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  • Raheja QBE Health Insurance

    Health Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    Raheja QBE is a joint venture between the Rajan Raheja Group and Australia-based insurer QBE. The general insurance firm was established after receiving a Certificate of Registration from the IRDAI (Insurance Regulatory and Development Authority of India) in December 2008. The company has a head office in Mumbai with regional offices in all major cities across India. The insurer offers varied insurance solutions for both individuals and corporates. Health insurance products offered by the insurer include a personal accident cover, a cancer cover, etc.

     

    Features and Benefits of Raheja QBE

    • Choice of Insurance Plans: Raheja QBE offers prospective policy buyers a host of insurance products. Plans are often customisable and can be purchased for an ideal sum insured, by both individuals and corporates.
    • Pre-Policy Medical Screening: A pre-policy medical screening is required if the individual is over a certain age or if one has pre-existing medical ailments/conditions. For select plans, if the screening is cleared successfully and the policy is purchased, the insurer will reimburse the costs of the medical test, either in part of full.
    • Tax Benefits: The premium paid, while purchasing your health insurance policy , is eligible for tax rebate under Section 80D of the Income Tax Act, 1961.
    • Customer Support: In case you need any assistance or have any queries, you can reach the insurer on their dedicated toll-free number, telephone number, email ID, or even walk into any of the insurer’s branches. You can find a list of company branches on the insurer’s official website.

    Plans offered by Raheja QBE

    Plan Name Plan Basis Sum Insured Policy Term
    Personal Accident Insurance Cover Individual Plan As per policy document NA
    Cancer Insurance Policy Individual Plan Rs.1 lakh – Rs.10 lakh As mentioned in the policy document
    Health QuBE Insurance Policy Individual/Family Floater Plan Basic Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    Comprehensive Plan:
    • Rs.3 lakh – Rs.50 lakh
    Super Saver Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    A la carte Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    Family Floater Plan: Sum insured has to be over Rs.2 lakh
    1 year or 2 years

    Personal Accident Insurance Cover

    This is an individual plan that offers members a cover against accidental death, total permanent disability, permanent partial disability, etc., as per the plan option chosen. The benefits payable will vary based on the nature and the severity of the accident.

    Unique Features of Personal Accident Insurance Cover

    • This policy comes with three plan options, which offers members varying levels of coverage:
    • Accidental Death
    • Accidental Death, Permanent Partial Disablement, and Permanent Total Disablement
    • Accidental Death, Permanent Partial Disablement, Permanent Total Disablement, and Temporary Total Disablement
    • Policy buyers can pay an extra premium to avail the Medical Expenses Extension benefit and a Daily Hospital Confinement Allowance.
    • If the insured member meets with an accidental death or suffers from permanent total disablement due to the accident, the insurer will pay the policyholder or the nominee 100% of the sum insured.
    • The payout for permanent partial disability will vary based on the severity of the injury.
    • If a member suffers from temporary total disablement, he/she will receive a payout that equals 1% of the sum insured or Rs.5,000, every week, up to a maximum of 104 weeks.

    Plan Details

    Plan Basis Individual Plan
    Sum Insured Range As mentioned in the policy document
    Premium Premiums will vary based on sum insured opted for, purchase of additional covers, etc.

    Cancer Insurance Policy

    This cancer policy will provide policyholders a payout if the insured member is diagnosed with cancer during the policy tenure. Policy buyers can choose an optimum level of protection since the sum insured can be customised.

    Unique Features of the Cancer Insurance Policy

    • If the insured member was diagnosed with Cancer during the policy term, he/she will continue to receive the benefits accorded by this policy, for a period of 5 years since the inception of the policy.
    • Medical screening will be required for individuals over the age of 50 years. The insurer will reimburse 50% of the expenses incurred by the individual due to this.
    • Children can be covered under this policy from Day 1.
    • The insurer guarantees lifetime policy renewability.
    • Claims will be reimbursed every quarter.

    Plan Details

    Entry Age Day 1 to 70 years
    Plan Basis Individual Plan
    Sum Insured Range Rs.1 lakh – Rs.10 lakh
    Premium Premium will vary based on the sum insured opted for, age of the insured member, etc.
    Medical Screening Medical screening is required for individuals over the age of 50 years.
    Cumulative Bonus Sum insured will increase by 5% for every claim-free year. The maximum cumulative bonus cannot exceed 25% of the initial sum insured amount.

    Health QuBE Insurance Policy

    This policy provides members a cover against expenses incurred during one’s hospitalisation, pre- and post-hospitalisation expenses, ambulance charges, ICU charges, domiciliary hospitalisation, etc. as per the plan option chosen. This policy can be purchased on an individual sum insured basis or as a family floater.

    Unique Features of the Health QuBE Insurance Policy

    • A maximum of 2 adults and 2 children can be covered when purchasing the policy on a family floater basis.
    • For family floater plans, the age of oldest member will be linked to the premium.
    • The policy comes with four plan options:
    • Basic Plan
    • Comprehensive Plan
    • Super Saver Plan
    • A la carte Plan
    • Plan options can be changed at the time of renewing the policy.
    • Health check-ups can be availed once in a year.
    • The insurer provides 3 add-on covers with which you can enhance your plan.

