HEALTH DEPT
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1<div class="row responsive">
2 <div class="col-lg-12 pb-4 side-nav print-exclude desktop-left-nav">
3 <p class="back pt-3"><a href="javascript:history.go(-1);"><img src="/o/irdai-theme/images/svg/icons/back-cta-chevron.svg" alt="back" title="back"> Back</a></p>
4<#include "${templatesPath}/NAVIGATION-MACRO-FTL" />
5
6<#if !entries?has_content>
7 <#if themeDisplay.isSignedIn()>
8 <div class="alert alert-info">
9 <@liferay.language key="there-are-no-menu-items-to-display" />
10 </div>
11 </#if>
12<#else>
13 <#assign
14 portletDisplay = themeDisplay.getPortletDisplay()
15
16 navbarId = "navbar_" + portletDisplay.getId()
17 />
18
19 <div id="${navbarId}">
20 <div aria-label="<@liferay.language key='site-pages' />" class="nav navbar-nav navbar-site claim-menu-list show" role="menubar">
21 <#assign navItems = entries />
22
23
24
25 <#list navItems as navItem>
26 <#assign showChildrenNavItems = (displayDepth != 1) && navItem.hasBrowsableChildren() />
27
28 <#if navItem.isBrowsable() || showChildrenNavItems>
29 <#assign
30 nav_item_attr_has_popup = ""
31 nav_item_caret = ""
32 nav_item_css_class = "lfr-nav-item nav-item"
33 nav_item_href_link = ""
34 nav_item_link_css_class = "nav-link text-truncate"
35 />
36
37 <#if showChildrenNavItems>
38 <#assign nav_item_attr_has_popup = "aria-haspopup='true'" />
39 <#assign nav_item_caret>
40 <span class="lfr-nav-child-toggle px-1 ml-auto">
41 <@clay["icon"] symbol="angle-right" />
42 </span>
43 </#assign>
44 <#assign
45 nav_item_css_class = "${nav_item_css_class} dropdown"
46 nav_item_link_css_class = "${nav_item_link_css_class} dropdown-toggle"
47 />
48 </#if>
49
50 <#if navItem.isBrowsable()>
51 <#assign nav_item_href_link = "href='${navItem.getURL()}'" />
52 </#if>
53
54 <#if navItem.isChildSelected() || navItem.isSelected()>
55 <#assign
56 nav_item_css_class = "${nav_item_css_class} selected active"
57 />
58 </#if>
59
60 <p class="${nav_item_css_class} text-wrap" id="layout_${portletDisplay.getId()}_${navItem.getLayoutId()}" role="presentation">
61 <a aria-labelledby="layout_${portletDisplay.getId()}_${navItem.getLayoutId()}" ${nav_item_attr_has_popup} ${nav_item_href_link} ${navItem.getTarget()} role="menuitem" class="text-truncate">
62 <span class="text-truncate"><@liferay_theme["layout-icon"] layout=navItem.getLayout() /> ${navItem.getName()} </span>
63 </a>
64 ${nav_item_caret}
65</p>
66 <#if showChildrenNavItems>
67
68 <ul class="claim-list">
69 <@buildChildrenNavItems2
70 displayDepth=displayDepth
71 navItem=navItem
72 />
73
74 </ul>
75 </#if>
76
77
78 </#if>
79 </#list>
80
81
82
83
84 </div>
85 </div>
86
87 <#macro buildChildrenNavItems2
88 displayDepth
89 navItem
90 navItemLevel = 2
91 >
92 <#assign
93 portletDisplay = themeDisplay.getPortletDisplay()
94 />
95
96 <#list navItem.getChildren() as childNavigationItem>
97 <#assign
98 nav_child_css_class = ""
99 nav_item_caret = ""
100 sub_menu_heading_css_class = ""
101 />
102
103 <#if childNavigationItem.isChildSelected() || childNavigationItem.isSelected()>
104 <#assign
105 nav_child_css_class = "active selected"
106 />
107 </#if>
108
109 <#if childNavigationItem.hasBrowsableChildren() && ((displayDepth == 0) || (navItemLevel < displayDepth))>
110
111 <#assign nav_item_caret>
112 <span <span class="lfr-nav-child-toggle px-1 ml-auto float-right">
113 <@clay["icon"] symbol="angle-right" />
114 </span>
115 </#assign>
116
117 </#if>
118
119 <li class="${nav_child_css_class} text-wrap" id="layout_${portletDisplay.getId()}_${childNavigationItem.getLayoutId()}" role="presentation">
120 <#if childNavigationItem.isBrowsable()>
