Brief Summary
Alright, so this session is all about cracking the pre-promotion exam, especially focusing on health insurance. We'll cover how to read for the exam, some pro tips to excel, and how to stay calm and comfortable during the test. Plus, we'll discuss health insurance policies, common templates applicable to all four public sector insurance companies, IRDA regulations, standardized products, and central government welfare schemes.
- Reading for exams is different than reading for knowledge.
- Stay calm and comfortable during the exam.
- Focus on commonalities across all four public sector insurance companies.
So, today we're gonna start with health insurance, which is a super important topic. We might see around five to seven questions on it, whether you're a junior or a senior. Then, this afternoon, we can dive into general miscellaneous stuff, and tomorrow we'll tackle liability insurance. This session will be interactive, so feel free to respond when I ask questions. It'll keep things lively and help me keep my energy up.
Reading for knowledge is different from reading for an exam. For exams, it's not just about gaining knowledge but also about applying it effectively. Examiners want to see how well you can use what you've learned. When reading for the exam, don't waste time on unnecessary details. You'll have different subjects, but you can choose four to focus on. Be thorough with those four, and keep one as a backup. Exam questions can be long and complex, so having a standby subject can be a lifesaver.
Make sure you've gone through the "Pro Tips for Excellence" that were already shared. It'll be super useful. When you start the exam, make sure you're in a comfortable zone. Pick the easy questions first to build confidence. There are three cycles: first, answer the easy questions; second, complete the remaining questions; and third, double-check that you've saved all your answers correctly. Stay calm and relaxed during the exam to avoid mistakes.
In the exam, there will be simple, moderate, and complex questions. Simple ones are usually for juniors, while the others are for seniors. Since we have a mix of people here, some questions might seem tough for juniors and easy for seniors. But the subject matter is the same. Understand what's expected from a junior versus a senior. For example, if you ask a junior about a tomato, they'll say it's a tomato or a fruit. A senior will know it's a tomato and a fruit, but they'll also know it doesn't go in a fruit salad.
When preparing, focus on what's common to all four companies. For example, even though United India calls it "Health Your Gold" and New India still uses "Mediclaim," focus on the common template applicable to all four. Whether it's miscellaneous, fire, or anything else, stick to the commonality of the subject matter. Don't focus on specific policies like "Uni Criticare," which is only marketed by United India. Instead, focus on common terms like "Critical Care policy."
Objective type questions can be one or two sentences, or they can be long. The answer can be direct, indirect, or analytical. You have to pick the best out of the four. When you read the question, be clear about whether it's asking for a direct or negative answer. "Not excluded" means included, and "not included" means excluded. Most of the time, you'll have to know the best out of the four options.
I want everyone here to be mentally prepared and confident. There shouldn't be any confusion. Give me your mind and physical activity, and walk along with me like a child. I'll be careful in teaching you, focusing on the exam point of view. Today, we'll talk about health insurance policies, and this afternoon, we'll cover miscellaneous policies. Tomorrow, we'll finish up with liability policies.
I'm going to tell you something different, something more practical and useful. We'll cover common templates applicable to all four public sector insurance companies. You'll also learn about regulations, new circulars, and updated information from IRDA. Plus, you should know about IRDA standardized products and central government welfare schemes.
First, understand the question. Read it properly. Then, understand the answer. If the question is positive, pick the positive answer. If it's negative, pick the negative answer. For example, "incorrect" means it's a negative, so the right answer is the positive one. Let's take an example: Rahul has a health insurance policy and wants to cancel it on the 20th day. He didn't make any claims. How does the insurer respond?
The question is about the free look period. Some people might think it's only 15 days, but after the 2021 regulations, it's 30 days. So, refund of premium is not possible as it exceeded the stipulated free look period is wrong. Refund amount would be considered in full is also wrong because the risk has commenced. The right answer is refund amount would be considered on a pro-rata basis for the balance of the period.
Now, let's see how this is interpreted for seniors. Rahul has a health insurance policy for one year, paying ₹9,500. He wants to cancel on the 20th day and didn't make any claims, but incurred ₹450 towards pre-medical examination charges. How does the insurer respond? The policy is not short-term, it's a one-year policy. The question includes ₹9,500, so they might ask for a mathematical calculation. He's returning within 30 days, so he's eligible.
The question also mentions ₹450 for pre-medical charges. As per IRDA, if the insurer insists on a pre-medical checkup and the proposal is accepted, 50% of the pre-medical exam fees must be returned. So, the right answer is refund amount would be considered on a pro-rata basis for the balance period, excluding the insurer's part cost of the medical checkup after deducting stamp duty.
Or, the answers may be like this: by refunding an amount of ₹9,500, by refunding an amount of ₹8,771 minus ₹225 and SD, by refunding an amount of ₹8,996 plus SD, refund and amount is not possible to exceed the stated free period. The correct answer is B. ₹9,500 divided by 365 days is ₹26 per day. He used it for 28 days, so ₹26 into 28 days is ₹728. ₹9,500 minus ₹728 is ₹8,771. Then, deduct 50% of ₹450 (₹225) plus stamp duty.
What did you learn? What is the free look period? What is the duration? What type of policy is it applicable to? It's not applicable to short period policies. It's applicable for one year or three years policies. How does the insurance expect to act to refund if the risk is not commenced? If the risk is commenced? If claimed? You should not simply skip because you know the right answer. You must sit there and think why the other three are wrong.
Here's another question: UIC policy period is 1/1/2019 to 31/12/2019 for ₹3 lakhs. NI policy period is 1/7/2018 to 30/9/2019 for ₹5 lakhs. Admitted on 1/12/2019, discharged on 16/2/2019. Claim amount is ₹3.8 lakhs plus non-medical expenses of ₹20,000. How does the insured make a claim? The claimant has the right to choose the first and second insurer based on the benefit that he likely gets reimbursed.
As per IRDA guidelines, an AYUSH hospital must comply with the minimum beds criteria. Is it 10 beds in rural, 15 in urban? Five beds in rural, 10 in urban? Five beds irrespective of rural or urban? Or no minimum number applicable? The answer is C: five beds irrespective of rural or urban.
IRDA guidelines on telemedicine stipulate: insurance cannot cover telemedicine procedures, insurance can cover telemedicine on a pilot product basis, insurance is advised to allow telemedicine but approval of pilot is required, or insurance is advised to allow telemedicine but no approval of pilot use required. The answer is D: insurance is advised to allow telemedicine, no approval of pilot use required.
Telemedicine is a facility where doctors contact patients without physical appearance over video. IRDA introduced this during COVID. Insurance is advised to allow telemedicine, no approval and file are required. All other products need file and approval, but telemedicine can be added by any insurer without file and use.
Which of the following disease conditions is not covered by standard health insurance policy? Hyperacute disease that is insidious and life-threatening, acute condition that is abrupt onset quick recovery, chronic disease condition existing before the policy, or chronic disease condition that acquired after certain policies policy period. The answer is C: chronic disease condition existing before the policy.
Hyperacute means immediately life-threatening. Acute means abrupt onset, quick recovery. Chronic means existing before the policy. Any disease that is pre-existing is generally not covered. A disease acquired after taking the policy is covered.
With regard to health insurance coverage, pick the odd one out: pacemaker, prosthetic leg, cochlear implant, or intraocular lens.
Pacemaker, prosthetic leg, cochlear implant, and intraocular lens. Anything that gets inside the body is payable, except one thing: cochlear implant. Anything that goes outside the body is not payable, except one thing: prosthetic leg. So, pacemaker is payable, prosthetic leg is payable, intraocular lens is payable, but cochlear implant is not payable. The right answer is C.
Odd one out means three are similar in one aspect, and one is different. Pacemaker is payable, intraocular lens is payable, prosthetic leg is payable, cochlear implant is not payable because it's excluded.