    Plan Details

    Policy term 1 – 2 years
    Entry Age Adults: 18 – 65 years Children: 90 days – 17 years
    Plan Basis Individual/Family Floater Plan
    Sum Insured Range
    • Basic Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    • Comprehensive Plan:
    • Rs.3 lakh – Rs.50 lakh
    • Super Saver Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    • A la carte Plan:
    • Rs.1 lakh – Rs.2 lakh
    • Rs.3 lakh – Rs.50 lakh
    Family Floater Plan can only be bought for a sum insured that exceeds Rs.2 lakh
    Premium Premiums will vary based on the plan basis, number of dependents enrolled, age of the oldest member, sum insured opted for, and the policy tenure
    Medical Screening Prospective policy buyers may be required to undergo a medical screening based on their age and sum insured
    Co-Payment
    • Super Saver Plan: In-built co-pay of 20%
    • A la carte Plan: Optional co-pay of 20%
    Waiting Period
    • Initial waiting period: 30 days
    • Specific ailments: 24 months
    • Pre-existing diseases: 48 months
    No-Claim Bonus For every claim-free year, the sum insured will be increased by 5% in the subsequent year. However, the no-claim bonus cannot exceed 50% of the initial sum insured amount.
    Discounts
    • Voluntary co-pay: 20% discount
    • Policies purchased on the insurer’s website: 10% discount

    Checklist before Buying Health Insurance from Raheja QBE

    A comprehensive health insurance plan is imperative to secure you and your dependents from financial difficulties in the event of a health concern or accident. However, it is necessary to consider a few things before you purchase a health insurance plan, such as:

    • Decide on what type of cover you require. It could be a personal accident cover, a general health insurance policy, or a cancer insurance plan.
    • Consider your needs and the needs of your dependents before opting for a cover.
    • Work out an optimum sum insured amount, after taking inflation, your liabilities, and rising medical costs into consideration.
    • Read the policy brochure for more information about the policy.
    • Contact an insurance advisor or reach out to the insurer using one of the Customer Service channels. You can also walk into the insurer’s office and directly purchase the required health insurance plan.

    Documents required for purchasing Health Insurance from Raheja QBE

    Most insurers will require prospective policy buyers to submit the following documents when purchasing a health insurance cover from them.

    • ID Proof: Passport, PAN card, Aadhaar card, etc.
    • Address Proof: Utility bills, Aadhaar card, Passport, etc.
    • Pre-policy medical screening documents, if applicable.

    Reasons to choose Raheja QBE

    • The company’s incurred claim ratio is high.
    • The insurer has products on offer for both individuals and corporates.
    • Individuals can choose to buy select policies on a family floater basis, and extend the cover to their dependents.
    • The insurer offers a cumulative bonus and discounts for certain plans.
    • The insurer has a presence in almost all major cities across India.
    • Select policies come with add-on covers, through which you can customise/enhance the policy so that it exactly meets your needs.
    • Transparency in handling claims.

    Incurred Claim Ratio of Raheja QBE

    The incurred claim ratio is calculated by totalling the value of every claim paid by an insurer during a financial year against the total premiums received for that same year. The incurred claim ratio of Raheja QBE, for the financial year 2015-2016 is 94.74%. A high incurred claim ratio is desirable since it indicates the insurer’s willingness to settle claims.

    Year Incurred Claim Ratio
    2016-17 126.70%

    Extra Benefits from Raheja QBE

    Grace Period A grace period of 30 days is provided by the insurer. The policyholder will have to renew his/her policy within the grace period, in order to maintain the continuity of benefits.
    Free-Look Period You can return your policy within the free-look period (15 days) if you are unsatisfied with the terms and conditions of your policy. The premium you paid will be returned to you, post cancellation.
    Portability You can choose to port your insurance policy from your existing insurer to Raheja QBE, without losing any of your accrued benefits. However, you will have to submit this application 45 days before your policy’s expiry.
    Tax Benefits You can claim tax benefits for premiums paid towards your health insurance policy, as per Section 80D of the Income Tax Act, 1961.

    Raheja QBE Policy Renewal

    Applications for policy renewal will have to be submitted before the policy’s expiry. You will have to pay your renewal premium within the grace period to keep the policy benefits from lapsing. You can contact the insurer’s Customer Service team on any of their channels, or renew the policy at the nearest branch. A list of branch locations is available on the insurer’s official website.

    Raheja QBE Network Hospitals for Cashless Treatment

    You can avail cashless hospitalisation at any one of the insurer’s network hospitals across the city. To locate the nearest network hospital, ensure you contact your insurance advisor or the Customer Service team.

    Claim Procedure for Raheja QBE

    Procedure to claim a Reimbursement:

    In order to register your claim, you will need to provide your policy number, information about the event due to which the claim is being made, and the name and contact number of the person who will be handling your claim. You can intimate the insurer by calling them on their toll-free number, mobile number, or also email them. It is imperative that you or your nominee contact the insurer as soon as possible in order to ensure speedy claims processing.

