bills amount to a total higher than what the insurance covers, they get included in the super top-up plan. Once your deductible amount is subtracted and your sum insured is fully used, your Chola Super Topup insurance comes into work, and can be used for covering the remaining amount.
Chola - Why choose Chola Super Topup Insurance Content
Why choose Chola Super Topup Insurance?
Chola - What Are The Types of Plans Available Super Topup Content
What are the types of plans available?
In-patient hospitalisation charges
Emergency ambulatory expenses
Coverage for AYUSH expenses
Chola - Who can buy the Chola Super Topup Insurance Plan Content
Who can buy the Chola Super Topup Insurance Plan?
While it is a good idea for every policyholder to get a super top-up plan, some can benefit greatly from this policy.
Persons over 60 years of age
As you grow older, your health problems increase, and so does your trips to the hospital. As a result, you end up making claims from your insurance more frequently than you would have in your thirties. There is a great possibility that you could end up using all your sum insured in a short period.
To prevent this from happening, senior citizens and parents should strongly consider getting this super top-up health insurance. Not only does it ensure better coverage, but the premiums to be paid also reduce considerably. This policy works as a win-win situation for the elderly.
Those with chronic diseases
If you are suffering from a chronic disease that tends to have acute exacerbations, you are aware of how frequently you need to avail yourself of various hospital services. This could include daily dialysis for kidney diseases, immune system disorders such as systemic lupus erythematosus and many others.
While basic insurance policies will provide daily allowances, they often fall short of the bills to be paid. Such persons can benefit greatly from a super top-up plan. Not only does this cover the low sum insured, but the premiums charged are also much lower.
Those with a family history of certain diseases
Genetics and heredity have a major influence on your body. Therefore, if any members in your family suffer from diseases and disorders such as diabetes, hypertension, cancer, cardiac diseases and so on, there is a high chance you could also end up getting them.
Since it is always a good idea to be prepared and precautious, opting for a super top-up plan in addition to your existing health insurance works like an additional cover and can help you out in the long run.
Those living in extended families
Those who live in extended or joint families with multiple members are used to buying everything in bulk. This also stands true for health insurances. Normally, most policyholders opt for a family floater plan to cover for each family member.
However, if the sum insured is not large enough, it may get used up very soon. To prevent this from happening, you can get a super top-up plan, allowing you to meet the needs of all the family members without paying ginormous premiums!
Those working in the corporate sector
If you are an employee in a corporate company, you have most likely been provided with an insurance plan by your employer. However, most plans provided to employees have a very limited sum insured, which gets used up much faster than you would think.
In such a case, instead of getting a new health insurance plan, you can simply purchase a super top-up plan. These plans come with a similar sum insured as the standard policies but charge much lower premiums. You can enjoy the same benefits as medical health insurance but at much lower prices!
Chola - What does Chola Super Topup insurance offer you Content
Chola - The benefits provided by Chola Super Topup insurance Content
The benefits provided by Chola Super Topup insurance
Once you have studied the benefits of the super top-up health insurance and have understood it with an example, the next step is understanding why Chola MS’ Super Topup is a great choice.
Chola - Additional features in Chola Super topup insurance Content
Additional features in Chola Super topup insurance
Pre-Hospitalisation Expenses (Applicable under plan SUPREME)
Medical expenses caused up to 60 days preceding the date of hospitalisation will be covered in the super top-up policy. Payment under this benefit will diminish the sum guaranteed.
Post Hospitalisation Expenses (Applicable under plan SUPREME)
Medical expenses caused up to 90 days from the date of release from the hospital will be paid under this super top-up plan by Chola MS. Payment under this benefit will lessen the sum insured.
Emergency Ambulance Expenses
Road Ambulance Expenses brought about to move the insured person following an emergency to the closest hospital with satisfactory offices will be given by the policy. The cashless benefit won't be accessible for ambulance expenses.
Expenses identified with the in-house hospitalisation of the insured person will be covered in this super top-up health insurance plan. This form of hospitalisation is useful when the insured cannot be transferred to a hospital or when a hospital bed is not available.
Medical Expenses caused as a daycare treatment that requires under 24 hours of hospitalisation will be paid under this policy. If the system is operated in a non-network hospital, the equivalent should be pre-approved by the insurance organisation. Payment under this benefit will diminish the Sum Insured.