With regard to IRDA standardized health and PA insurance coverages, pick the odd one out: Arogya Sanjeevani, Corona Kavach, Health Insurance Gold, or Mashak Raksha.
The odd one out means there are three similarities and one is odd. Arogya Sanjeevani, Corona Kavach, and Mashak Raksha are standardized policies introduced by IRDA. Health Insurance Gold is not an IRDA policy; it's a word given by public sector organizations. So, C is the right answer.
Now, we'll get into the subject: common template of four PSU health insurance products. This is common; there's no odd one. You should know the basics of this.
What are the sciences of medicine covered by public sector organizations? Allopathy, ayurvedic, unani, siddha, homeopathy, yoga, and naturopathy. Hospitalization means a minimum period of hospitalization not less than 24 hours required for basic hospitalization covers.
Domiciliary means the patient is not able to go to the hospital, and there are some criteria. He can get treated at home. There's a limited sum insured for domiciliary. Daycare means because of the advancement of medical science, doctors are not admitting the patient for 24 hours.
Critical care is a life-threatening condition. Specific illness policies are there. Travel for all four companies is not the same. Even though we use the word overseas medical policy, the coverages and conditions are common for all four companies.
You must know government schemes like RSBY and PMJAY. There are a lot of questions coming every year because it's connected to our central government. The products are marketed by all the insurance companies: hospitalization product, domiciliary hospital product, daycare product, critical care product, specific illness product, travel product, and government skill product.
How are the policies issued? Individually, floater, stop loss, group policy, or specific risk policy. Individual includes family, proposer, and dependents. Floater means a single sum insured will be floated, and the premium will be paid. Claim will be shared among all the members in the family.
Stop loss is a top-up policy. If the basic policy is not enough to reimburse the loss, there must be one more additional policy which will take care of the difference of loss incurred by the customer. Group is given to more number of people. As per IRDA, seven and more is considered a group.
There's a difference between individual and group policies. Individual policies are eligible under ATD income tax benefit. Under group, it is taken by the organizer or employer, so there is no ATD. In group, some facilities are there, like maternity add-on cover. Individual has a waiting period; after three years, the fourth year, free medical checkup they can avail the facility. That is all not there in group.
Maternity benefit is not at all covered in individual. In group, it is an add-on cover. In a group of a thousand people, if there are only 200 female members, out of 200, only 50 are newly married, then for the 50 people, they are only eligible for the maternity benefit, but the premium must be paid for the entire group.
Individual has a benefit of ATD; group does not have. Individual has pre-medical checkup after three years; group does not have. Individual has a bonus class; group has both bonus and manage class. Individual has no add-on covers; in a group, you can have a lot of add-on covers.
How are claims settled? Indemnity basis, benefit basis, fixed benefit basis, or excessive loss basis. Indemnity means actual loss incurred as per the policy condition. Benefit means no question will be asked once it is proved that you are suffering from the disease. The entire amount will be paid to you without any deduction.
Sum insured means it's a maximum amount by which whatever you're eligible, that will be paid. Sum assured means this is the amount; no question will be asked. The total entire amount will be paid.
Fixed benefit policy: in individual policy, there are some policies in the end they have given Hospital benefit. Excessive loss: when your basic policy is not able to compensate your loss, that is excess of your loss.
If you pay a premium in an insurance company, what is the ATD eligibility for a non-senior citizen who has got an age below 60 years? Who has got above 60 years, senior citizen? Who is a super senior citizen who is above 80? A non-senior citizen is eligible for only ₹25,000. If the parents are also below 60, they can have a maximum of ₹50,000 under tax deduction.
For a senior citizen, it's ₹50,000. If both are senior citizens, they can avail a maximum of ₹1 lakh from ATD. For a senior citizen, the ₹50,000 need not be the premium paid. They have given a provision for senior citizens: premium, preliminary checkup, and any medical expenses incurred more than the policy amount.
ATDD: tax deduction on expenses incurred towards treatment of specific diseases. Section 80 DD: tax deduction on medical treatment of dependent who is a person with disability.
Non-senior citizen: ₹25,000. Senior citizen: the ₹25,000 includes the cost of medical expenses also. In the case of a senior citizen, the ₹50,000 includes premium, medical expenses, and preliminary checkup.
Hyperacute, acute, chronic, and pre-existing: I explained to you.
A person has taken a policy, and it is expiring on the 25th of December. This person got admitted on the 20th of December and underwent treatment for typhoid. His policy expired on the 25th of December. He got discharged after the expiry of the policy. Will the claim be paid? Yes, the claim will be paid because the claim has occurred during the policy period.
He got back the same disease within 45 days, even though he has not renewed the policy in time. If he has to get admitted again for the same illness, if there's a balance of sum insured there, he can avail the facility under any one illness clause.
Even if the policy is expired, then also it is payable. This is the only exception under AYUSH. It is common for all four companies. It is not there in any private companies. It is a class in the policy. A disease reoccurring, relapse of the same fever occurring within 45 days, even though the policy is expired, but he has got eligibility to make a claim within 45 days of the discharge.
When I ask you about the waiting period, what is the waiting period common for everything? You will say, "Sir, waiting, we know it's only 30 days." No, my dear friends, don't read like that. If you know 30 days, okay, it's applicable for all standard policies. But there are some waiting periods: 15 days, 90 days.
Where does 15 days waiting period come from? Corona policy. Where does 90 days waiting period come from? Critical Care.
Free look period is 30 days. Portability: an individual policy can be floated to a group, and a group to individual at the same company. If it is a different company, from company A to company B also can be gone. Loading: why do we load the premium? If there is any medical condition what we regard as adverse medical conditions.
Adverse medical conditions: excessive cholesterol, hyperlipidemia, diabetes, high blood pressure, hypertension. If anyone has got it at the time of taking the policy, insurance has a right to load the premium towards adverse medical condition, maximum of 30%, provided if they got it approved by the IRDA at the time of file and use. Adverse claims ratio loading: you can load a bad client provided you should also got approved to load at the time of file and use.
Now, we'll go to the other features that are common to all four companies. Each and every feature, maybe you may be knowing, but some intricacies I, whatever what all you I think you know, I'll rush. What all I think you know the intricacies, I'll take a little time and explain.
Age means what is the age at entry? What is the age at exit? Whom can we cover at what age? For a standard health insurance policy, the age at entry is 18 years to 65. We can also cover a child provided that it completed 90 days or 3 months, provided one of the parents must have been covered. There is no age limit. As long as we are continuing, till our life, we can continue.
Hospital means it must be a recognized hospital, registered hospital with the local authorities. It must be registered with the Rogini. It must have the minimum number of beds. It should have a qualified registered medical practitioner.
If a family is covered, we normally give discounts: family discount 5 to 10%. If he has not made any claim every year, the cumulative bonus goes up, maximum 50% of the sum insured. If he has not made any claim for 3 years, after completion of three years, 1% of the sum insured of positive policies.
Tax benefit we already discussed. Hospitalization science of medicine we already discussed. Waiting period already we discussed. 24 hours condition. Prehospitalization and post hospitalization: any expenses incurred before admission into the hospital is prehospitalization. After discharge, the doctor is advising you have to take the medicine for some time.
Our liability is restricted to a maximum of 30 days prehospitalization, 60 days discharge. Their amount put together, both pre-hosp and post-hosp, should not exceed more than 10% of the sum insured.
Any one illness already we discussed. Living with the disease already we discussed. Waiting period: what is the waiting period common for everything? If you know 30 days, okay, it's applicable for all standard policies. But there are some waiting periods: 15 days, 90 days.
Under Hospital definition, they have made it 10 inpatient beds in places having a population of less than 10 lakhs people and 15 impatient beds in all other places. Pre-existing disease: the condition which the patient or the customer or the client is aware of even before taking the policy.