    Procedure to avail Cashless Treatment:

    Firstly, the individual undergoing the treatment will have to request for pre-authorisation at least 48 hours before the planned hospitalisation, or within 48 hours of being admitted in the hospital (or before being discharged, whichever happens first) in case it is an emergency hospitalisation. If the pre-authorisation is accepted, the insured will not have to pay for the medical expenses. The insured member only needs to go to the hospital and provide the health membership number with a valid photo ID proof.

    Terms and Conditions of Raheja QBE

    • The policy may be cancelled, or renewal may be denied on grounds of non-disclosure of information or misrepresentation.
    • The insurer reserves the right to withdraw the policy at any time, with approval from the IRDAI. Insured members will be intimated of this and will be notified of the options that they have.
    • Any modification or revision made to the policy terms and conditions will be intimated to the policyholder.

    Frequently Asked Questions before Purchasing a Raheja QBE Health Insurance Plan

    1. How is a personal accident insurance policy different from a general health insurance policy?

      A personal accident insurance policy will provide you a cover against medical expenses that you may incur due to an accident, whereas a general health insurance plan will cover any medical expenses that you may incur due to unforeseen hospitalisation.

    2. What is insurance portability?

      Insurance portability allows you to port or transfer your health insurance policy from one insurer to the other without having to lose any accrued benefits. However, you will have to do this 45 days before the expiry of your policy.

    3. Does every policy buyer have to undergo a pre-policy medical screening?

      No, pre-policy medical screening is only necessary if you are over a certain age, if you have pre-existing medical conditions, or if the sum insured is a relatively large amount (in some cases). Medical screenings are also typically not required if you renew your policy at the end of every policy term, without any breaks.

    4. Can I make changes to the plan option chosen or the sum insured during the policy term?

      No, plan options and the sum insured cannot be modified during the policy term. However, with approval from the insurer, you can modify or enhance your policy cover while renewing it.

    5. Will I receive my premium back if I cancel the policy after purchasing it?

      Every policy comes with a free-look period of 15 days. If you cancel your policy within the free-look period, the insurer will refund the premium paid by you, in full, after adjusting the amount for stamp duty charges. However, if you cancel your policy during the policy term, the insurer will only refund a certain percentage of the premium that you paid.

    6. How can I reduce my premium?

      Your premium is linked to your age (or the age of the eldest family member for family floater policies), pre-existing diseases, additional riders opted for, etc. You can reduce your premium payable by choosing a lower sum insured, opting for co-pay, and covering a lesser number of dependents.

    7. Will I receive any discounts for renewing my policy?

      If you renew your policy year after year, without any breaks, you may be entitled to receive a cumulative bonus or no-claim bonus on the initial sum insured, as per your policy terms and conditions. You will find information pertaining to eligible discounts and bonuses in your policy brochure.

    8. Can I purchase a health insurance policy from Raheja QBE even if I am covered under my corporate health cover?

      Yes, and it is highly recommended that you do so. A retail or individual policy will ensure that you can customise the level of protection so it matches what you require, enrol your dependents, and have a health cover that is independent of your employment.

    9. What is the initial waiting period?

      Insurance policies come with an initial waiting period of 30 days, during which claim cannot be made. However, this is not applicable if the insured member is hospitalised due to an accident. Any other claims made during the initial waiting period will be rejected by the insurer.

    10. What ailments and diseases are covered under pre-existing diseases?

      An exhaustive list of all disease, surgeries and ailments that fall under pre-existing diseases can be found on your policy brochure. In most cases, pre-existing diseases come with a waiting period of 48 months.

    11. How many members can be covered under a family floater health insurance plan?

      Family floater health insurance plans let you extend the insurance cover to your dependents. Most policies will cover your spouse, dependent children, dependent parents, etc. To know the exact number of dependents that can be covered, ensure you read through your policy brochure.

    12. Can cashless treatment be opted for in case of an emergency hospitalisation?

      Yes, cashless treatment can be opted for even if it is an emergency hospitalisation, provided it is done at a network hospital. However, you will have to ensure that the insurer is notified of the hospitalisation, as soon as possible (between 24-48 hours of the hospitalisation).

    13. Until what age can health insurance plans be purchased?

      Health insurance plans come with a maximum age at entry, until which you can purchase a new policy. Ensure you check your insurer’s eligibility criteria to know about your plan-specific age limits. The maximum age at entry does not apply to policy renewal.

    14. Does the Health QuBE Insurance Policy cover maternity expenses?

      Treatment or hospitalisation due to maternity, childbirth, or abortion is not covered under the Health QuBE Insurance Policy. Only hospitalisation due to ectopic pregnancy is covered under this policy.

    15. What is co-pay?

      A co-pay is a fixed amount of hospitalisation expenses that the insured member will have to pay out of their pocket. A co-pay can be a compulsory component in your policy or a voluntary option. Opting for co-pay is one way to reduce your premiums.

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