Raheja QBE General Insurance : a closer look

Raheja QBE General Insurance Co. Ltd is one of the famous insurance companies in the world. This company was founded by Rajan Raheja Group, which happens to be one of the dynamic business groups in India. This company is renowned for its unique insurance products. They believe in offering help to their clients during tough times by its insurance related products. This Company is a collaboration between Prism Cement Limited of Rajan Raheja Group and QBE Holdings of Australia. The stakes held by Prism Cement is a goof 74% and the stakes held by QBE Holdings is the balance of 26% in this general insurance company.The QBE Holdings is majorly based out of Australia. It is located in more than 45 countries handling financial services since a long time.

Praveen Gupta is the CEO and the Managing Director of the Raheja QBE General Insurance Company.

Features – Raheja QBE Health Insurance

The features of Raheja QBE Health Insurance are mentioned below:

of members- The plan covers maximum 4 members of your family that may include up to 2 children and 2 adults.
Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
Pre & Post hospitalization cover– The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan, super saver and a la carte plans. It covers 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
Health Check-ups – Health Check-ups are available once a year
Pre-existing diseases– Pre-existing diseases are covered after 4 years of waiting period.
Co-payment– The plan has in-built health insurance benefits and contains add-on covers for co-payment policy

Benefits – Raheja QBE Health Insurance

The benefits of buying Raheja QBE Health Insurance are mentioned below:

Discounts: Raheja Health Insurance provides a premium discount in case you opt for a 20% co-pay policy
Cashless facility: Offers cashless facility with a very strong network of hospitals
Flexibility: Offers flexibility to make the premium payments via UPI, Paytm, Net banking, Debit/Credit card etc. as per your convenience
Organ donor benefit: Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
Inpatient benefit: Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Mediclaim settlement: Offers quick and hassle-free claim settlement services
Ambulance cover: Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Tax benefits: Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Products offered – Raheja QBE Health Insurance

Health QuBE Insurance Plan

Raheja QBE Health Insurance plan is one of the best health insurance plans in India. It is further sub-divided into 4 variants. These are Basic plan, Comprehensive Plan, Super Saver Plan and A la carte Plan. The overall features of and eligibility criteria of the plan are mentioned below:

Entry Age

Minimum entry age is 90 days to 65 years. The minimum entry age for dependents is 18 years and the maximum entry age is 65 years

Policy Period

1 years and 2 year plans

Sum assured

Basic Plan

SI 1 to 2 lakh & Rs.3 to 50 lakh

Comprehensive Plan SI Rs.3 to 50 lakh

Super Saver Plan Rs.1 to 2 lakh and Rs.3 to 50 lakh

A la Carte Plan

Rs.1 to 2 lakh & Rs.3 to 50 lakh

The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan, super saver and a la carte plans. It covers 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
Offers day-care treatments in case the insured is hospitalized for less than 24 hours
Offers domiciliary hospitalization in case the treatment continues for minimum of three days
Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Insurance Company offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.
For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:
Fissure/fistula in anus, hemorrhoids, pilonidal sinus
Ulcer and erosion of stomach and duodenum
All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
Perineal and/or Perianal Abscesses
Cholecystectomy and Surgery of hernia
Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
Varicose veins
Fibroids/Polycystic Ovarian Disease
Surgery of Hydrocele/Rectocele
Surgery of prostate
Intervertebral Disc Prolapse
Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
Cataract
Internal tumors, cysts, nodules, polyps, skin tumors
Sinusitis/Rhinitis/Tonsillitis
Gastro Esophageal Reflux Disorder (GERD)
Surgery on tonsils / adenoids
Calculus diseases of gall bladder including Cholecystitis
Pancreatitis
Dilatation and curettage (D&C)
Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

Any expense, condition or treatment not admissible under the policy wordings
Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
Circumcision done unless necessary for treatment of an Illness or due to an Accident.
Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
Treatment of any Congenital External Anomaly or Illness
Treatment of stress, mental illness or any psychological disorders.
Any OPD Treatment.
Any treatment undertaken abroad
Non-allopathic treatment.
Any expenses incurred due to X-ray or laboratory tests
Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
Any treatment for cirrhosis due to alcohol and complications arising from its
Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.
Any nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense
Impairment of an Insured Person’s intellectual faculties by abuse of stimulants or depressants.
Any medical or physical condition or treatment or service, which is specifically excluded under the Policy Schedule.