Adverse history loading: diabetes, hypertension, elevated cholesterol, maximum 30%. Two years waiting period: cataract, benign prostatic hypertrophy, hysterectomy, hernia, hydrosil, piles, sinusitis, GBL stones, gout, rheumatism, car.
Congenital internal disease: congenital means a defect existing at the time of birth. Congenital disease cannot be covered. Four years: all joint replacement.
General exclusion: 30 days waiting period, pre-existing 36 months, chronic even before taking policy that's not at all covered.
Moratorium period: after 5 years, if a person is making a claim, the insurance company cannot repute the claim for the reason that he is aware he has not told the insurance company.
Cosmetic: changing face lifting, body lifting that is not covered. Circumcision: removal of tissue from the male reprod organ. Dental treatment of any kind is not payable unless otherwise it necessitates hospitalization.
Routine eye checkup, general checkup is not payable. Supportive debility: I just go to a doctor, doctor, I'm weak, give me B prescription, that is not payable. Irrelevant diagnosis: the person goes for a small problem in the foot, but he was asked to take an entire scan of the body, that is all not payable.
STD: sexually transmitted diseases and any AIDS, all these not payable. Maternity is not at all payable under individual policy. Naturopathy is excluded only in allopathy.
Intoxication: if it creates a problem like alcoholic gastritis, that is not payable. War, nuclear, and invasion: it's a very, very common explosion for any policy.
Domiciliary hospitalization: the disease must be there for more than 3 days. The condition of the patient necessitates he or she cannot remove to the hospital. Lack of accommodation. Under domiciliary hospitalization claim, pre and post hospitalization are not covered.
Asthma, bronchitis, chronic nephritis, gastro entries, diabetes, epilepsy, hypertension, cough, cold, influenza, mental illness, PUO, urinary tract infection, tonsillitis, laryngitis, arthritis, gout, rheumatism.
Maternity is an optional cover, normally given only along with the group policy, wherein 10% premium should be paid by everyone. Standard liability is ₹50,000.
Waiting period under maternity benefit is 9 months. Any medical recency miscarriage due to accident, legal termination, everything is automatically covered under normal policy as maternity policy. No pre and postnatal expenses.
IRDA regulations: the first regulation started in 2013. Subsequently, master circulars came in 2016, 19, 20, and the latest is 24.
IRDA created standardized policies because individual insurance companies were simply confusing the people. Telemedicine is automatically allowed.
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Transcript
Full transcript of “GIEAIA Promotion Exercise 2025 26 Class Miscellaneous, Liability and Health 07/12/2024”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:02 so what I uh prefer to share with you today morning first I'll finish off the health insurance because health insurance is one of the very important topic today across the country so sometimes there might be some questions about five to six seven questions is coming in health insurance whether they are junior or a senior so first we'll finish off the health insurance travel and other thing subsequently today afternoon we can also start with their General miscellaneous tomorrow we can talk about or discuss over liability insurance my session will be totally different I would rather prefer to be interactive little even though I'm not able to see every one of you over the screen and uh if I ask some questions I
0:49 would request you any one of you can respond so that I'll be also feeling that I'm very comfortable otherwise I'll be only talking to a screen where I will be also not having that energy if somebody's responding to me when I'm asking some questions that will energize me so that I can continue my topic so today the first day I think the first day means of my my session you are in the last day of your sessions I know that today we are going to discuss about health as I told you reading for knowledge is different from reading for exam reading for knowledge is only to acquire you just go through the book you acquire you wellers and it is only for knowledge but reading for exam it's not
1:35 only that you acquire the knowledge but how best you going to apply that's more important because the examiners they try to understand how best you are able to apply the knowledge what you gained and moreover the the way that we have to read for exam it is not like General uh reading because you should not waste your time when it is not at all required as you know that the examination will be about different subjects but you have the option to select four subjects and you can write only four subjects you want you can also write more but I would request you be thorough with the four subjects keep one subject a standby in case if you feel comfortable with the four subject sometimes because of the shuffling of exam questions sometimes
2:23 you will be little uh feeling the questions are tough because of the automatic shuffling in the computer sometimes the question will be very big even it will have about 10 15 lines it will take your time in that case you can also peping the other one which you are kept as a standby so that you can also select the best out of the five total seven you can select the four and you can write and I have given a very detailed information how to go for exam how to read for exam how to pick up the right answer for the exam how best you can make make make yourself comfortable everything in a different writer that was already circulated to you that Pro tips for excellence that I already written I hope every one of you already
3:10 gone through it's my request whatever subject you are selected and uh you please go through that it would be really useful to you first of all when you appear for exam first you should make your mind very comfortable that you will definitely pass then you have to go for the next step that you will excel you should not feel that the questions are tough or the questions are time is not enough all these things will not come when you in a comfortable Zone first of all you should select all the questions which are very easy for you so that you will ensure that you are in a comfortable Zone and you will definitely pass once you definitely pass the next step as I told you in my tips there are three tips three uh cycles first cycle
3:55 you have to select only the easy question the second cycle you have to see the questions what you are not attended to complete the total number of questions as expected by the your management the third one to ensure that you correctly saved all the answers because in the Harari sometime you would selected the right answer but you would miss to save the right answer then it will unnecessarily create some problem so the third cycle will help you to re-examine whether the questions and the answers are compatible or you have selected any wrong answer so so that you'll be put into the comfortable Zone this is how you to program when you appear moreover you should make your mind very comfortable very calm the more you calm the more you relax you never do
4:41 mistakes if you are stressed if you are uh if you're not comfortable you tend to do a lot of mistake so before attending the exam you try to make yourself imagine visualize that as though you are attending exam when you are at home and make yourself make adapt the situation where you will be facing the real situation at the time of exam when you do it regar and regarse and regarse at home you will never feel the stress the real time of examination because already you come across when you are at home the as you are visualize how best you can attend the exam so make yourself comfortable and in the exam I told you there may be a very simple question we have to select the right direct answer
5:27 sometime there will be a moderate question sometime there complex the complex and moderate mostly goes to the senior cus the simple goes to the junior cus since I'm talking to a group of people like you you are not a homogeneous group homogeneous means everyone appearing for class one to scale one to scale two there are seniors appearing for scale 3 to 4 4 to 5 and there are seniors 2 to three and there are Juniors so you you are a composite group of your heterogeneous group so naturally when I share information about questions and answers some questions for the juniors maybe you may be feeling little tough but some questions for the seniors
6:12 you may be feeling is very easy but whatever it may be all the question may be interpreted in a different way the subject matter may be the same first you should understand what is expected from a junior what is expected from a senior if I show you a tomato if I ask a junior what what is this the junior will tell it is a tomato or it's a fruit if I ask a senior he will also know he will be able to know it's a tomato he he also knows it's a fruit but what is expected from him he has to say it will never go well with the fruit salad because even though tomato is a fruit it will never go with the fruit salad because it's a it's a vegetable salad so that is how you have interpret the subject what you learn for examination point of view you
6:59 should not read all what all you know you should only read which is common to all four companies for example if you take health insurance even though I say health insurance even though in United India it is said as health your gold and your senior citizen Platinum New India never says like that new India you still uses the word medic claim so you do not worry about which is not connected to each other but you should know the common template which is which is app applicable to all four companies whatever subject you prepare for yourself whether it's a misenus or it's a fire or it's misleaders anything you should always go with the commonality of the subject matter for the four companies you should not see for example
7:45 if I started talking about uni criticare to you it is not useful for your exam because uni criticare is a particular policy that is marketed only by United India you as a new India person as a Oriental person as a national person you may not be seeing that word in examination but you may be seeing a word Critical Care policy because critical is a common word so that is how you to read for the exam so when you see the objective type the question may be one or two sentence the question may be more than five 10 sentences it may be a big question to read about or the answer may be a direct the answer may be indirect the answer may be an analytical and you have to select the best out of the four but when you read answer when you read