121 <a aria-labelledby="layout_${portletDisplay.getId()}_${childNavigationItem.getLayoutId()}" href="${childNavigationItem.getURL()}" ${childNavigationItem.getTarget()} role="menuitem"> ${childNavigationItem.getName()}
122
123 </a>
124 ${nav_item_caret}
125 <#else>
126 <a href="javascript:void(0)"> ${childNavigationItem.getName()}</a>
127 </#if>
128 </li>
129 <#if childNavigationItem.hasBrowsableChildren() && ((displayDepth == 0) || (navItemLevel < displayDepth))>
130 <ul class="claim-list">
131 <@buildChildrenNavItems2
132 displayDepth=displayDepth
133 navItem=childNavigationItem
134 navItemLevel=(navItemLevel + 1)
135 />
136 </ul>
137 </#if>
138
139 </#list>
140 </#macro>
141
142
143
144 <@liferay_aui.script use="liferay-navigation-interaction">
145 var navigation = A.one('#${navbarId}');
146
147 Liferay.Data.NAV_INTERACTION_LIST_SELECTOR = '.navbar-site';
148 Liferay.Data.NAV_LIST_SELECTOR = '.navbar-site';
149
150 if (navigation) {
151 navigation.plug(Liferay.NavigationInteraction);
152 }
153 </@>
154</#if>
155 </div>
156 </div>
157
158 <div class="row responsive">
159 <div class="col-lg-12 side-nav print-exclude mobile-left-nav">
160<#include "${templatesPath}/NAVIGATION-MACRO-FTL" />
161
162<#if !entries?has_content>
163 <#if themeDisplay.isSignedIn()>
164 <div class="alert alert-info">
165 <@liferay.language key="there-are-no-menu-items-to-display" />
166 </div>
167 </#if>
168<#else>
169 <#assign
170 portletDisplay = themeDisplay.getPortletDisplay()
171
172 navbarId = "navbar_" + portletDisplay.getId()
173 />
174
175 <div id="${navbarId}">
176
177
178<div class="dropdown mobile-left-nav">
179<button class="btn btn-default dropdown-toggle w-100 text-left" type="button" data-toggle="dropdown"><span class="fa fa-bars mr-2"></span>Select Menu
180 </button>
181 <ul class="dropdown-menu">
182
183 <#assign navItems = entries />
184 <#list navItems as navItem>
185 <#assign showChildrenNavItems = (displayDepth != 1) && navItem.hasBrowsableChildren() />
186
187 <#if navItem.isBrowsable() || showChildrenNavItems>
188 <#assign
189 nav_item_attr_has_popup = ""
190 nav_item_caret = ""
191 nav_item_css_class = "lfr-nav-item nav-item"
192 nav_item_href_link = ""
193 nav_item_link_css_class = "nav-link"
194 tes=""
195 />
196
197 <#if showChildrenNavItems>
198 <#assign nav_item_attr_has_popup = "aria-haspopup='true'" />
199 <#assign nav_item_caret>
200 <span class="lfr-nav-child-toggle px-1 ml-auto">
201 <@clay["icon"] symbol="angle-down" />
202 </span>
203 </#assign>
204 <#assign
205 nav_item_css_class = "${nav_item_css_class} dropdown"
206 nav_item_link_css_class = "${nav_item_link_css_class} dropdown-toggle"
207 />
208 </#if>
209
210 <#if navItem.isBrowsable()>
211 <#assign nav_item_href_link = "href='${navItem.getURL()}'" />
212 </#if>
213
214 <#if navItem.isChildSelected() || navItem.isSelected()>
215 <#assign
216 nav_item_css_class = "${nav_item_css_class} selected active"
217
218 />
219 </#if>
220 <#if showChildrenNavItems>
221 <#assign nav_item_link_css_class="dropdown-submenu"
222 test="test"/>
223 </#if>
224 <li class="${nav_item_link_css_class}">
225 <a tabindex="-1" ${nav_item_href_link} ${navItem.getTarget()} class=" " >
226 <span class="text-truncate" title="${navItem.getName()}"><@liferay_theme["layout-icon"] layout=navItem.getLayout() /> ${navItem.getName()}</span>
227
228 </a>
229 ${nav_item_caret}
230 <#if showChildrenNavItems>
231
232 <ul class="dropdown-menu">
233 <@buildChildrenNavItems
234 displayDepth=displayDepth
235 navItem=navItem
236 />
237 </ul>
238
239 </#if>
240 </li>
241
242
243 </#if>
244 </#list>
245 </ul>
246 </div>
247
248 <#macro buildChildrenNavItems
249 displayDepth
250 navItem
251 navItemLevel = 2