Chola - Understanding with an example Content
Understanding with an example
Since Chola Super Topup insurance are not commonly availed of by policyholders, they are also not understood well by everyone. As a result, many misconceptions are floating around about this insurance policy. To clear some of your doubts, let us understand Chola Super Topup insurance with an example
|An illustration to help you understand better|
|Sum Insured opted by the Insured||Rs.5,00,000/-|
|Deductible opted||Rs.3,00,000/-||Deductible will apply over aggregate of all admissible claims under the policy per annum by insured (Individual cover) or insured family (in case of Family Floater cover).|
|Policy Period||01-Jan-2021 to 31-Dec-2021|
|Claim||Month||Claim Amount||Deductible Applicable||Claim admissible under Chola Super Topup Insurance|
Family Floater Cover
|Claim||Month||Claim Amount||Deductible Applicable||Claim admissible under Chola Super Topup Insurance|
|1 - Insured 1||April||Rs.75000/-||Rs.75000/-||Nil|
|2 - Insured 3||August||Rs.200000/-||Rs.200000/-||Nil|
|3 - Insured 4||November||Rs.400000/-||Rs.25000/-||Rs.375000/-|
Chola - Make A Claim Super Topup Plan
Steps To Register A Claim
Chola - (White)Modifying/Endorsing Your Insurance Details Content
Modifying/Endorsing your Insurance details
In case of change in name, address or any other details in the policy, you can contact Chola MS for endorsement request. The request will be raised and the same changes will be updated in the policy.
Chola - Super Topup Plan FAQ Content
Super Topup Plan Frequeltly Asked Question
Under health insurance, the age and the measure of cover are two principal factors that choose the premium. Generally, more youthful individuals are considered healthier and, along these lines, pay lower yearly premiums. While older individuals pay a higher health insurance premium as their danger of health issues or ailment is higher.
Similarly, smokers and individuals who consume liquor have higher premiums. Indeed, even the idea of your work and where you stay can impact the premium of your medical insurance policy.
Indeed, it is entirely secure to purchase a super top-up health insurance plan online. At Chola MS, we hold a secure payment gateway on our website to guarantee your transaction is handled securely; This is the sole reason why the majority of customers are choosing to buy health insurance plans online.
Numerous people don't consider purchasing insurance since they think it isn't required when they are young. In any case, it is generally prudent for a person to begin considering purchasing a health insurance policy when they turn 18 years old.
Since you are young, almost certainly, you are fit as a fiddle and would not face any health entanglements any time soon. This is how you can obtain insurance policies at entirely reasonable expenses. You additionally get a ton of coverage alternatives from your insurance provider, which probably won't be the situation when you become old.
Indeed, you can cover the whole family under one policy. Your health insurance policy is in power across India. You should check whether there is any network hospital near to you, just as your family's place of home.
You should check if your insurance provider has an associated hospital near you or where the remainder of your family dwells. Association Hospitals are the hospitals tied up with the TPA(Third Party Administrator) for cashless settlement for costs brought about there.
If there are no associated hospitals at the place of your home, you could decide on a repayment method of settlement.
In a cashless mediclaim repayment, it is settled straightforwardly with the associated hospital. In situations where there is no provision of cashless settlement, the claim amount is paid to the policyholder's nominee.
Healthcare crises can come thumping when you wouldn't dare to hope anymore. Regardless of how young or fit you will be, you are never 100% protected from a disease or ailment. Simply take the COVID-19 pandemic, for example – it can influence anybody!
Also, healthcare costs are rising each day, making it incredibly hard for ordinary residents like you to cover clinical costs. Luckily, with a plan such as a super top-up health insurance policy, you can have confidence realising that you are covered against the economic effect of such possibilities.
Health insurance coverage amount is the maximum aggregate of the amount you can claim as reimbursement if there should be an event of a clinical possibility.
It is otherwise called the sum insured or sum assured of the plan. You can choose the coverage amount of your health insurance policy when you buy it. Simply be careful; a higher coverage amount converts into a higher premium amount.
The plan offers a casual section age from 3 months to 70 years. Notwithstanding, the insured ought to be at least 18 years old enough to buy this policy.
Anyone between the ages of 18 to 70 years is qualified to purchase super top-up health insurance.
The super top-up plan involves a broad scope of Sum insured options that range from Rs. 3 Lakh to Rs. 25 Lakh.
The coverage is accessible for 141 daycare procedures recorded in the health insurance policy, where hospitalisation of fewer than 24 hours is required.