8:33 the question you should very clear about the question whether the question is direct answer whether the question is asking the negative answer which is incorrect it's a negative answer whether it is not excluded means it is included and it is not included means is excluded they may they may not be asking you which is an exclusion which is an inclusion but they may interpret the way they are asking you most of the time any any of the above none of the above will not come most of the time most of the time he will be expected to know the best out of the four so you have to read in such a way before exam whenever you go through the questions and answers I'm going to give you lot of questions online also you at the end of this
9:19 particular topic we are going to interact different question answer how best you to select the answers for the relevant topics if it is Health I'll be giving you some questions if it is other message I'll be giving questions that is how you to prepare yourself why I am taking little time to get into the subject because some of you would have also expected to join you are only 49 people now even though there are more people register probably these 49 or 50 people who are in front of me today may be more interested in missing this others may not be appearing for whatever it may be I want my students in front of me today in the online class mentally prepared they should be confident when they when they subjected themselves for my session they should not get any
10:06 confusion everything should be clarified properly and you have to give your mind and your physical activity everything to me and you should walk along with me by sitting in front of a camera or sitting in front of a laptop or a desktop or a mobile phone if you started thinking something if you started attending something all my sessions all my efforts will not be fully useful to you so I would request you please be with me these two days the entire day I'm going to take for you tomorrow half a day I'm going to take for you please be with me and you should walk along with me like a child I am your are wellish you should walk along with me child each and every word I'll be very careful in teaching you because
10:51 I'm more focused only on examination point of view now we'll go to the topic first we are going to talk about health insurance policies afternoon I'll be talking about miscellaneous policy and tomorrow if anything left out after covering that I'll be completing the liability policy today we are going to see the health insurance policy what we should know for the examination point of view first of all how to prepare for pre-promotion exam it is not the one what you already know it is not the one already all other faculties shared with you something I'm going to tell you something different which is more practical and more useful that what I'm having that confidence so how to prepare for exam in health insurance policies and apart from that I'm going to share
11:37 with you common template common template means that is applicable for all four public sector you know insurance companies okay and the third one in health insurance you're going to learn you're going to uh get from me the regulations the regulation in the sense what all changes are what all new circulars have come what is the updated information from I regulations that's more important in health insurance especially for senior C for uh your seniors who are attending the exam then the last the fourth one you should know what are irdi standardized products standardized products means I has come out with some
12:24 specific products name the product at their end you cannot name as you like a name only must be used and coverages exclusions everything same across the country it must be marketed by all companies whether they are private companies or a public sector so this kind of products you must know because the examiner who is preparing the exam is very concerned very keen in understanding whether you are keeping updated the latest changes from irda so that products also we are going to see the last one what today we are going to see some central government welfare schemes there are some schemes are there definitely two or three questions are coming every year so you will be also
13:10 learning something about central government schemes now we will go for how to preper for pre-promotion exam I'm not going to tell you what you already know I'm only putting into the interactive session how the questions will be there how you have to answer if you are a junior how you have to answer if you are a senior here for example we'll take first you should understand the question so you to read the question properly then you to understand the answer once you understand the answer you will be able to pick up the right answer according to the question the question is positive you have to select the positive answer if the question is negative you have to select the negative answer for example incorrect means it's a negative which is the right answer the positive so that is all now I'm going to
13:57 put up into a different test see for example you are today learning from me health insurance products and policies marketed by four Prime public sector insurance companies the subject matter what the examiner is going to uh find out whether you know whether you have enough knowledge is a Freel Loop period so what is Freel Loop period okay now I have put a question for juniors Juniors the question might be like this Raul has obtained a health insurance policy with a term of one year and is not satisfied with any of the terms and conditions and requested the insurer for cancellation on the 20th day of issuance of policy he did not make any claim during this
14:43 period how does the insurer respond to his request this is a very simple question for a junior so what would be the answer see the answer I've given four answers refund of Premium is not possible as it exceeded the stip Creed free Loop period will it be the right answer anyone can respond a one refund of Premium is not possible as it exceeded the stipulated pre loook period will it be the right answer wrong very good very good okay wrong wrong why wrong because people who have not updated their knowledge they will be still thinking the freelook up period is only 15 days people who have updated knowledge they know especially after
15:29 2021 new circulars came new regulations came Master circular came from IA they increased the freelook period to 30 days so definitely it has not exceeded so this is not the right answer okay refund amount would be considered in full what receip from the proposer and insured whether this will be the right answer this may not be the right answer because I'm not going to interact more otherwise will take lot of time at the end I've got nearly 50 to 100 questions there I will interact with you but I will also question I'll also read the question I'll also tell the answer meanwhile in between I'll ask you your word because I want your voice to get my energy so and if I ask you to say you say okay now the second answer refund amount will be
16:15 considered in full see when it will be considered in full when the risk has not commenced we can settle in full when the risk has com we cannot settle in full what it says he does he did not make any claim that means risk has Comm so this is not the right answer C refund amount would be considered on proa basis for the balance of the period whether it's the right answer yes this is the right answer last one refund amount would be considered on short period basis no what because it is even though it is cancelled by the insured like other policies when policies cancel in other subject matter in other line of business like your fire or any other policy
17:02 normally how do we go we refund the premium on short period basis but pre lookup period is a benefit given to the customer so we should not refund on short period basis we should only refund for the balance of period for which he has not replaced on only Pro basis so the right answer you see the tick now C so this is how if you know a junior it is enough please understand but even for a junior you should know some Basics what is free look period what is the changes has occurred how do we consider this is now we the same question how it is interpreted for seniors see the size of the question now seniors Raul has obtained a health insurance policy with
17:48 a term of one year that is 365 days by paying a premium of rupees 9,500 see the complex of the question my dear seniors please see the the complex he is not satisfied with any of the terms and conditions and requested the insurer for cancellation on the 20th day of issuance of policy he did not make any claim during this period but incurred rupes 450 TOS premedical examination charges as sought by the insurer along with the proposal as sought by the insurer he has not produced because insurer wanted it that is why I sought by the insurer how do the respond to his request see the complex of the question many things are
18:33 involved the policy is not long-term policy it is it is it the policy is not a short period policy the policy is a one-ear policy so you should know why the question is triggering your mind telling 365 days next they also given you 9,500 they may be asking your sum they may be asking a mathematical calculation that's why they given 9,500 premium he is not satisfied okay when he is returning 28th okay 30 days there so he is eligible to return and for repent so that is there that is why they put 20th did not make any claim okay the policy has commenced that is why you did not make any claim if it is not com there is no question of claim so the policy has already com that you should
19:19 also know then again this question 450 is incurred toward premedical charges why the question is indicating that because as per the I NS if a insurer insist for a premedical checker and if it is produced by the insured and if the proposal is accepted by the insurer 50% of the cost of the medical examination fees premedical exam fees must be return to the insured by the insurer that is why they put 450 and how does the insur respond Tois so see this question how much a single word free lookup period but how much inep imp is expected from Seniors now what would be the answer part they have give two types of answer
20:05 part you see there are two types of answer part the answers may be like this or the answers may be like this first we'll see the answers refund of Premium is not possible as it exceeds a stipulated free period this is not the correct answer because it's not exceeded ref amount would be considered in full what received from the proposer and insure this is also not correct because the in the risk has already comen refund amount would be considered on Pro basis for the balance period excluding insur part cost of medical Checker after deducting stamp Duty and the last answer refund amount will be considered on short period this is wrong so the right answer