252 >
253 <#assign
254 portletDisplay = themeDisplay.getPortletDisplay()
255 />
256 <#list navItem.getChildren() as childNavigationItem>
257 <#assign
258 nav_child_css_class = ""
259 nav_item_caret = ""
260 sub_menu_heading_css_class = ""
261 />
262
263 <#if childNavigationItem.isChildSelected() || childNavigationItem.isSelected()>
264 <#assign
265 nav_child_css_class = "active selected"
266 />
267 </#if>
268
269 <#if childNavigationItem.hasBrowsableChildren() && ((displayDepth == 0) || (navItemLevel < displayDepth))>
270 <#assign
271 nav_item_caret = '<i class="fas fa-chevron-right"></i>'
272 sub_menu_heading_css_class = ""
273 />
274
275 </#if>
276
277 <li class="${nav_child_css_class}" id="layout_${portletDisplay.getId()}_${childNavigationItem.getLayoutId()}" role="presentation">
278 <#if childNavigationItem.isBrowsable()>
279 <a aria-labelledby="layout_${portletDisplay.getId()}_${childNavigationItem.getLayoutId()}" class=" dropdown-item ${sub_menu_heading_css_class} " href="${childNavigationItem.getURL()}" ${childNavigationItem.getTarget()} role="menuitem"> ${childNavigationItem.getName()}
280
281 </a>
282 <span class="dropdown-toggle" data-toggle="dropdown">
283 ${nav_item_caret}
284 </span>
285 <#else>
286 <span class="dropdown-item font-weight-semi-bold navigation-menu__submenu">${childNavigationItem.getName()}</span>
287 </#if>
288
289 <#if childNavigationItem.hasBrowsableChildren() && ((displayDepth == 0) || (navItemLevel < displayDepth))>
290 <ul class="dropdown-menu submenu">
291 <@buildChildrenNavItems
292 displayDepth=displayDepth
293 navItem=childNavigationItem
294 navItemLevel=(navItemLevel + 1)
295 />
296 </ul>
297 </#if>
298 </li>
299 </#list>
300
301 </#macro>
302
303
304 <@liferay_aui.script use="liferay-navigation-interaction">
305 var navigation = A.one('#${navbarId}');
306
307 Liferay.Data.NAV_INTERACTION_LIST_SELECTOR = '.navbar-site';
308 Liferay.Data.NAV_LIST_SELECTOR = '.navbar-site';
309
310 if (navigation) {
311 navigation.plug(Liferay.NavigationInteraction);
312 }
313 </@>
314</#if>
315 </div>
316 </div>
317
318
319
320 <style>
321 @media (max-width: 768px) {
322 .desktop-left-nav {
323 display: none;
324 }
325 .mobile-left-nav {
326 display: block;
327 }
328 .mobile-left-nav ul.dropdown-menu.show {
329 position: relative !important;
330 max-width: 100% !important;
331 width: 100% !important;
332 transform: translate3d(0px, 0px, 0px) !important;
333 }
334 .mobile-left-nav ul.dropdown-menu.show > li > a {
335 width: 94%;
336 float: left;
337 }
338 .mobile-left-nav ul.dropdown-menu.show > li {
339 clear: both;
340 }
341 .mobile-left-nav ul.dropdown-menu.show li > ul > li::before{
342 content: "";
343 width: 8px;
344 height: 8px;
345 background: #95b2c5;
346 border-radius: 3px;
347 display: block;
348 position: relative;
349 top: 22px;
350 }
351
352 }
353
354 @media (min-width: 768px) {
355 .desktop-left-nav {
356 display: block;
357 }
358 .mobile-left-nav {
359 display: none;
360 }
361 }
362 .caret {
363 width: 0;
364 height: 0;
365 display: inline-block;
366 border: 10px solid transparent;
367 }
368 .caret.down{
369 border-top-color: black;
370 }
371 .mobile-left-nav li.dropdown-submenu > ul {
372 display: block;
373 position: relative;
374 border: none;
375 box-shadow: none;
376 padding-left: 40px;
377 background: #fbfbfb;
378 width: 100%;
379 max-width: 100%;
380 padding-top: 0;
381 max-height: max-content;
382 }
383
384 .mobile-left-nav li a span.text-truncate {
385 max-width: 80%;
386 float: left;
387 }
388 .mobile-left-nav li {
389 padding-top: 0;
390 padding-bottom: 0;}
391 </style>
FAQs
What are the Insurance Companies that offer Health Insurance in India?
