In Family Floater will the claims made for other life insured also taken into consideration to arrive at Multiplier Benefit?
Yes, Claim made by any of the life insured in a family floater will be taken into consideration to arrive at Multiplier Benefit.
When can I claim Inpatient Hospitalization Benefit & other benefits?
You can claim Inpatient Hospitalization Benefit in case; Life Insured is hospitalized for a period exceeding 24 hours on recommendation of a Registered Medical Practitioner to seek medical intervention due to sickness/illness or accident.
When will the Emergency Ambulance Benefit is payable?
Emergency Ambulance Benefit can be payable only in case the hospitalization is in an ICU or emergency ward of the hospital and the Inpatient Hospitalization Benefit is eligible for payment
When can I claim Donor Expense Benefit?
You can claim Donor Expense Benefit when the Life Insured is the recipient of the organ.
Can I claim maternity benefit under Family Floater Silver Plan option?
No, Maternity benefit is available under Family Floater Gold Plan option only.
Can I claim benefit up to my Annual Limit under Maternity Benefit?
No, the maximum Maternity Benefit limit is 3% of Sum Insured.
I bought HDFC Life Health Assure Family Floater Gold Plan 2 years back for myself & my parents. After a year I got married & included my wife as one of the Life Insured in 3rd policy year. Can I claim Maternity Benefit in the 5th policy year?
No, you will not get Maternity Benefit for this claim, as the female life insured has to be covered in family floater health insurance for at least three continuous years & in this case your wife is covered only for only 2 years .
Can I submit the claim that had occurred during grace period?
Yes, you can submit the claim occurred during grace period; however the benefit will be paid only if the policy is renewed i.e. due premium is paid within grace period.
Under which circumstances the Pro-ration of Claims will come into effect?
If life insured opts for a room that is higher than the eligible room rent category, then the Pro-ration of Claims will apply & total eligible medical bill will be settled on a pro rata basis. This will apply irrespective of whether the patient is admitted into a Network or Non-Network hospital.
Who will get the claim amount in case of death of any other Life Insured?
Policy Holder will get the claim amount.
Will I get the entire money I had claimed under the policy?
You will get all the eligible expenses incurred during hospitalization which are within the policy benefits limits as specified in the policy document & are duly supported by required documents / reports.
Can any claim be rejected or denied by company?
Yes, the claim for any uncovered expenses as mentioned in policy document will be refused / rejected by company.
Can I be denied of Cashless Claim Services?
Yes, Cashless Claim Services can be denied if
- you fail to submit the information required to authorize the Cashless Claim Services
- the disease / event is not covered under the policy
- you got admission in non-network hospital
- there is a delay in submission of pre-authorization form to us/TPA
Above are the indication & not the exhaustive list. In case cash less service is denied you can pay the hospital bills & submit the document for reimbursement of claim.
Can I opt for Reimbursement Claim facility if I do not wish to use Cash Less facility in Network Hospital?
In case you do not avail cashless service in a network hospital, You or Your representative must intimate our TPA or Us:
- At least 72 hours prior to planned date of Hospitalisation
- Within 48 hours of being hospitalized for Medical Emergency
In case you fail to intimate our TPA or Company as mentioned above, we may admit the claim only if the reasons for such failure to intimate Our TPA or Us were beyond Your control.
How to Track claim status?
Claim status can be tracked from our or the TPA's website.