20:50 here the right answer here you see the right answer is C here you must know the proposal is not completed he has not accepted he he's canceling it so naturally the 50% what he has given see here you should know refund amount they are not mentioned premium see when something is involved three things are involved when you buy a health insurance policy three factors are involved Factor number one the premium what you are paying Factor number two the amount of uh expenses that is incre was premedical checkup as sought by the insurer Factor number three stamp Duty so all the three it comes as amount
21:37 it's not comes as a premium so the answer is refund amount so what will happen he's canceling so naturally has to BU the St Duty why I have not put stamp Duty as one rupe the one rupe stamp duty is not the same across the country it goes to the state governments some state it is more some states is one Rupee so I not mention deducting one rupe I put only stamp Duty but I mentioned 50% because the polic is cancel the proposal is not accepted further so naturally but still already has paid that 50% cost because now it has to recover by the insurance that is why in that amount that amount will be deducted so the right answer is refund amount would be considered on Pro basis for the balance of period excluding they
22:24 have to get back the 50% he's going away plus stamp Duty they deduct and pay the balance amount or the answers may be like this by refunding an amount of R 9,500 by refunding an amount of rupees 8771 minus rupes 225 and SD by refunding an amount of rup 8996 plus SD refund and amount is not possible to exceed the stated fre period so what is the answer here can anyone tell the second part what is the answer senior are you hearing me B yeah B why why B is right because 9,500
23:11 divided by 20 oh 28 days he has taken okay so it must be I put 28 days or 26 days okay it is 28 days okay so 9,500 divided by 365 means per day it comes 26 rupees so he is used for 28 days so 26 rupees into 28 days the amount comes 72876 so 728 might must be deducted from 9,500 so it comes 8771 that is TOS premium but the insur also has to dedu because now the proposal has not been accepted so what they have paid already what they shared the 50% 225 should be deducted plus the SD also should be dedicted so the right
23:57 answer is B so you are all clear now we'll go to the next question are you all clear okay 25 okay now what you learn what is free looka period what is the period duration what is applicable to what type of policy see it is not applicable to short period it is not applicable to more than three years policies it applicable to long-term policies but normally long-term policy issued only for three only only some policy are issued for 5 years what are the policy issued for years I'll tell you later but suppose see for example applicable to what type of policy short period policy not applicable and it is applicable for
24:42 one year or three years policy the preo period how the insurance expect to act to refund if the risk is not commen already we discussed if the risk is commen already we discussed if claimed nothing will be paid by the insurance company that we are not discussed so this is how you have to learn see here you may be wondering sir Health has got so much informations why you are taking so much time for free looker period my dear friend I took only one simple example free look period you should not do a mistake oh free only 30 days that's all we learn other topic no each and every time when you attend a objective type of examination you should not simply skip because you know the right answer you should not simply skip skip
25:28 the other three wrong answers you must sit there you must stay there the other three wrong is why it is wrong you should think and other three wrers whether it is connected to this particular question or this other three connected to some other question if you stay and think and pass one by one you will be master in the subject no exam will confuse you at the time of examination you will never get stressed you will never get confused and that will be easy you will confidentially select your topics okay so we will go to the next question model question UIC u means United India policy period is 111 2019 to 3112 2019 for a
26:13 sumur of 3 lakhs ni policy period is 17 2018 to 39 2019 for some sure have 5 lakhs admitted on 1 12 2019 discharged on 162 2019 claim amount is 3.8 lakhs plus non-medical expenses of rupes 20,000 how the insured can make a claim see this question is not for uh it may be for a not super senius it may be for a scale two to scale three it can even come for a scale one to scale two so scale so you must understand there are two different insurance companies are involved so how does ins to make a claim on
27:00 proportionate basis whether this is correct C from UIC and balance from Ni is it correct first from NAA because na he has taken five LS policy so then later balance us is it correct no because now the reason circulus the reason means not to this year last 3 four years the irda select made this answer climate has a right to choose the first and the second ins he can choose any insurance that doesn't mean first policy UA policy is to go only with the first policy he can even select ni he can even select U also why he will check which policy will give more claim for example in some insurance
27:45 company there may be more deductible some insurance company there may be more co- share so which insurance company there is no goare which insurance company there is no deductable he may first opt for that insurance company the balance amount only you op because the koser portion be lesser so the right answer is climate has the right to choose the first and second insurer based on the benefit that he likely get reimbursed right next we will go my dear friends I'm going one by one before getting to the subject because I'm triggering your mind this is how you have to read your subject for health not only for health for the matter any subject but I am concentrating heart because that is a topic that I have to share with you today so you may be
28:32 thinking I'm only taken few example then I'll go to the subject if you understand the examples you will understand the way I teach the subject also in the fourth coming part question number two as per I guidelines an aish Hospital must comply the minimum bir SC criteria so I want one of you to answer the right answer as per I guines an aish Hospital must comply in the in the minimum bets criteria one 10 bets in the rural area 15 bets in the urban area B five BS in the rural area 10 bets in the urban area C five BS irrespective of rural or Urban D no minimum number applicable what is the answer my dear friends can anyone
29:17 respond please C option C very good very good very good that shows how you are very good in your subject see unlik you know the reason circular you would have not selected C you have select you have selected the right answer because the norms for BS it change later by irda for example earlier what we said it must have been a registered hospital and you should have a minimum number of beds or it should have a minimum number of beds the minimum number of beds what they said for Orban Area 15 bits for for rural area 10 bits but later what they have done they changed it what they did minimum number of beds but for example for 10 beds minimum number of beds for
30:05 population less than 10 lakhs and for all other area it is 15 beds like that they changed but recently that reason means within 3 years they have Incorporated a new condition especially for aush minimum number is five bir irrespective of rural nural so the people who knows the answer the people who answer today my friends you are really very good we are very knowledgeable and you are updated your knowledge even though you're attending the sessions you're AB breast of all updates I'm really happy now we'll go to the next question question number three model question three I guance on tele medicine stipulates a insurance cannot cover tele medicine procedures Insurance can cover tele medicine on pilot product basis
30:51 Insurance are advised to allow tele medicine but approval of pirate is required insurance are advised to allow Insurance are advised to allow that is by tele medicine but no approval of fent use required can anyone of you tell what is the right answer D which one D which one tell me tell me which one even d d you said D what is the meaning of tele medicine sir what is the meaning of tele medicine very good very good very good this is why I want you to interact with me tele medicine it's a it's a facility especially irda thought after the
31:39 covid during covid infection Corona infection people were not able to move out of their home because there's a possibility of infecting others so doctors also advised to be quarantine at home only very serious cases been got admitted in the hospital so doctor has to contact them without physical appearance over video facility like cell phone video so they used to see the patient through the cell phone video that is what what your video call and they used to interact with the patient they used to prescribe the medicine so they will not have a physical touch they will only see the patient through video and prescribe the medicine this was not thought of this was not allowed in our earlier health insurance policy during
32:26 Corona time I they thought this is a must in the future life so theyve introduced the tele medicine can be also covered by any health insurance policies that is what tele medicine number one tele medicine is today is a very common subject across the world even exp experts from other countries doctors also coming only on video callard they never come to the countries so that is now allowed in health insurance policy number one to give the facility those who really suffer those who got the product health insurance product in India I said Insurance are advised to allow tele medicine no approval and file are you they have granted direct permission see all other product if it is introduced in health insurance by the