Health Insurance policies are offered by all Life, General and Health Insurance companies that are registered with IRDAI. The names of the Insurance companies that are registered with IRDAI are available in IRDAI website www.irdai.govl.in. Standalone Health Insurance Companies also offer Personal Accident Policies, Domestic Travel Policies and Overseas Travel Policies.
What is Health Insurance Business?
Section 2 (6C) of Insurance Act, 1938 defines Health Insurance Business as under:
"health insurance business" means the effecting of contracts which provide for sickness benefits or medical, surgical or hospital expense benefits, whether in-patient or out-patient travel cover and personal accident cover "
What is the maximum age at entry for taking a Health Insurance policy? Whether Health Insurance is available lifelong once taken a policy?
The Authority, as part of its administration of Health Insurance Business notified IRDAI (Health Insurance) Regulations, 2016 (hereafter referred as Health Insurance Regulations, 2016). In accordance to the provisions of Regulation 12(i) titled "Entry and Exit Age" all health insurance policies shall ordinarily provide for an entry age of at least up to 65 years. There are also Health Insurance Products that offer Health Insurance Coverage beyond age 65 years. In accordance to the provisions of Regulation 12(ii) once a proposal is accepted in respect of a health insurance policy (except Personal Accident and Travel Policies) and a policy is issued which is thereafter renewed periodically without any break, further renewal shall not be denied on grounds of the age of the Insured. Thus, health insurance policies are lifelong renewable.
Whether pre-existing diseases are covered under a health insurance policy?
Offering health insurance coverage to any person who was already suffered / has been suffering from any disease / illness is subject to underwriting policy of an insurer. It is also to be informed that providing coverage for those persons who were cured of any specific illness / disease is subject to product design of the Insurers. Insurers design products keeping in view certain factors such as viability and self-sustainability of products and the needs of the intended target market segment.
What is pre-existing disease?
As part of Guidelines on Standardization IRDAI has already defined Pre-Existing Disease. A Pre-existing disease is defined as under (reproduced verbatim).
Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and I or were diagnosed, and I or for which medical advice I treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter. (Life Insurers may define norms for applicability of PED at reinstatement).
Are there any principles for charging premiums for Health Insurance coverage?
Health Insurance Regulations, 2016 specified certain principles of pricing of Health Insurance Products offered by Life General and Health Insurers. These principles are placed hereunder (in verbatim).
a. Regulation (10): Principles of Pricing of Health Insurance Products offered by Life, General and Health Insurers:
b. Insurers shall ensure that the premium for a health insurance policy shall be based on,
i. Age: for individual policies and group policies.
ii. Other relevant risk factors as applicable
c. For provision of cover under family floater, the impact of the multiple incidence of rates of all family members proposed to be covered shall be considered.
d. The premiums filed shall ordinarily be not changed for a period of three years after a product has been cleared in accordance to the product filing guidelines specified by the Authority. Thereafter the insurer may revise the premium rates depending on the experience subject to (d) (e) and (I) hereunder. However, such revised rates shall not be changed for a further period of at least one year from the date of launching the revision.
Whether Premium rates are unchanged?
The Policy Premium rate shall be unchanged for all group products for the term of the policy and for all individual and family floater products, other than travel insurance products offered by General and Health Insurers for a period of one year or three years as per the tenure of the policy. For further information, Regulation 10 (d) (e) and (f) may be referred.
What is Cashless facility? Whether cashless facility is offered at all hospitals?
