Chola MS Flexi Health

Chola MS Flexi Health Plan is provided by Cholamandalam MS General Insurance Company Limited.

It stands out as a cost-effective health insurance option with unique features that cater to budget-conscious individuals and families. Notably, the plan offers the convenience of monthly premium payments, a flexibility not commonly found in many other health insurance plans. While it covers hospitalisation and associated expenses, it might help with an informed decision to be aware that the coverage might not be as comprehensive as some competing plans in the market. 

Our research indicates that the insurer received relatively fewer complaints regarding policy purchases, but there is a higher number of concerns related to claim settlement. Weighing these factors based on your specific healthcare needs and preferences will aid in making a decision.

What are the benefits offered by the Chola MS Flexi Health Plan?

● Inpatient hospitalisation coverage: Like all health insurance plans, the Chola MS Flexi Health Plan provides coverage for expenses associated with inpatient hospitalisation. These are expenses you incur when you are hospitalised for more than 24 hours such as room and boarding fees, nursing charges, medical practitioner fees, prescription drugs, ICU expenses, and other relevant expenses.

● Pre-hospitalization coverage: Medical expenses that you incur before hospitalisation are referred to as pre-hospitalization charges. These expenses typically include consultation fees, lab tests, checkups, medical reports, etc. However, the insurer will only cover these expenses if they are related to the medical condition that eventually leads to hospitalisation and the claim is approved as part of the inpatient hospitalisation coverage. The good news is that with the Chola MS Flexi Health Plan, pre-hospitalization expenses are covered for 30 days before hospitalisation up to the sum insured. Though it is important to note that in this plan, pre-hospitalization expenses will be covered only if they are incurred after the initial 30 day waiting period

●Post-hospitalization coverage: After you are discharged from the hospital, you might encounter further medical expenditures referred to as post-hospitalization costs. These expenses may include consultations with your physician, medical check-ups, rehabilitation schemes, physical therapy, etc. To have these costs covered, they must be relevant to your initial hospitalisation, and your claim must be approved under inpatient hospitalisation. The Chola MS Flexi Health Plan provides coverage for post-hospitalization expenses for 60 days after hospitalisation up to the sum insured.

●Daycare treatment coverage: Daycare treatment is a medical procedure or surgery that used to require an extended hospital stay but can now be completed within 24 hours due to advancements in medical technology. With Chola MS Flexi Health Plan, expenses related to 539 daycare procedures are covered without any limit. Though, if you choose to go to a non-network hospital, the insurer's pre-authorization is required.

●Domiciliary treatment coverage: Domiciliary treatments are medical treatments for illnesses or injuries that require immediate attention at the hospital but are given at home due to the severity of your medical condition or the absence of hospital beds in the vicinity. With the Chola MS Flexi Health Plan, domiciliary treatment expenses are covered up to the sum insured with the exclusion of 15 diseases.

●Organ donor coverage: Under the Chola MS Flexi Health Plan, organ donor expenses are covered up to the sum insured. This coverage encompasses organ harvesting expenses in the event of an organ transplantation surgery - where you are the organ recipient.

●Modern treatment coverage: As medical technology advances, innovative treatments that were once deemed impossible are now becoming a reality. These modern treatments, including stem cell therapy, radio surgeries, etc. intend to cure ailments that were once regarded incurable. The Chola MS Flexi Health Plan is designed to keep up with these advancements by covering expenses related to modern treatments without any limits.

●Non-medical expenses coverage: The Chola MS Flexi Health Plan does not cover the non-medical expenses, this is a big drawback of the plan. Such expenses are essential and include the cost of gloves, nebulization kits, oxygen masks, etc.

●No Claim Bonus: The Chola MS Flexi Health Plan offers a No-Claim Bonus - a reward given to you if you don’t make any claims in a policy year. This bonus amounts to 10% of the sum insured subject to a maximum of up to 50%. However, if you file a claim during the policy term, the accumulated bonus will be reduced. 

●Super No Claim Bonus: The Super No Claim operates in the same way as the standard No Claim Bonus, but is an accelerated version. It is important to note that the Chola MS Flexi Health Plan does not provide the Super No Claim Bonus feature.

●Restoration Benefit: The Restoration Benefit is another feature of the Chola MS Flexi Health Plan. It restores the sum insured once it is utilised during a policy year. This benefit applies to both related and unrelated illnesses. The refill benefit kicks in once both the sum insured and No Claim Bonus are partially used up. 

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured.

Chola MS Flexi Health Plan: Financial Limits

●Room rent limit: The room rent limit is the maximum amount that your insurance provider will cover for the hospital room you stay in during your hospitalisation. If you opt for a room that falls within this limit, you won't have to bear any additional expenses. However, if you decide to choose a room with a higher rent than your eligibility, a proportional deduction will apply. This means that you will have to bear a proportionate share of the entire bill, rather than paying only the difference. With the Chola MS Flexi Health Plan, you can select any type of room without restrictions.

● ICU rent limit: The Chola MS Flexi Health Plan provides coverage for expenses incurred during an ICU stay. There is no limit on the amount covered, ensuring that you receive the best possible medical care without any financial burden.

●Copayment: It is a certain percentage of the approved claim amount you need to pay out of your own pocket before your insurer covers the remaining amount. However, the Chola MS Flexi Health Plan doesn’t have a copayment limit.

●Deductible: It is a certain amount that you must pay from your end before your policy starts to cover your medical expenses. However, the Chola MS Flexi Health Plan does not have a deductible limit.

●Limits on surgeries/treatments: It is the maximum amount that the health insurance policy will cover for certain medical procedures or treatments. However, some plans have limitations on the amount they will cover for specific procedures, while others don't. In the case of the Chola MS Flexi Health Plan, it offers coverage for important surgeries and treatments like cataract treatment and joint replacement surgery without any cap. 