Indeed, the super top-up plan will be paying for non-allopathic methods and treatments, which need in any event 24 hours of hospitalisation for accidental injury or any infection supported by the insured individual up to the measure of sum Insured in an abundance of the deductible.
Likewise, the treatment probably has been conducted in a Government healthcare office or hospital or any foundation perceived by the government or associated by the Quality Council of India or National Accreditation Board of Health. Payment under this element will lessen the measure of Sum Insured.
Deductible implies a cost-sharing prerequisite under a health insurance policy that means that Chola MS won't be responsible for a predefined sum of money in the event of health insurance policies and for a predetermined number of days/hours during hospitalisation.
The Super top-up plan by Chola MS provides you extended protection at an affordable cost. Claim reimbursement up to the sum insured in an abundance of deductible. The deductible is a cost-sharing necessity under this health insurance policy.
The company won't be at risk for medical expenses up to a predefined amount measure of the included expenses in a policy year as opted. A deductible doesn't diminish the sum insured.
Deductible will apply over the total of all admissible claims under the policy per annum by insured under Individual cover or insured family under Family Floater cover. Super Top Up policy offers two specific plans with sum insured and deductible choices to suit your requirements.
The varied selection of sum insured and deductible available under the plan are tabulated below for a better understanding:
|Sum Insured (in Lakhs)||Deductible (in Lakhs)|
A deductible is a base sum over which a super top-up policy comes into power.
Indeed, there is a waiting period of 30 days for all claims from the inception date of the super top-up health insurance besides in the event of wounds brought about by accidents.
Indeed, if you are making the payment through a cheque, you can profit from the tax benefit as per section 80D of the Income Tax Act.
The policy renewal is considered a new insurance plan, and because of this reason you can easily downgrade/upgrade/adjust your plan during renewal according to your prerequisite.
Indeed, the super top-up policy extends the option of lifelong renewability to its clients. Lifelong renewability is permitted given that the plan's premium is paid on/before the expiry date of the health insurance plan or not later than the grace period of 30 days after the expiry date.
Terminologies associated with super top-up insurance policies
To receive the maximum benefit from your super top-up insurance, here are some commonly used terminologies.
● Grace period
For every policy, there is a fixed grace period that varies from company to company. It is the time from the expiration of the policy to the renewal of the policy. Once the grace period has passed, the policy is no longer applicable for renewal and simply expires. The insured has to purchase a new policy after that.
This refers to the group of doctors, hospitals, and other health care centers and providers affiliated with or has a tie-up with the insurance company. They fall under the company's network, and all the services available in these centers can be included in the insurance claim. If you opt for a hospital not under the company's network, the charges cannot be reimbursed to you.
● Sum insured
This is the payout amount that the insurance company is required to pay when a claim is filed. For example, if you have purchased a policy with a sum insured of Rs. 2 lakh and your hospital bill comes to Rs. 1 lakh, your insurance is responsible for paying the bill altogether.
● Waiting period
The waiting period is the time interval during which your policy cannot be used. This is applicable when a new health policy is purchased. Since the insurance benefits cannot be availed during the waiting period, the insurance provider will reject all claims filed.
This refers to all the conditions or treatments that are included in your insurance policy and will be covered by the policy if a claim is filed. This includes room rent, surgery, medications, investigations, and many more such services.
This refers to costs that are not included or covered by your insurance policy. The insurance provider will reject any claim filed for these services. This commonly consists of the cost of consumables and specific surgical or daycare procedures.
● No-claim bonus
This is the amount you receive as a reward if you do not file for a claim during your policy tenure. Depending upon the policy you purchase, this no-claim bonus gets added to your sum insured. However, if you miss the period of policy renewal and grace period, you end up losing the no-claim bonus benefit.
● Inpatient hospitalization
Any surgical procedure or treatment that requires admission to the hospital for longer than 24 hours is referred to as inpatient hospitalization. The charges incurred during this stay get covered under the health insurance.
AYUSH stands for Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy. It refers to the other forms of medicine besides allopathy. With the increased awareness about the side effects and implications of allopathic medicine, people have begun turning towards other disciplines for treatment.
● Ambulance charges
Ambulance services are required to provide emergency medical care for critical conditions and illnesses. This ensures that the patient receives the basic care for survival till he reaches the hospital. The cost incurred during this service is added to the overall bill as ambulance charges. It can be claimed under your health insurance.