33:12 insurance insurance companies they have to appear they have to get approved pile and approved but this is the only add-on cover not an add-on cover it is automatically can be added by any insurer in India without file and use so those who know the latest changes they can only select the D answer so I'm happy even if you are innocent you ask me what is tele medicine this is how you have to interact with your faculty you should not feel you should not feel guilty because I I I am also not master of everything I also learn sometime I also learn from my student sometime my students question will trigger me to make myself corrected so don't feel anything bad you if you have any doubt please ask so now we will see so here
34:00 you should not jump here you to think one more thing see here tele medicine you learn here you learned tele medicine is automatically Allowed by a you also learn tele medicine never require F and use but you should think here little sir final use is common for any new changes or new add-on cover or new policies but is there any word is also there use and F yes there is a provision in I for certain things use and file that means you can use that add-on cover you can come across your experience whether it's a loss making or profitable and find if you are happy that it is a profitable then you can get approved after filing it there is some provision a new
34:46 provision also introduced byda that is use and file which product has got use and file facility no other product has got use and facility except only one product introduced by irda which is the product you think it over I am not going to tell the answer now I'll tell the answer then I dealing this particular product subsequently okay meanwhile if you find out the answer I'm happy if you not find out the answer I'll will tell you the product is eligible for use and file all the product are important for file and use but tell medicine there is no pent use is required now we go to the next question which are the following disease condition that is not covered by standard health insurance
35:32 policy which are the following disease condition that is not covered by standard health insurance policy hyperacute disease that is Insidious and lifethreatening what is insidious in means asymptomatic people are not aware that they are suffering no symptoms will be there it will be inside it will not show any symptom people not not even aware that they have got the noise disease so that is called Insidious but once it is diagnosed immediately you have to get treated otherwise it will kill the person that is a lifethreatening so what is the question which of the following disease condition not covered by standard health insurance policy hyperacute acute condition that is abrupt onset quick recovery that means
36:19 for example first answer hyperacute means somebody found out he's having vomiting he's having high fever he's going to a doctor doctor says his appendix is highly inflamed immediately append appendix should be removed if it is he suffering from appendicitis if it appendic is not done the appendix inside the body will burst septic will happen the person will die so immediately life threaten condition immediately should get operated that is hyperacute so any hyperacute condition it is not excluded by our health insurance policy because it is uncertainity City are not covered by in any insurance policy unsanity is covered by any insurance policy next acute acute means I I drenched myself in a rain I
37:07 got cold cough I'm careless I'm still stressing myself I got I'm not able to breathe doctor diagnos I'm suffering from bronchitis if I'm not get treated it will become a pneumonia once you become a pneumonia I'll get I'll die so doctor is admitting me abrupt answer but if immediately after giving antibiotic within 3 days I got recovered I'm discharged so acute disease it is admitted so naturally it is also paid chronic dise condition existing before the policy chronic disease condition that acquired after certain policies policy period so which is the right answer here is the right answer third third third third C thir yes chronic disease condition
37:54 existing means it is a pre-existing condition unless otherwise it comes under some other facilities of your there is a period is there for pre-existing condition but still it is known to the personent at the time of taking policy it creates a problem that all we'll discuss later but any disease that is pre-existing generally not covered but a disease acquired for example I taken a policy for four years or 3 years but third year I get a disiness I go to a doctor doctor diagnosing diagnos that I'm suffering from what I'm suffering from diabetes so diabetes was not there 3 years before that is acquired so if I get admitted for diabetes if I treated for diabetes hospitalization occurs that is
38:41 payable so the right answer is three okay question number five with regard to health insurance coverage pick up the odd one out seniors don't feel that I'm showing small small question you got tough questions later and at the end of the session but why I am taking so much of time to explain everything seniors should know the intricacies of this question Juniors they can straightly pick up the right answer they can move on but seniors the answer a with regard to health insurance coverage pick up the odd one out one of you said yeah okay I stop here I'm not going to ask you the question but explain you see how to find out some see here pacemaker is a
39:27 something that is added to the body prosthetic L something it is added to the body colear implant it is something added to the body intraocular lens something added to the body okay please understand seniors as well as Juniors how to know something is payable in insurance policy when it is an added to the body it is very easy easy to remember how to remember if anything gets inside the body please note my points if anything gets inside the body are all payable except one thing anything goes inside the body for example I have got a cataract after 2 3 years the waiting period is over I'm eligible for a claim but god-given lens
40:15 is removed man-made lens is inserted that is intraocular lens for intraocular L it gets inside the body the claim is payable so anything goes inside the body for example I met with a accident fractured there's a plating and pinning metal the metal cost payable and after 4 years my joint has gone out and I have been continuing the policy for more than 5 six years joint replacement happens the claim is I pa I asked a claim the joint replacement G inside the body manmade joint that is payable so anything goes inside the body are payable for example my heart is not producing enough electricity so doctor says new electricity should be given more so we need more voltage so what he
41:03 does he's adding a pacemaker inside my body bemer is not like your collar it is not a neck collar it's not a collar which is used for neck pain it is something insert inside your skin and it is connected to your heart through your blood vessel so it is also inside so pacemaker goes inside payable okay then intraocular lens it's payable okay then the problem is only with the prostate and C implant which is the hard one out you have to select out of the four which all which which of the three is payable which is not payable I told pacemaker is payable goes inside intal L payable but I told everything goes inside payable except one thing which is even though
41:48 goes inside it is not payable which is the one clear implant what is clear implant my I have a definition it may be a differentness due to my birth it may be a differentness due to my age it may be a def due to my accident so to to set the def doctors will put an implant inside man-made implant a diaphragm a sensor which will hear the voice or sound and it will pass it on to the brain so that is called cckar implant that is inserted into your head it goes inside the body but the price of the implant is 6 to 8 lakhs so earlier it was silent now all the insurance companies said because it's very expensive so C imp plant even though it goes inside the body it is not
42:35 payable so pacemaker is payable it's not hardd one clear is not hard one inra lens is not hard one and prosthetic L I'll come see prosthetic L here you think I told you anything gets inside the body are all payable except one thing C implant but it is it an hard one year just wait but I didn't tell you what about anything goes outside the body for example nebuliser okay thermometer or abdominal belt or neck cner okay everything is goes inside the body suppose I'm not able to respire I'm an osmatic patient doctor ADV me to keep a NE so anything goes outside the body are not at all payable except one thing
43:22 here also one exception is there what is even though it is outside the body it is payable what is that prosthetic leg so so now we find out the odd one pacemaker is payable prosthetic leg is payable intraocular is payable but colear implant is not payable so the right answer is C got it got it are you still confused got it or not come on a little sir a slight confusion slight confusion yeah tell me tell me see the the criteria of eliminating the options is based on the high cost of that Co clear implant and not the criteria that it is inserted inside the body and which is
44:09 payable you foret everything you forget odd one out so out of the four which are payable which are not payable you select now tell me OD one out means three are similar in one aspect one is different in one aspect so pacemaker is payable int is payable Pro is payable cant is not payable because it is not payable high cost because of cost forget about high cost it's excluded okay it's excluded so out of the four three are payable one is not payable so the right answer is C that is OD one out am I right or not why you answer yes sir yes sir right
44:54 see why I took so much of interest to expl explain you what all goes inside the body are all payable except one thing that is C implant what all goes outside the body are all payable except one thing prosthetic leg here prosthetic leg is not excluded prostetic included so you must know if the question is framed prostate you should get confused so Prost leg is comes out outside the body so it is not b no Pro is exemption so you please understand if you any question asked any addon to the body remember whether it goes inside the body or fitted outside the body if it goes inside the body whether it comes under the exemption if it goes outside the body whether it comes under the
45:41 exemption accordingly you select the answer clear clear no answer from you okay okay okay next next we'll go question number six this is the last question okay then we'll go to the sub subject okay last question any I shown the answer any I ask you with regard to I standardized health and paa insurance coverages pick up the odd one out tell me AR sanjini and coron Ka and coronaa health insurance gold and and masak raka the Corona raka and mashak raka