Cashless facility means a facility extended by the Insurer or TPA on behalf of the Insurer to the insured, where the payments for the costs of treatment undergone by the Insured in accordance with the policy terms and conditions, are directly made to the network provider by the Insurer to the extent pre-authorization is approved. Cashless facility shall be offered only at Network Providers which have entered into an agreement with the insurer to extend such services.
What is A YUSH Treatment? Whether A YUSH Treatment is allowed in all Health Insurance Policies?
AYUSH Treatment refers to the medical and / or hospitalization treatments given under 'Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems'. Whether or not AYUSH treatment is allowed in a Health Insurance Policy is subject to the product features offered by the insurers.
What are the Regulatory provisions for settlement of Health Insurance claims by TPAs/lnsurers?
1) In terms of Regulation 27 (i) an insurer shall settle or reject a claim, within thirty days of the receipt of the last 'necessary' document.
2) Regulation 27 (ii) specified that except in cases where a fraud is suspected, ordinarily no document not listed in the policy terms and conditions shall be deemed 'necessary'. The insurer shall also ensure that all the documents required for claims processing are called for at one time and that the documents are not called for in a piece-meal manner.
3) Regulation 27 (iv) stipulated that every Insurer may stipulate a period within which all necessary claim documents should be furnished by the policyholder/insured to make a claim. However, claims filed even beyond such period should be considered if there are valid reasons for any delay.
4) In terms of Regulation 27 (v) every Insurance Claim shall be disposed of in accordance to the Terms and Conditions of the policy contract and the extant Regulations governing the settlement of Claims.
What is Portability of Health Insurance policies
"Portability" means the right accorded to an individual health insurance policyholder (including family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another or from one plan to another plan of the same insurer.
Clause No. 12 of Schedule - I of IRDAI (Health Insurance) Regulations 2016 specifies that on receipt of the data from the existing insurance company, the new insurance company may underwrite the proposal and convey its decision to the policyholder in accordance to the applicable regulatory framework relating Protection of Policyholders' Interest Regulations.
Clause 18 of Schedule - I of IRDAI (Health Insurance) Regulations 2016 specifies that the portability shall be applicable to the sum insured under the previous policy and also to an enhanced sum insured, if requested for by the insured, to the extent of cumulative bonus acquired from the previous insurer(s) under the previous policies.
When to apply for Portability?
A policyholder desirous of porting his/her policy to another insurance company shall apply to such insurance company to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the premium renewal date of his/ her existing policy.
Who is Third Party Administrator (TPA)?
Third Party Administrator means any person who is registered under the IRDAI (Third Party Administrators - Health Services) Regulations, 2016 notified by the Authority, and is engaged, for a fee or remuneration by an insurance company for the purposes of providing health services.
How Cost of pre-insurance health checkup is treated by Life, General and Health Insurers:
The cost of any pre-insurance medical examination shall generally form part of the expenses allowed in arriving at the premium. However, in case of products with term of one year and less, if such cost is to be incurred by the insured, not less than 50% of such cost shall be borne by the insurer once the proposal is accepted, except in travel insurance policies.
If a person is having multiple policies are there any norms that specify the manner of settlement of claim?
The norms on multiple policies are as under:
i. In case of multiple policies which provide fixed benefits, on the occurrence of the insured event in accordance with the terms and conditions of the policies, each insurer shall make the claim payments independent of payments received under other similar polices.
ii. If two or more policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies.
- In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.
- the policyholder having multiple policies shall also have the right to prefer claims from other policy I policies for the amounts disallowed under the earlier chosen policy I policies, even if the sum insured is not exhausted. Then the lnsurer(s) shall settle the claim subject to the terms and conditions of the other policy I policies so chosen
- If the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or co-pay, the policyholder shall have the right to choose insurers from whom he/she wants to claim the balance amount.
- Where an insured has policies from more than one insurer to cover the same risk on indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the chosen policy.
Whether any proposal or medical examination is required at renewal stage?
No Insurer shall resort to fresh underwriting by calling for medical examination, fresh proposal form etc. at renewal stage where there is no change in Sum Insured offered.
What is Co payment?
Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
What is Cumulative Bonus?
Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated increase in premium.
What is deductible?
Deductible means a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured. (Insurers to define whether the deductible is applicable per year, per life or per event and the manner of applicability of the specific deductible)
What is Grace Period?
Grace period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of preexisting diseases. Coverage is not available for the period for which no premium is received.