● Accumulation period
This period is the time during which the policy is not activated. In other words, the benefits of this policy cannot be availed during the accumulation period. In most super top-up policies, the accumulation period is 30 days. Any charges incurred during this period can be covered by the deductibles that the policyholder has to pay.
The deductible is a sum of money that applies to any insurance policy that a policyholder purchases. This amount is not covered by the insurance company, policy, or provider. It is a fixed amount that the policyholder has to pay to enjoy the benefits of the policy.
It is not deducted from the sum insured but is an aggregate over and above this amount. For example, if the total hospital bill is Rs. 10,000 and the deductible amount is Rs. 1,000, the insurance policy will only cover Rs. 9,000 while the policyholder pays the remaining amount.
● Acute care
Any care provided as emergency care or for an acute condition or critical illness at a hospital or registered professional nursing care center refers to acute care. This type of treatment or care is generally provided for temporary and acute conditions rather than chronic diseases.
The policyholder is the person who receives the benefits of the purchased insurance policy. The policyholder is required to pay the premium, and can extend their coverage to include their family members, spouse, children and so on, depending upon the type of cover and plan they have opted for.
The nominee refers to the person or the entity who has been mentioned in the insurance policy by the policyholder. This person, also called the nominee, receives the benefits of the policy, including a cash refund, in the event of the untimely or unlikely demise of the policyholder. It is compulsory to mention the nominee’s details in the insurance policy.
Every policyholder is required to provide a name in the policy which is the beneficiary of the policy. This is the person who receives the benefits of the policy after the death of the policyholder. This could be an individual or even an entity.
● Cancer insurance
When a person is diagnosed with cancer, they need to undergo multiple investigations to correct and reliable diagnosis. Their treatment is also expensive and long-term. This leads to several charges being added to the hospital bill.
However, with cancer insurance, the costs get mitigated to a large extent. This insurance can be purchased as a stand-alone policy or an add-on to an existing health insurance policy.
A claim is a financial benefit you receive from your health insurance. When a claim is filed with the company, they either directly dissolve or cover the hospital charges or reimburse them into your account. The claim can either be a cashless claim or a reimbursement claim.
This claim can be filed either after the treatment has been done or even during the treatment. The claim is considered settled and is known as claim settlement after the money has been acquired by the policyholder or subtracted from the sum insured.
● Certificate of insurance
Whenever you purchase a commodity, you must receive the purchase receipt, which acts as proof. The certificate of insurance is the legal copy of your policy purchase. It contains detailed information about the policy, what it covers and what it does not cover, the sum insured, the premium to be paid, and the process of calculating that premium. It also contains the information of the agent or the insurance provider, the policyholder, the beneficiary, and the term or tenure of the policy. The certificate of insurance provides a form of a summary of your insurance policy.
● Insurance policy
The insurance policy is the document that provides detailed information about the insurance that the policyholder has purchased. It includes every small detail about the policy, its deductions, inclusions and premium to be paid. You can also ask your agent for the extra covers you can avail of under your purchased insurance policy.
According to the English calendar, age implies the completed years of the Insured Person on his/her last birthday.
● Break-in Policy
Break-in Policy happens toward the finish of the current policy term when the premium due for renewal on a given policy isn't paid before the premium renewal date or within 30 days thereof.
● Cashless Facility
Cashless facility implies a benefit provided to the insured by the insurer where the costs, or expenses of treatment gone through by the insured as per the policy terms and conditions, are straightforwardly made to the network provider by the insurer as per the degree of pre-approval endorsed.
The company refers to the provider of the policy. It is the organization responsible for providing the cover benefits to the policyholder. In this case, the company is Cholamandalam MS General Insurance Company.
● Critical illness
Any illness that falls under the category of critical illnesses, and requires immediate treatment and attention is referred to as a critical illness. Different policies have different lists of critical illnesses that they cover. Chola MS also offers its own separate insurance policy for the same.
● Condition Precedent
Condition Precedent will mean an approach term or condition under which the insurer's accountability under the policy is restrictive.
Contribution is the privilege of a backup plan to the insurer to call upon different insurance providers net providers obligated to a similar insured to share the expense of a reimbursement guarantee on a rateable extent of sum Insured.
Co-payment is an expense-sharing prerequisite under a health insurance plan that gives that the policyholder/safeguarded will bear a predetermined level of the allowable case sum. A co-payment doesn't diminish the Sum Insured.