46:27 pick up the hard one out which one which you selected d d d which one so all are telling different different answer I I explain you why I selected C see the odd one out means there is three similarities and one is OD out what are the three similarities standardized policy that means it is introduced by across the country must be followed by both private as well as public company and the name is also given by irda right arog sanj standardized policy sakaa it's a new PA policy both are
47:13 standardized name is also given so that is one Corona coronaa that is also standard policy two are similar which is the third one similar Corona raka and mashak raka Mash raka so this is I policy so a b c both are introduced by I policy and there is a similarity why I selected C the mashaka is I policy but insurance health insurance gold is not a i policy some companies say it's a gold but some companies not saying as a gold they say Med claim so this is the word given by the public sector organizations not by IA so
48:00 this is the odd man out so C is the right answer are you got have you got my answer yes sir yes okay now you may be asking sir what is the intricacies arini what is the intricacies in what all we should learn for the examination point of view what all we should learn for kach K Raa and what is mashak raka what we should know for the examination point of VI don't worry I'm going to tell you when the slide comes okay now we'll get into the subject common template of four PSU health insurance products now I have triggered your mind how you to prepare for your exam the earlier slides that is why I interacted I took lot of time to explain this is all you have to learn
48:46 now I'm going to tell you from the forthcoming slide this is common no no odd one or something this is common you should know the basics of this science of medicine what are the science of medicine covered by publicity organization what are science of medicine alob ayic unani Sid Hopi okay okay then you have got yoga naturop see when you select why that that's a question for juniors last year what is why stands in aush so they have given an answer yoga they also given an answer yoga naturop you should have selected yoga naturop because the why stands yoga and naturopathy why never stands only yoga so science of medicine means in
49:33 Indian public sector insurance companies all the science of medicines are covered so that you must know hospitalization what is hospitalization a minimum period of hospitalization not less than 24 hours required for basic hospitalization covers so there are some exemption for example domicillary there are some exemption for example daycare so that all we will read what are there we would know so hospitalization means the person who has taken a policy must have got admitted in a hospital for such disease not less than 24 hours what is domiciliary there are some condition in which the patient is not able to go to the hospital and there are some criteria if it fulfills the criteria three criteria are there that we'll see later
50:21 and he can get treated at home the doctor can come and keep treatment so that is called domicillary so that is also the provision is there but the provision is not for the total Su insur there is a limited Su ins for the domicillary that we'll see later what is daycare dayare means because of the advancement of Medical Science today doctors are not admitting the patient in 24 hours or the patient himself not preparing to be there in hospital for more than one day they want to go like a beauty parallel they get treated they'll come back immediately for example you take a cataract our grandma goes as a to the hospital and immediately comes within 4 five hours as a beauty parallel you take about liy the urine is not coming goes to the hospital put on the bed they use a CER they relieve and the
51:08 urine is coming out he got relieved he's coming back within 1 hour so this all dayare so what all dayare are covered I has given some names of the diseases some new changes also occurred in the dayare as per the I a new circular I'll teach you later but you should know from this slide what is hospitalization what is domicillary what is De what is critical care Critical Care is something nothing but it is a condition which is a lifethreatening and once it is diagnosed that this particular person is having the disease it shows the the person may not live for long time his days are numbered so we have a critical care individual policies also in different different company
51:54 different different words are used but critical is a word for all the four companies you must know how the critical care policy is designed all for all the four companies what is the common waiting period what is the common coverage what is the common condition these all you should know that we see one by one specific illness what is specific illness already we talked about Kar kach Kara raka and other policies so that's also we are going to learn this only connected to if a person got the disease and admitted to the hospital there may be a reimbursement or there may be a benefit some policies will not ask any question once he's diagnosed he's suffering from disease the total amount will be paid because it is like a
52:40 PA policy no deductions will be there if it is a illness policy hospitalization policy deduction will be there so in a specific illness policy both benefit as well as inity policies are there what is travel travel for all four companies is not same even though we use OMP the word overseas medical overse medical poliy if you have read the book what you are supposed to read for exam you are supposed to read for exam is associate book you are expected to read associate book 2024 Edition I don't know how many of you read the 2024 Edition many of you read the old Edition like 2018 and and later but new revision has come some small changes has occurred whatever it may be
53:26 they never use the word om normally they used overseas health insurance policy so let us talk as over because the O is not same for all four companies but the coverages the conditions s some things are common for all four companies which we will share in the forthcoming sessions government schemes you must know there are some government scheme rsby and you know what is pram MRI health insurance scheme no BM Joy so all the there are lot of questions are coming every year because it's connected to our central government so this is the how the products are marketed by all the insurance companies the four public seta insurance companies are involved with different kind of product hospitalization product dois Hospital
54:12 product daycare product critical care product specific illness product travel product government skill product now how the policies issued it could be issued as individual it could be issued floater it could be issued stop loss it could be issued group group policy it could be also issued specific risk policy see why I'm talking all these things seniors please bear with me you may be knowing all these things Juniors if you are fresh first time you exam writing exam you may not be knowing all these things the way that I want you to know and those who are in between like scale two to scale three and you may be knowing and you may not be knowing because the may not knowing about the changes you
54:58 may be knowing about the old informations that is why I'm taking so much of time if he knows already if you are all knowing already please bear with me uh refresh your knowledge if you do not know about this things please learn from me and keep it your memory that will be useful for your exam so the products are marketed the product how it is marketed individually you know it is given to individual individual means it includes family proposal and dependence the dependence may be wife children and depending parents parents of the spouse as well as parents of the proposer floater means a single some insured will be floated and the premium will be paid claim will be shared among all the
55:43 members in the family premium will be also comparatively less and the risk of the insurance company is Flo over the entire member of the group it is need not be individually paid like a individual policy for example individual the husband is a professor sorry the husband is the professor he has taken for 2 lakhs the wife is dependent one lakh children each one one lakh so individually each claim will be attended by the insurance company in a floater husband wife two children one single sub for all the four they'll take only two lakhs so anyone if they get admitted in the claim will be shared that is Flo so stop loss what is stop loss you may be knowing there is one
56:30 policy marketed by some of the public sector insurance company and they named that as topup policy see super topup is not the policy issued by all the four companies super topup only by United India but the word commonly used by all the four companies topup policy what is topup if the basic policy not enough to reimburse the laws there must be one more additional policy which will take care of the difference of loss incurred by the customer and to compensate that is called stop loss so that is why all top of policy or example of top loss so that is the policy okay when the basic policy is inadequate the balance will be taken care of is top L what is group group is given to more number of people
57:16 as per the Ia what is the definition of a group earlier it was 100 now even seven and more is considered as a group and I has given some norms for group group that we will learn later but there's a difference between individual policy and group policy that also we will learn from group okay for example individual policy they are eligible under ATD income tax benefit under group it is taken by the organizer or it taken by the employer so there is no ATD and group some facilities are there for example maternity add-on cover is there individual there is no matal recoveries there and again in group if you take there is a bone man class if they make more claim and they'll be penalized by pen by they will penalized by more
58:04 premium in the subsequent renewal in individual there is no malus class but in individual there is a bonus class is there and in individual there is a waiting period after 3 years fourth year free medical checkup they can Avo the facility that is all not there in group so this is how you have to compare for the juniors then coming to the specific risk we are going to see indivually yeah tell me tell me yeah maternity benefit is covered in individual you said or in group ma maternity benefit is not at all covered in individual if it is covered by any other company out of the four that is specific to that company but generally all four companies in their policy