Basic Plan

This is a very basic health insurance plan that has in-built health insurance benefits. This plan however doesn’t provide options for any add-on covers.

The features of this plan are mentioned below:

The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan
Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
Offers day-care treatments in case the insured is hospitalized for less than 24 hours
Offers domiciliary hospitalization in case the treatment continues for minimum of three days
Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Insurance Basic plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions:

Same as Raheja QBE Health Insurance plan

Comprehensive Plan

This plan contains in-built health insurance benefits. The main feature is it offers add-on cover for Sub Limit Waiver.

Sub limit waiver: This plan waives off the sub-limits related to ICU charges, room rent, disease related sub-limits & medical practitioner’s fees, if the insured pays additional premium

The features of this plan include all the below inbuilt health insurance benefits:

The plan covers medical expenses for 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the comprehensive plan
Offers day-care treatments in case the insured is hospitalized for less than 24 hours
Offers domiciliary hospitalization in case the treatment continues for minimum of three days
Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
In case of the insured gets hospitalized during the policy tenure, Raheja QBE Comprehensive Health Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions:

Same as Raheja QBE Health Insurance plan

Super Saver Plan

This plan contains in-built health insurance benefits. It offers Add-on covers for Co-Pay.

Co-pay add-on cover: Offers a premium discount if you opt for a 20% co-pay

The features of this plan include all the below inbuilt health insurance benefits:

The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the super saver plans
Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
Offers day-care treatments in case the insured is hospitalized for less than 24 hours
Offers domiciliary hospitalization in case the treatment continues for minimum of three days
Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Super Saver Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions:

Same as Raheja QBE Health Insurance plan

A la carte Plan

This plan offers in-built health insurance benefits. Here, you are offered a choice to choose your add-on as per your requirements. You may also change your plan if you wish to but only during renewals.

The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the a la carte plans.
Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
Offers day-care treatments in case the insured is hospitalized for less than 24 hours
Offers domiciliary hospitalization in case the treatment continues for minimum of three days
Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health A la Carte Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions:

Same as Raheja QBE Health Insurance plan

Cancer Health Insurance

Raheja QBE has come up with a Cancer Insurance that would help you financially in case you get detected with the dreadful disease. You get adequate financial help to get cured in timely manner and lead a normal life.

The overall features of and eligibility criteria of the plan are mentioned below:

Entry Age	Minimum entry age is 1 year and maximum is 70 years
Policy Period	5 years
Sum assured	Minimum Rs.1 lakh and maximum Rs.10 lakh

If the insured is detected with Cancer and the same requires a detailed diagnostic investigation, the insured is paid the below:
A lump sum amount of 50% of the Sum Insured or Rs.2.5 lakh whichever is less
Any expenses incurred for diagnostic investigation or medical treatment of Cancer, in excess of 75% of the amount paid as a lump sum as stated above.
Offers reimbursement of medical expenses only on submission of the original bills. This reimbursement of claims are made quarterly till the entire sum insured is exhausted.
In case the insured is detected by Cancer and is suffering, even though there is a claim reported during the policy period, the insured would still get the benefits under the Cancer Health Insurance post expiry of the sum insured up to 5 years from the inception of the Policy
Offers reimbursement for medical expenses for pre-policy medical examination would be limited to 50% of actual expenses.

