What is health insurance?

Health insurance is an insurance product that covers the medical and surgical expenses of an insured individual. It reimburses the expenses incurred due to illness or injury or pays the care provider of the insured individual directly.

When can I use my health insurance?

Insurance covers require a minimum of 24 hours of hospitalization. Insurance covers do not reimburse you for OPD visits, health checkups, or medicines that don’t involve a hospitalization. 

Note that technological and medical breakthroughs have made it possible for certain treatments and surgeries to be administered and conducted over a few hours. Examples include chemotherapy, radiotherapy, dialysis, cataract surgery, kidney stone removal, etc. These are called daycare procedures as it is performed without requiring 24-hour hospitalization. 


What is a cashless facility?

Insurance companies have tie-ups with several hospitals all over the country as part of their network. If you take treatment in any of the network hospitals, the insurance company pays your (admissible) hospital bills to the hospital directly. You would only need to pay for the expenses not covered under the policy to the hospital. The cashless facility is not available if you take treatment in a hospital that is not in the network.
 

Is there a limit on the number of claims during a year?

No. You can make an unlimited number of claims during the policy period. However, the sum insured is the maximum limit under the policy.


Does this policy cover treatments outside India?

No. The policy is restricted to treatments done in India.

Is there any age limit for insurance?

Yes, adults between 19 to 80 years and dependent children between 3 months to 25 years can be covered.

What are the benefits of health insurance?

The main purpose of medical insurance is to receive the best medical care without any strain on your finances. Health insurance offers protection against high medical costs. It covers hospitalization expenses, daycare procedures, domiciliary expenses, and ambulance charges, among many others.

How can the employees use their Plum health insurance?

Your team members would get the Plum app to understand their insurance cover, see what's covered and what's not covered. They would also see the step-by-step claims process on the app itself. Plum’s health insurance can be used via a cashless treatment at a hospital. Alternatively, employees can pay out of pocket for treatment and then claim the cost of treatment via reimbursement from the insurance company.

Is there a limit on the number of claims during a year?

No. You can make an unlimited number of claims during the policy period. However, the sum insured is the maximum limit under the policy.

What is a Health Card and what is its use?

A health card is a way to keep all relevant information regarding your health insurance in a handy and easy way to carry around. Now in the digital world, you only carry your phone, not even your wallet, so Plum provides a digital health card that you can find inside your Plum app.

How do I get my health card?

Plum provides a digital health card which you can find inside your Plum app.

Do I need to get treatment only at network hospitals?

No, you can get treatment at any government-approved hospitals. But for a better experience and to avoid the hassle of paying first and then filing for a claim, it is always recommended to take treatment at a network hospital.

What happens when I take treatment in a non-network hospital?

You can take treatment from non-network hospitals but in that case, you have to pay for the treatment first and then claim the treatment amount from the insurance company.

Does my health insurance cover expenses on outpatient treatments?

Most health insurance plans in India cover expenses that are incurred while you are hospitalized. Plum provides a doctor-consultation add-on benefit, in case you want your outpatient consultations to be covered.

Can an employee convert the group plan to an individual plan in case he/she leaves the company?

No. But the employee could move to a similar policy with the same insurance company, however, the premium & terms may vary according to the retail product structure. Please check with the insurance company directly.

Are mental health treatments included? Or are there any add-ons for this?

Hospitalization due to mental conditions is covered under Plum’s policies. We additionally provide a mental-wellness add-on that provides continuous support to employees. Do talk to the Plum team to set it up.

Is home treatment covered?

Home Healthcare on a cashless (IL impaneled provider) basis is covered, if the treating doctor advises an active line of treatment at home instead of being admitted to a hospital. Services are available in 9 major cities only i.e.Bangalore, Chandigarh, Chennai, Delhi (NCR), Hyderabad, Jaipur, Kolkata, Mumbai, Pune. To avail please call ICICI Lombard, Health Assistance Team.

Is Covid-19 treatment covered in my health insurance?

Your health insurance does cover all Covid-19 treatments in case you are hospitalized.

Is Covid-19 test covered in my health insurance?

Covid-19 tests are covered only for positive cases. The insurance won't cover the test in case the result is negative.

How does a Floater cover work?

For instance, a person wants health insurance for himself, his spouse & their children, the Family Floater plan offers insurance coverage to the entire family under one premium payment. Let’s take an example wherein the person insures himself, his spouse & the dependent children with the individual insurance plans with a sum insured of Rs. 1 lakh each, he ends up paying a premium ranging between Rs. 1000 - Rs. 2000 for each family member. On the other hand, if the person would have opted for the family floater plan with the sum insured of Rs. 3 lakhs, the total premium would surely be less than the separate premium payments in individual health insurance plans. Moreover, the separate health plan holds the cover of only Rs. 1 lakh as against Rs. 3 lakh in case of the Floater plan thus helping the family in case the medical treatment costs go beyond that. This Rs. 3 Lac is available for each of the family members individually as well as collectively.

How to submit a claim?

Please follow the following steps,

  • Receive claim form via email (along with checklist) - via chat option in Plum web app

  • Read carefully instructions for filing up claim form (refer claim form)

  • Print the claims form, fill the detail & sign

  • Get treating doctors' signature on claim form

  • Attach all documents as per claim form

  • Keep photocopy all medical documents/ bills/reports etc for your record (as your have to submit the originals for claim)

  • Courier all documents hence prepared to address provided in the claim form

How to get a cashless pre-approval for a treatment?

Cashless pre-approval requires the following steps at the network hospital:

  • Plan treatment with the doctor / hospital

  • Show Policy number and Health ID and Patient photo ID proof (Download your health card from your profile in Plum web app)

  • ​Fill up Pre-authorization form provided by the treating hospital

  • You will receive call/SMS from Insurance company in case of queries/ rejection

  • Insurance company approves cashless pre-approval request for treatment and informs the hospital

  • ​Receive cashless treatment

(Please note a slight variation may exist in the exact process from hospital to hospital)

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