● Day Care Treatment
Day Care Treatment alludes to medical treatment, and additionally surgery which is:
i. Embraced under General or Local Anesthesia in an emergency clinic/daycare center on account of innovation advancement and
ii. Which would have, in any case, required hospitalization of over 24 hours.
● Dental Treatment
A dental practitioner will undertake dental treatment, including assessments, fillings (where proper), crowns, extractions, and medical procedures barring any type of cosmetic medical procedure/implants.
● Hospital Confinement
Hospital confinement implies confinement for a constant continuous time of 24 hours in a hospital as an inhabitant/enlisted bed patient as per the written advice and under the continual care and guidance of a Medical Practitioner.
Hospitalization will mean admittance in a Hospital (upon the written advice of a Medical Practitioner) for a base time of 24 continuous hours aside from any Day Care Procedures/Treatments, where such admittance could be for a period of fewer than 24 consecutive hours.
Illness implies a disorder or infection or pathological condition prompting the disability of typical physiological capacity, which shows itself during the policy Period and requires clinical treatment.
Injury implies accidental, bodily harm except for ailment or sickness exclusively and straightforwardly brought about by external, vicious, and visible and evident methods checked and guaranteed by a Medical Practitioner.
● Inpatient Care
Inpatient Care implies treatment for which the individual insured needs to remain in a hospital for over 24 hours for a covered occasion.
● Intensive Care Unit
Intensive Care Unit is a recognized segment, ward, or wing of a hospital that is under the ongoing management of a devoted Medical Practitioner(s), and which is uniquely prepared for the constant checking and care of patients who are in a critical condition or require life support services and where the degree of care and monitoring is impressively more refined and escalated than in the customary and different wards.
● Insured Event
Insured event implies any occasion explicitly referenced as covered under this policy.
● Loss of Use
Loss of Use implies the complete loss of motion of at least one limb or loss of hearing about one or both the ears or loss of vision of one or both the eyes, which is ensured in writing by a Medical Practitioner to be perpetual, complete, and irreversible.
● Medical Advice
Any type of consultation or guidance from a Medical Practitioner, including the issue of any prescription or repetition of prescription.
● Medical Expenses
Medical Expenses implies those costs that an insured person has essentially and brought about for clinical treatment because of illness or accident on the guidance of a medical practitioner, as long as these are close to would have been payable if the insured person had not been insured and familiar to other hospitals or doctors in a similar territory would have charged for the same clinical treatment.
● Medical Practitioner
A medical practitioner is an individual who holds a significant registration from the medical council of any state or Medical Council of India or Council for Indian Medicine or Homeopathy established by the Government of India or a State Government and is in this manner qualified for practicing medication inside its jurisdiction, and is acting inside the degree and purview of permit.'
Nominee implies the person(s) named by the Insured Person to get the insurance benefits under this policy payable on the passing of the insured person. For evasion of uncertainty, it is explained that if the insured person is a minor, his guardian will select the nominee.
● Non- Network
Non-Network refers to any hospital, Day Care Center or another provider that isn't part of the organization's network.
● Notification of Claim
Notification of claim is the practice of notifying a claim to the insurance or TPA by indicating the timelines just as the location/phone number to which it ought to be informed.
● OPD Treatment
OPD treatment is when the Insured stays at a hospital/ clinic or network facilities like a consultation space for diagnosis and treatment depending on a medical practitioner's guidance. The insured isn't conceded as daycare or inpatient.
Out-patient implies the Insured Person who isn't hospitalized for more than 24 continuous hours. It may be that as it may, who visits a Hospital, center, or related office for finding or treatment. Anyway, any insured person going through any predetermined "determined daycare strategies/treatment" won't be considered an out-patient.
● Physical Separation
Physical Separation implies the hand, severance of appendage at or over the wrists, and the foot, severance of appendage at or over the lower leg.
The policy implies the Policy booklet with the schedule, extensions, and any applicable endorsements.
Portability implies a move by an individual medical coverage policyholder (counting family front) of the credit acquired for initial conditions and time-bound avoidances in case he/she decides to switch from one insurance provider to the next.
● Pre Existing Disease
The pre-existing disease implies any condition, affliction or injury, or related condition(s) for which an individual had signs or side effects, analyzed, or got clinical treatment inside four years before the initial policy issued by the insurance provider.
● Qualified Nurse
A qualified Nurse is an individual who holds a significant registration from the Nursing Council of India or the Nursing Council of any state in India.
