Edelweiss Health Insurance
Edelweiss Health Insurance Overview
Nowadays, taking a medical treatment at a good hospital, for something as small as fever, can make a hole in your pocket. And for this reason, it is important to have a health insurance cover. Taking into consideration the increasing medical inflation and growing number of health ailments, Edelweiss Health Insurance has come up with three types of health insurance plans. These plans cater to different audiences and also life-threatening diseases like cancer. Edelweiss health insurance offers three variants of its health insurance policy for its different audience. You can opt for a plan that meets most of your requirements.
Benefits & features of Edelweiss Health Insurance
Edelweiss General Insurance Company offers three types of health insurance policies that come with the following benefits:
- Edelweiss health insurance offers coverage to applicants above the age of 3 months. Basically, you don’t need to worry about the age limit to get health insurance from Edelweiss.
- You can buy health insurance for a maximum of 8 members including self, spouse, 3 children, and other relatives ( as permissible in the plan)
- Edelweiss health insurance platinum plan offers health insurance cover up to 2 Crores
- Irrespective of the plan, you can avail these benefits- medical monitoring cover, medical repatriation, medical referral cover, compassionate visit, emergency medical evacuation, the return of mortal remains and second medical opinion.
Why Edelweiss Health Insurance?
Edelweiss Health Insurance plans are tailor-made to offer maximum protection to the insured members at an affordable price. You can purchase any of the Edelweiss health insurance plans to avail the following benefits:
- Edelweiss Health Insurance covers customary and reasonable charges incurred towards healthcare treatment taken by the policyholder during the policy term for an injury, illness or any other medical condition that is covered in the plan.
- Co-payment of 20% is applicable only to members above the age of 60 years.
- The insurer provides an option of mid-term inclusion of an applicant in case of childbirth or marriage. The premium will be charged on a pro rata basis.
- The eligibility criteria to buy an Edelweiss health insurance policy is 90 days for all the plans ( Silver, Gold and Platinum) and the maximum age criteria is 65 years for both Silver and Gold variants. And there is no age-limit for premium variants.
Edelweiss Health Insurance Plans
Edelweiss General Insurance plans are the most comprehensive ones. There are 3 variants – Silver, Gold, and Platinum. And the sum assured limit is listed below:
- Silver Plan - The sum assured limit for this plan is up to Rs. 5 Lakhs
- Gold Plan - The sum assured limit for this plan is up to Rs. 20 Lakhs
- Platinum - The sum assured limit for this plan is up to Rs. 1 Crore
|Silver Plan||Gold Plan||Platinum Plan|
|Hospitalization Expenses(Up to the Sum Insured)||Covered||Covered||Covered|
|Room Rent limit per day - Standard Single Private Room||Sum assured Rs. 3 lakh and above||No Capping||No Capping|
|No Capping on ICU charges||Covered||Covered||Covered|
|Pre and Post Hospitalization Medical Expenses(Up to the Sum Insured)||30 to 60 days||60 to 90 days||90 to 180 days|
|Day Care Treatment(Up to the Sum Insured)||Covered||Covered||Covered|
|Ambulance Cover(Per hospitalization)||Up to Rs. 1500||Up to Rs. 3000||Up to Rs. 10,000|
|Organ Donor Cover||Not Covered||Up to 1 lakh Rupees||Up to 2 lakh Rupees|
|Domiciliary Hospitalization(Up to the Sum Insured)||Covered||Covered||Covered|
|Ayush (Up to the Sum Insured)||Covered||Covered||Covered|
|No-Claim-Bonus(If you do claim, the No Claim Bonus will reduce at the same rate at which it increases in a claim-free year)||Sum Assured Increases by 10% forevery claim-free year up to amaximum of 50%||Sum Assured Increases by 50% forevery claim-free year up to amaximum of 100%||Sum Assured Increases by 50% forevery claim-free year up to amaximum of 100%|
|Health Check-Up for every claim-free year(Policyholders who are 18yrs or above)||Covered||Covered||Covered|