Exclusions:

Not anything and everything is covered under the Raheja Cancer Insurance Plan. The exclusion list is mentioned below:

Any injury, disease or illness caused by nuclear weapons. If the same is caused due to contact of the insured person with radiation from non-diagnostic or therapeutic source.
If the insured had any signs and symptoms of cancer or any related condition and if he has received the treatment for the same during the waiting period of 48 months prior to his/her first policy with Raheja QBE
If any fraudulent or incorrect representation is done to make a claim under this policy
Any claim where the diagnostic investigation does not reveal the positive existence or presence of Cancer.

Claims process – Raheja QBE Health Insurance

There are two ways to make claim under a Health Insurance Policy:

a.) Cashless basis

b.) Reimbursement basis.

In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form.

In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Raheja QBE Health Insurance has a well-defined claim processing system.

Documentation for smooth Claim Settlement

The below documentation is required within 15 days from the discharge of the insured from the hospital. The below documentation is required as per the type of claims registered:

Duly filled and signed form in original;
Original bills, receipts and discharge card from the Hospital / Medical Practitioner;
Original bills from the chemists;
Medical Practitioner’s prescription advising drugs, diagnostic tests/consultation;
Original pathological/Diagnostic Test reports/radiology reports and payment receipts;
Indoor case papers;
Death Certificate from the municipal authorities;
Post mortem report, if conducted;
Panchnama Report;
Coroner‟s Report;
Medical Practitioner’s referral letter advising Hospitalization
First Information Report, final police report, if applicable;
Post mortem report, if conducted;
Death Summary from the Hospital authorities, if death is confirmed by the Hospital;
Any additional document to access the claim as required by Raheja QBE Health Insurance Company

Claim Process – Cashless Service

Once the doctor advises hospitalization or a treatment, intimate your claim. This pre-authorization should be done by calling the call center by requesting an authorization within 48 hours before the planned hospitalization or within 48 hours of admission to the hospital or before discharge from the hospital whichever is earlier
Intimation can be done by calling on the toll-free number of the Raheja QBE Health Insurance Company 1800 102 7723 or email on claims@rahejaqbe.com
Get hospitalized in any of the network hospitals
Show your Raheja QBE Health Card to the representative at the TPA desk
Complete the ‘Cashless Request Form’ available at the hospital’s insurance/TPA Desk.
Submit your authorization form along with your health card copy and your photo identity copy
You will have to wait for an approval from the hospital.
Send the completed form via email TPA along with any important medical details
Verify and sign the details along with all the bills
You may leave the investigation and original discharge letter with the hospital and retain a photocopy of these for your reference
If the authorization of the cashless claim is denied by Raheja QBE either due to insufficient sum insured or any incorrect or insufficient information, you will be liable to make payment of the hospital bill and then apply for a reimbursement. The reimbursement would be done by Raheja QBE considering the terms and conditions of the policy

Claim process – Reimbursement facility

Get hospitalized
This pre-authorization should be done by calling the call center 1800 102 7723 or email on claims@rahejaqbe.com by requesting an authorization within 48 hours before the planned hospitalization or within 48 hours of admission to the hospital or before discharge from the hospital whichever is earlier
Immediately intimate or register the claim at the call center/E-mail as soon as possible
Make the hospital bill payments in full as required
Collect all the original bills, documents and reports at the time of discharge
Register a claim with TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form

The claim intimation can be done via Raheja QBE Health Insurance toll free number 1800 102 7723 the same could also be emailed to claims@rahejaqbe.com

Review – Raheja QBE Health Insurance

Raheja QBE Health Insurance offers an array of reasonably priced health insurance policies. Their plans are made-to-measure to shield you against your mounting financial responsibilities towards your family during and after hospitalization and medical treatments. They boast of a very good claim settlement ratio amongst other private insurers. Their continuous efforts to offer excellent customer service is their ultimate performance. Hence, if you are scouting for an insurer who will deliver dependability, competence and brilliant post sales services in consort with the product