● Reasonable and Customary Charges
Reasonable and Customary Charges imply the charges for administrations or supplies, which are the standard charges for the particular provider, and are consistent with the current charges in geological territory for similar or alike services, considering the concept of sickness/ injury included.
Renewal characterizes the terms on which the contract of Insurance can be reestablished on common assent with an arrangement of grace period for treating the renewal nonstop with the end goal of every waiting period.
● Room Rent
Room rent implies the sum charged by a hospital for the inhabitants of a bed on each day (24 hours) premise and will incorporate related clinical costs.
● Senior Citizen
Senior Citizen implies any individual who has completed at least sixty years old on the date of beginning or renewal of a health insurance plan.
Subrogation will mean the privilege of the insurer to accept the benefits of the insured individual to recuperate expenses paid out under the plan that might be reimbursed from any other source.
● Sum Insured (SI)
Sum Insured implies and indicates the highest amount of cover accessible to the Insured Person under each part and augmentation.
● Surgery or Surgical Procedure
Surgery or Surgical Procedure implies manual and operative practices (s) needed to treat a sickness or injury, adjustment of deformations and imperfections, diagnosis and treatment of illnesses, relief of agony or prolongation of life, acted in hospital or daycare center by a medical practitioner.
War implies war, no matter if it is announced or not, or any activities related to war or utilization of military power by any sovereign country to accomplish monetary, geographic, nationalistic, political, racial, strict, or different purposes.
● Accumulation Period
This is alluded to as soon after buying a health insurance policy when the policyholder is ineligible to claim any cover from the plan (except in the case of accidental expenses). All things being equal, any cost he/she causes during this time goes toward fulfilling a deductible, if pertinent. As a rule, in various policies accumulation period is 30 days from the day of the obtaining of health insurance plan
● Claim Settlement
The procedure of obtaining the claim amount is known as claim settlement. The insurance provider, for the most part, has two methods of claim settlement. The primary one is the reimbursement method, where you pay for the treatment and file a claim for repayment of the expenses later. The secondary one is the cashless claim method, where the insurance agent straightforwardly settles your medical expenses with the network hospital.
● Claim Settlement Ratio
The claim settlement ratio alludes to the number of claims that an insurance provider settles in one year against the complete number of claims it gets. Considering the claim settlement ratio is significant before picking your guarantor, as it uncovers whether your insurance provider will probably settle claims effectively and decrease the risk of being dismissed.
● Cumulative Bonus
Cumulative bonus is the reward your health insurance plan collects over progressive claim-free years, for example, if a claim-free year brings about an enhancement of the entire insured sum to the policy by 5% and you go through 5 progressive claim-free years free in one go; your cumulative bonus will be equal to 25%.
● Family Floater Policies
A single health care coverage plan covering the clinical treatment cost for more than one individual from the family for a pre-decided amount insured is a family floater plan. Aside from the principal policyholder, other individuals under this plan may incorporate their spouse and children. Under a family floater plan, every part covered under it shares a single amount of sum insured.
● Free Look Period
The Free-look period alludes to a particular time frame during which a policyholder can search for other Insurance providers without bringing about any penalties or extra charges. For the most part, the free look period stretches out to 10-15 days from the health insurance coverage policy.
● Annual Deductible
The amount you need to pay each year before your healthcare benefits plan starts to repay you. Preventive services are exempt from the deductible requirement.
● Emergency Medical Care
Services are given in a healthcare facility for the first outpatient treatment of an acute medical problem. In most healthcare systems, emergency medical treatment is defined by precise standards.
The amount that must be paid regularly for your health insurance or plan. It's typically paid monthly, quarterly, or annually by you and your employer. It's possible that the premium isn't the sole cost of insurance coverage. In addition to your premium, you will usually have to pay a copayment or deductible.
● Allowable Expense
An authorized cost is an amount billed for service by an in-network healthcare provider. This is generally less expensive than if you didn't have your health insurance. It's referred to as an "allowable fee" by Cigna.
● Date Claim Received
When your health plan receives the information for a claim, it is known as the date claim was received. Then they'll be able to start processing it. Typically, your provider must file the claim within 3 to 6 months after the date of your treatment.
● Date of Claim
You will be asked for the claim date if you have disability insurance and need to file a claim. This is the date on which you become disabled due to an injury. For example, the day you were hurt at work may coincide with the date you last worked.