|Maternity Benefit||Not Covered||Up to Rs. 50,000 ( waiting period of 4- years)||Up to Rs. 2 lakhs ( waiting period of 4- years)|
|Recovery Benefit(Starts from the day of hospitalization)||Not Covered||Rs. 1,000 per day from the 11th-20th day||Rs. 1,000 per day from the 11th-20th day|
|Shared Accommodation||Rs. 800 per day ( maximum up to Rs. 4,000)||Rs.1000 per day ( maximum up to Rs. 5,000)||Rs.1200 per day ( maximum up to Rs. 6,000)|
|Critical Illness Coverage(Starts from the first time you're diagnosed with a critical illness.)||Not Covered||Sum assured amount increases by 50 percent||Sum assured amount increases by 100 percent|
|Restoration - Top it up by 100%(Top it up by 100% that is your Sum Insured doubles.)||Not Covered||Covered||Covered|
|Critical Illness Coverage(Starts from the first time you're diagnosed with a critical illness.)||Sum assured amount increases by 50 percent||Covered in the basic plan||Covered in the basic plan|
|Recharge(Top it up by 100% that is your Sum Insured doubles.||Not Covered||Covered||Covered|
|Voluntary Co-payment(This option is available for ages 60 years and below.)||10 to 20 percent||10 to 20 percent||10 to 20 percent|
Inclusions of Edelweiss Health Insurance
The coverage provided in all the plans may vary. Some of the common inclusions of Edelweiss health insurance plans are listed below:
- Ambulance expenses are covered
- Hospitalization room expenses in a standard single private room are covered
- Hospitalization expenses are covered up to the sum assured amount
- Pre and post hospitalization expenses are covered up to the sum assured limit
- Organ donor expenses are covered
- ICU room charges are covered
- Domiciliary hospitalization charges up to the sum assured limit
- No claim discount benefits
- Ayush expense cover up to the sum assured limit
- Critical Illness coverage is provided
- Maternity cover is also provided
- Recharge benefit
- Recovery Benefit (starts from the day of hospitalization)
- Restoration benefit
- Voluntary co-payment up to 60 years of age
Exclusions of Edelweiss Health Insurance
There are certain limitations in an Edelweiss health insurance plans. And the exclusions of Edelweiss health insurance plans are listed below:
- First 30-Day waiting period
- Hemorrhoids / Piles, Fissure / Fistula in anus, Gastric, Duodenal Ulcers, and Pilonidal Sinus
- All types of Hydrocele and Hernia
- Myomectomy for fibroids
- Oral Chemotherapy
- Any medical conditions related to sexually transmitted diseases, including Gonorrhea, Genital Warts, Genital Herpes, Syphilis, Acquired Immunodeficiency Syndrome (AIDS), HIV, Chlamydia, Pubic Lice, and Trichomoniasis
- Any medical expenses incurred on children and new-born below the age of 91 days shall not be covered under this policy
- Any charges related to the cost of contact lenses, spectacles, hearing aids, eye and ear examinations, dentures, laser surgery, artificial teeth and expenses incurred on other similar external appliances
- Plastic surgery or cosmetic surgeries
- Treatment required for stress or psychological disorders, mental illness, Alzheimer's or Parkinson's disease even if it happened after an Illness or an accident.
Edelweiss Health Insurance Optional Covers
Apart from the basic health insurance cover, you can opt for the following other optional benefits:
- Critical Illness cover in Edelweiss health insurance silver plan and the limit is 50 percent of the sum assured amount.
- Restoration benefit is available in the silver variant and the limit is 100% of the sum assured amount
- Recharge option is available in both gold and platinum plans. Edelweiss will replenish the entire sum assured amount on indemnity basis during a policy period.
Edelweiss Health Insurance Claim
To avail the benefits of your Edelweiss health insurance policy it is important to notify the insurer at least 72 hours before a planned hospitalization. In the event of an emergency hospitalization, it is required to intimate the insurer within 48 hours of hospitalization or before the discharge date whichever is earlier. However, the insurer may consider delays in extreme cases along with a proof.