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs.

Chola MS Flexi Health Plan: Waiting Periods & Exclusions

👉Waiting period
A waiting period is a certain time frame during which specific illnesses and medical conditions are not covered right after buying a health insurance policy. You can only claim for these conditions once the waiting period has ended. The duration of the waiting period varies depending on the policy you choose. Here are some types of waiting periods -

• Initial waiting period: For the Chola MS Flexi Health Plan, an initial waiting period of 30 days is applicable for all medical conditions, except for accidents. During this period, you will not be able to claim any hospitalisation expenses unless it is due to an accident. Once the initial waiting period is over, you can claim for all covered medical conditions without any restrictions.
• Waiting period for pre-existing diseases: If you had any medical condition or illness within 36 months before applying for a health insurance policy, it is considered a pre-existing disease. With the Chola MS Flexi Health Plan, you will need to wait for 36 months before the policy covers expenses related to your pre-existing condition. This means that during this waiting period, you will not be able to make any claims for expenses related to your pre-existing disease.
• Waiting period for specific diseases: The Chola MS Flexi Health Plan applies waiting periods for certain medical conditions apart from your pre-existing diseases. These waiting periods are predetermined by the insurer and are not related to your current health status. A waiting period of 24 months is applicable for specific diseases under this plan.

👉Exclusions
Health insurance policies do not cover certain situations or medical conditions called exclusions. These include –

• Standard permanent exclusions: Insurance companies in India are required by the Insurance Regulatory and Development Authority of India (IRDAI) to follow a set of ‘standard permanent exclusions’. These include -

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes alone.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for rest or respite where no active medical treatment is given.
3. Obesity/weight control: Any surgical or medical procedures intended for weight control or obesity.
4. Change of gender treatment: Medical treatment aimed at altering the body's characteristics to that of the opposite gender is excluded.
5. Plastic/cosmetic surgery: Surgical or medical procedures intended for modifying appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while participating as a professional in adventure activities such as mountaineering, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses related to the treatment of a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Treatment expenses incurred in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without prescription: Expenses on vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Costs related to pre/post-natal care, childbirth, and other hospitalisation expenses.

• Additional permanent exclusions: Apart from the permanent exclusions mandated by the IRDAI, insurance companies have the authority to impose ‘specific exclusions'. If a particular illness is regarded as high-risk, insurers can opt to permanently exclude it from coverage. Nevertheless, insurers are restricted to those diseases on the pre-approved list of illnesses established by the IRDAI for applying permanent exclusions. 
• Non-standard exclusions (Specific exclusions): The Chola MS Flexi Health Plan has specific exclusions in addition to the standard exclusions specified by the IRDAI. These exclusions may vary among insurance providers and are dependent upon the plan’s terms and conditions. Here are some specific exclusions under this plan -

1. Injury or disease due to war, invasion, act of foreign enemy, and warlike operations
2. Treatment related to intentional self inflicted Injury or attempted suicide by any means
3. Injury or illness directly or indirectly due to nuclear emissions
4. Circumcision unless necessary for treating a disease or injury
5. Vaccination and inoculation costs (except post animal bite treatment)
6. Treatment for any sexually transmitted disease
7. External equipment of any kind like wheelchairs, crutches, artificial limbs, etc.
8. Expenses for treatment related to external birth defects
9. Dental treatment or aesthetic surgeries unless necessary for treating a disease or injury
10.  Hearing aids, eyeglasses or contact lenses
11.  Yoga and Naturopathy
12.  Treatment related to any sexual problem

What to expect in terms of claims experience if you buy from Cholamandalam MS General Insurance Company Limited ?

●Speed of claims: Cholamandalam MS General Insurance Company has shown a high level of efficiency in claim settlement, processing 96.52% of claims within 30 days. This indicates that you can expect a seamless claim settlement process.

●Claim-related complaints: Based on our research, Cholamandalam MS General Insurance Company has an average frequency of complaints related to claims compared to other insurance providers accounting for just 0.14%. This suggests that their claim settlement process might not be as efficient and streamlined.

●Claims incurred ratio: It represents an insurer's financial performance. It is the total claims paid out in proportion to the premiums received in a given fiscal year. Cholamandalam MS General Insurance Company boasts a claim incurred ratio of 66.67%.

●Claim settlement ratio: Cholamandalam MS General Insurance Company has a low claim settlement ratio of 76.63%. It represents the ratio of total claims received to the total claims settled by the company in a given fiscal year.

●Network hospitals: Cholamandalam MS General Insurance Company offers access to a vast network of over 12,000+ hospitals. This extensive network enables customers to receive cashless treatment without any financial constraint.

How is the customer service of HDFC ERGO General Insurance Company Limited?

●Policy purchase-related complaints: Based on our research, Cholamandalam MS General Insurance Company has received no complaints regarding their post-sales service, and stands at an unbeaten 0.00%.

●Response on Toll-Free: On the other hand, during our research, we found that Cholamandalam MS General Insurance Company’s response rate on their toll-free number is average compared to other insurance providers.

● Response on Twitter: Cholamandalam MS General Insurance Company’s response rate on Twitter is slow.

About Cholamandalam MS General Insurance Company

Cholamandalam MS General Insurance Company Limited is a joint venture between Murugappa Group and Mitsui Sumitomo Insurance Company Limited, Japan. They offer a range of insurance plans like motor insurance, health insurance, property insurance, accident insurance, liability insurance, marine insurance, travel insurance, crop insurance, etc. for individuals and corporates. It was founded in 2001 and is headquartered in Chennai, Tamil Nadu. V. Suryanarayanan is the company's CEO and MD.