Important Points for IC 27 - Health Insurance Exam
Page 19 Of 27
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Pre Existing diseases: It is estimated that an overwhelming majority of claim disputes in non-life sector are related to medical insurance and majority of these pertains to pre-existing diseases.
A claim also refers to the documents and process by which the insured demands the admissible insured from the insurance company.
Cashless hospitalisation is a service provided by an insurer wherein the insured is not required to settle the hospitalisation expensers at the time of discharge from hospital , to the extent covered by policy.
A hospital, which has an agreement with a TPA/insurer for providing cashless treatment, is referred to as a Network Hospial.
Non-network hospitals are those which do not have tie-up with TPA or Insurer and any policyholder seeking treatment in these hospitals would have to pay for the treatment and later claim as per the reimbursement procedure.
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