The process to file Edelweiss health insurance claim is defined below:
- You can notify Edelweiss Health Insurance on their helpline number i.e. 1800 12000
- You can also inform them over an email at support[@]edelweissinsurance[.]com to file a claim
- Your claim procedure will start and your claim amount will be compensated or will be settled directly at the hospital in the event of cashless claims
Documents Required for Edelweiss Health Insurance Claims
To initiate a claim you need to provide the following documents/details/information to the insurer:
- Duly signed Edelweiss health insurance claim form
- Medical Investigation reports
- Pre-authorization request (original)
- MR/CT/ USG/HPE and other investigation reports
- Also, submit a copy of the pre-authorization approval letter
- Reference slip from the doctor
- A copy of the photo ID card of the patient (verified by the hospital)
- Discharge summary from the hospital
- Operation theatre reports/notes
- Chemist's bills
- Police FIR
- MLC report
- Hospital final bill
- Death certificate from the hospital (in original where applicable)
- Hospital break-up bill
- Other documents/bills as per the situation
How to Calculate Edelweiss Health Insurance Premium?
To know the premium for your selected policy you can use the online health insurance premium calculator. It is one of the most convenient and cost-effective methods to calculate the premium.
All you need to do is select the plan, go to the online calculator page, enter the basic details such as sum insured amount, number of family members, geographical location, age etc.
Once you enter all the required details, you will get the premium that the insurer will charge for that particular plan.
How to Compare and Buy Health Insurance?
You can consider these parameters while picking a health insurance policy –
- Risks covered in severe health conditions/ emergencies
- Amount of premium/sum insured
- Saves extra medical expenses or not
- Hospitalization cover
- Panel of hospitals under the health insurance list
- Check for NCB ( No Claim Bonus)
- Check for the age limit criteria
- Claim process to be followed
- Family floater plans are available or not
How to Renew Edelweiss Health Insurance Plans?
It is quite easy and convenient to renew Edelweiss health insurance policy online. Online renewal saves both time and efforts. You can check with the insurer for any specific procedure which is followed to renew the policy online.
But before that, you need to decide if you want to continue availing the benefits from your current insurance policy or you want to upgrade it. Also, make sure that you renew your policy before the expiry date. If the policy is not renewed within the stipulated time then you will not be able to avail the continuous benefits of your policy.
Things to Know About Edelweiss Health Insurance
- Edelweiss Health Insurance offers the facility to buy a 2-year policy by paying a one year premium cost
- There are three plan options – Silver, Gold, and Platinum
- The sum assure limit ranges from 5 lakhs to 1 crore rupees
- Plans do not have any capping on the ICU charges
- Day care treatment and domiciliary hospitalization expenses are also covered
- All the plans provide Ayush cover
- Gold and Platinum plans provide critical illness cover
- You can also buy critical illness coverage as an add-on benefit
Edelweiss Health Insurance FAQs
Q1. How may family members are covered under Edelweiss health insurance policy?
Under the family floater policy, coverage is provided to you, your spouse, and up to 3 children between the age group of 3 months to 21 years.
Q2. Is critical illness covered in my Edelweiss health insurance policy?
It depends on the type of plan that you have purchased. If you buy gold or platinum plan then critical illness is covered in the basic policy. However, you can buy this as an add-on benefit with your silver plan.
Q3. Can I upgrade the coverage provided by Edelweiss health insurance plans?
Yes, you can increase your coverage benefits at the time of renewal. You can upgrade your silver health plan to a gold or platinum plan. You can also opt for optional benefits to upgrade it further.
Q4. What is the validity period for my Edelweiss health insurance policy?
You can pay a single premium to get coverage for 1 year, 2 years or 3 years. And the coverage is provided for lifetime with timely renewal of the plans.
Q5. Is it possible to transfer my No-claim-bonus from my previous insurance provider?
Yes, you enjoy your No-claim-discount even after changing your insurance company. But make sure that you renew your policy in time or before the expiry date to avail the NCB.
Q6. What will happen if I happen to misplace my policy documents?
Even if you lose the hard copy of your Edelweiss health insurance policy then you can refer to the soft copy that is mailed by the insurer. Or you can apply for a fresh hard copy.
Q7. How to find the network hospitals in my area?
Edelweiss health insurance has a great network of cashless hospitals. So, you can easily find one in your area. You can check the list of network hospitals on their official site.
Q8. Do I need to undergo medical tests before buying an Edelweiss health insurance policy?
You don’t need to undergo pre-medical screening before buying a policy. However, the insurer will take a call on the basis of your age, sum assured and the plan that you have opted for.
Q9. How can I avail cashless facility in the network hospitals?
To avail the cashless services you just need to showcase your health card in any of the network hospitals where you are planning to book an appointment or take an emergency treatment.
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