58:51 individual policy maternity benefit is not covered but there is some exemption as IA rule what is there even though it is connected to child birth there is some exemption what is that exemption I'll will tell you when I'm going to teach you the maternity slide okay but generally maternity or anything connected to child birth in infedility sterility are not covered under individual policy in group it is an add-on cover in a group of thousand people Suppose there are only 800 there are 800 male member there are only 200 female member out of 200 female member only 50 females are newly married and all other are old people they already got two children means the for the 50
59:37 people they are only eligible for the maternity benefit but the premium must be paid for the entire group even the male member has to bear the cost all these things I'll be telling you when I'm dealing with the slight maternity benefit section what is the new changes inced by also I'll tell you but in this slide you please understand the common difference between the IND ual and group individual has got a benefit of ATD group does not have individual has got premedical checkup after completion of three years in the fourth year group does not have individual has got bonus class group has got both bonus and manage class individual no add-on covers add-on covers it is given it becomes a customiz policy I'm talking about standard individual policy so generally no add-on covers in individual policy in
1:00:22 a group you can have lot of add-on covers like maternity B okay shall I proceed now shall I proceed now yes sir yes sir yes sir okay now specific policy we are going to deal respectively in the different sections what are the specific policies but you must know how the policies are marketed by the four companies now how the claims are settled by the four companies in inity basis in benefit basis in fixed benefit basis in excessive loss basis see you must know the word exactly if you are a junior if you are a senior you must know to pick up the right answer if it is given as a sum or if it is whether it's payable or not see for examp inity means actual
1:01:10 loss incurred as per the policy condition suppose a standard policy has been taken it says and for example room rent only 1% of the sum insured and ICU only 2% of the some insured maximum this much see some policies give maximum 2,000 some policies gives maximum 5,000 some policies give maximum 10,000 which are the polic we see later that is only common to four companies but in a standard policy inity for the room rent is generally 1% of the sum insured for room rent and 2% of the some insured for ICU so inity means actual loss as per the policy norms for example if you have a CO share of 20% only 80% of the claim will be settled if there is a deductable
1:01:56 deducting the DED only that will be paid that is called Indemnity okay then coming to benefit what is benefit if you come across that disease no question will be asked once it is proved that you are suffering from the disease whatever you taken that entire amount will be paid to you without any deduction that is called benefit here it is not some insured here it is called some assured please understand some insured means it's a maximum am by which whatever you eligible that will be paid some assure means this is the amount no question will be asked the total entire amount will be paid that is meant for benefit policies like PA that is meant for some benefit policies like Corona in Corona
1:02:41 there is a benefit policy so which is the benefit policy in Corona that we'll see later then coming to fixed benefit policy what is fixed benefit policy it may be sir yeah tell me tell me m sir what is the difference the difference between some assured and some insured please repeat some insured means see you have taken a policy with me for one lakh health insurance policy okay not you leave it I don't want to show you I tell you you as an example A A A is a person who has taken a policy with me I'm insurance company for inity policy like a standard health insurance policy for one L unfortunately he got admitted for a viral infection because the fever is not suceeding and he got admitted or for
1:03:26 a uh for any hospital he he was there 3 days he incurred some amount room rent uh there was not admission in ICU room rent doctor fees and all other things and whatever eligible for example Gest diet is not eligible but patient diet is eligible what is patient what the diet has been given to the patient by the doctor is eligible what he purchase something for the guest who came to see him like Coca-Cola or Biryani that is not payable so whatever payable as per the policy that is actually paid in the sum insured see he has taken 1 lakh even though he has incurred about 70,000 but whatever is eligible is only 49,000 so only 49,000 will be paid out of 1 lakh some insured that is called some insured
1:04:11 not the entire amount understand okay now I have taken a critical care policy the critical policy says if I come across any other disease enumerated below like brain tumor multiple sclerosis or and or both kidney failure enumerated some diseases and doctors diagnosed I taken the policy I I kept the policy for some time then later I was diagnosed because my old age I'm suffering from multiple sclerosis that is indicat in the benefit policy that shows if at all you are diagnosed suffering from this particular disease as no question will be asked whatever I assure you like agreed value policy
1:04:56 whatever I assured you I assured you that one lakh will be paid to you if you come across an unexpected this is like multiple scis that I'll be paid that is why it is some assured you are able to understand yes yes sir right now fixed benefit you may be confused here sir you told about benefit and what is fixed benefit my dear friends don't worry in indiv policy there are some policies in the end they have given Hospital benefit that means for 15 days maximum 15 days if you happen to be in a hospital some additional expense would also occurred it may not be a part of your regular medical bill for example you would have gone to buy medicine and saw
1:05:43 some additional expenses contingency expenses so we cannot give a contingency expenses but but we can compensate like a fixed benefits that is Hospital cash benefit per day this much if you opt for that you have to pay an add-on cover is there in your Corona policy so that is called fixed benefit that can be added with inity policy that is why you have to differentiate what is IND dominity what is benefit what is fixed benefit now excessive loss what is excessive loss nothing but when you your basic policy is not able to compensate your loss that is excess of your loss for example you taken a one lak policy but you incur a claim for 125 so you at loss of 25,000 so your basic policy will not reimburse because there a maximum amount
1:06:28 that is payable by the insurance policy suppose how you are going to manage you taken a top of policy then this claim is admitted top of policy is also admitting so naturally the 25,000 will be paid by the top of policy so the excessive loss will be taken care that is why it's also called stop loss so top of policy stop loss excess of loss are all connected to each other that you should remember okay now we'll go to tax benefit what is the tax benefit if you pay a premium in insurance company see earlier what happened in earlier time one second I'll close this in the ear time we have different different thing if I ask you what is a um ATD eligibility for a non- senior
1:07:14 citizen who has got a age below 60,000 60 years sorry below 60 years who has got above 60 years senior citizen who is super senior citizen who is above 80 so above 80 Superior senior citizen above 60 is a senior citizen below 60 is a non- senior citizen so what is the expected uh benefit under ATD tax benefit that's a small change you all know if it is not a senior citizen the proposer is eligible only 25,000 please understand is eligible self spouse dependent children below 60 years only 25,000 of Premium paid under taxable income under 80 not the entire premium whatever is eligible as for the income CL only taxable income is eligible
1:07:59 maximum of 25,000 okay suppose the parents also below 60 so he's adding he a dependent parents see he's only 35 his parents are only 56 so naturally they are also non- senior citizen so maximum they can have 50,000 under tax deduction and ATD suppose the person who is taken a non senior citizen is adding a parent uh senior citizen so he's eligible for 75,000 suppose The Proposal himself is a senior citizen I am 16 my parents are already covered and they are actually continuing the policy for many years now they exceed they are 75 or 76 so I'm also eligible for 50,000 they are also eligible for 60,000 so maximum a
1:08:46 person in India if both are senior citizen they can a a maximum of 1 lakh from ATD what is it changes has occurred earlier this only talked about the premium Now what they have done for a senior citizen the 50,000 Rupees need not be the premium paid normally we will not pay premium for that amount so they have given a provision for senior citizen premium prelimary check up what they incurred because it was s by the insurance company and any medical expens incurred more than the policy amount for example I've taken a policy for 2 lakhs I'm a senior citizen and my 2 lakhs policy I incurred a claim the insurance company said 2 lakhs but my claim amount is 4 lakhs the additional 2 lakhs
1:09:32 insurance company will not settle because my policy is exhausted so that is a loss to me so that loss also can be claimed under 8D with but within a limit of Maximum 50,000 so now the class has changed in 80d it could be only premium it could be all put together also so you read here premium prelim he checkup medical expenditure in one are all together they are eligible up to 50K for senior citizen so please understand now it is includes of all these things not only premium and check of expenditure and other thing so you also should know what is atdd is for the policies taken
1:10:19 from the insurance company by way of check not by way of cash so they are eligible for 20 ,000 a non senior citizen if they are eligible for a senior citizen 50,000 now the small word changed what is 80 ddb tax deduction on expenses incurred TOS treatment of specific disease see for example if they suffered from Corona if they suffer from some specific diseases they can also claim under 8 ddb but it is not connected to insurance but you must know even 80d be also included under 80d because it can be within the 50 then section 80 DD tax deduction on medical
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