United India Family Medicare

United India Family Medicare Policy is a health insurance policy offered by United India Insurance Company Limited.

The United India Family Medicare Policy covers hospitalisation and related costs, including expenses for pregnancy, mental illness, etc. However, it does not provide coverage for domiciliary treatment. Additionally, the plan has financial sub-limits on key benefits like modern treatment, pre-hospitalization, post-hospitalization, and common surgeries such as cataract, etc. and this may result in significant out-of-pocket expenses for you.

Our research indicates that the insurer has a higher number of complaints related to policy purchases but a lower number of complaints regarding claim settlements. This suggests a strong track record in settling claims but a less favourable experience when purchasing the policy.

What are the benefits offered by the United India Family Medicare Policy?

• Inpatient hospitalisation coverage: The United India Family Medicare Policy covers the expenses of being admitted to the hospital for more than 24 hours. This includes charges for the room, nursing care, prescribed medications, medical practitioner fees, ICU expenses, and other related costs.
• Pre-hospitalisation coverage: Before you get admitted to the hospital, the medical expenses you incur are called pre-hospitalisation expenses. These include fees for consultations, tests, checkups, lab reports, and more. To be covered, these expenses must be linked to the medical condition that requires hospitalisation, and your claim for them must be approved as part of your inpatient hospitalisation coverage. With the United India Family Medicare Policy, pre-hospitalisation expenses are covered for up to 30 days before hospitalisation, up to 10% the sum insured.
• Post-hospitalisation coverage: After you leave the hospital, you might still have medical expenses to pay. These are called post-hospitalisation expenses and include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related costs. To be covered, these expenses must be linked to the medical condition that caused your hospitalisation, and your claim must be approved under your inpatient hospitalisation coverage. With the United India Family Medicare Policy, post-hospitalisation expenses are covered for up to 60 days after your hospitalisation, up to 10% of the sum insured.
• Daycare treatment coverage: These treatments are medical procedures or surgeries that once required prolonged hospitalisation but can now be completed within 24 hours because of groundbreaking advancements in the medical field. In the United India Family Medicare Policy, all daycare procedures are covered without any limit, up to the total sum insured.
• Domiciliary treatment coverage: These treatments are medical treatments for injuries/illnesses that require immediate attention at the hospital but are administered at home due to the severe condition of the patient or the unavailability of beds in the nearby hospitals. In the United India Family Medicare Policy, domiciliary treatments are not covered.
• Organ donor coverage: The United India Family Medicare Policy also covers the inpatient expenses of  the donor associated with an organ transplant surgery up to the sum insured, where you are the recipient.
• Modern treatment coverage: In today’s evolving healthcare, we are seeing amazing advancements in treatments that were once unimaginable. Innovations like radio surgeries, stem cell treatments, etc., offer hope and potential cures for medical conditions previously thought untreatable. The United India Family Medicare Policy includes coverage for these modern treatments, with sub-limits for different procedures.
• Non-medical expenses coverage: Non-medical expenses are costs associated with consumables, such as nebulization kits, gloves, oxygen masks, and other items that are necessary for treatment. The United India Family Medicare Policy does not provide non-medical expenses coverage.
• No claim bonus: It is a reward offered to you if you do not file any claims during the policy year. The United India Family Medicare Policy does not offer a No claim bonus.
• Super no claim bonus: The Super no claim bonus is an enhanced version of the standard No claim bonus and operates in the same way. However, the United India Family Medicare Policy does not offer the super no claim bonus feature.
• Restoration benefit: The restoration benefit is a feature in the United India Family Medicare Policy that replenishes your sum insured when it is used up in a policy year. This can be utilised once per year as an add-on. It applies to subsequent claims for unrelated illnesses and is triggered when your sum insured is partially exhausted.

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

United India Family Medicare Policy: Financial Limits

• Room rent limit: This limit is the maximum amount that the insurer will cover for your hospital room. Staying within this limit ensures you won't have to pay extra costs. But if you choose a room above this limit, you'll face a proportionate deduction. Meaning, you’ll need to bear the proportionate share of the entire bill, not just the room cost difference. Under the United India Family Medicare Policy, the room rent limit is either 1% of the sum insured or the cost of a single standard AC room, whichever is higher.
• ICU rent limit: It is the maximum amount that a health insurance policy covers for your stay in the ICU. The United India Family Medicare Policy does not have an ICU rent limit. This means that the insurer covers the entire cost of an ICU stay without any limit up to the total sum insured.
• Copayment: This is a part of the approved claim amount that you must pay, and the insurer will cover the rest. The United India Family Medicare Policy does not have any copayment.
• Deductible: Before your policy covers your medical expenses, you need to pay a certain amount from your own pocket. This is called deductible. The United India Family Medicare Policy does not have a deductible.
• Limits on surgeries/treatments: This is the most your insurer will pay for certain medical procedures or treatments. Some policies may restrict the amount they cover for specific procedures, while others may not. Under the United India Family Medicare Policy, there is a limit of 10% of the sum insured per eye per policy year, up to a maximum of Rs. 50,000 for cataract treatments. And joint replacement surgery costs are covered up to the sum insured, without any limit.

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

United India Family Medicare Policy: Waiting Periods & Exclusions

👉Waiting Period

Some diseases and illnesses may not be covered for a specific duration after you purchase health insurance. This is called the waiting period. Any claim can be submitted for coverage only after the waiting period ends. Here are some types of waiting periods –

• Initial waiting period: The United India Family Medicare Policy has an initial waiting period of 30 days for all medical conditions, except for accidents. This means that you cannot claim for any hospitalisation unless it is due to an accident.
• Waiting period for pre-existing diseases: In essence, a pre-existing disease is an illness or any medical condition that you have experienced within 36 months prior to applying for health insurance. The United India Family Medicare Policy has a waiting period of 48 months for such pre-existing diseases. This implies that during this 48-month period, you cannot file any claim for expenses related to pre-existing diseases.
• Waiting period for specific diseases: Insurance companies may also apply specific waiting periods on certain medical conditions or illnesses apart from your pre-existing diseases. These waiting periods are solely decided by the insurer and are not based on your current health status. The United India Family Medicare Policy has a waiting period of either 24 months, or 48 months for specific diseases.

👉Exclusions

There are certain situations that your insurer will not cover at any cost which are referred to as exclusions. These include –

• Standard permanent exclusions: Every insurance company must adhere to a list of “standard permanent exclusions” that are laid out by Insurance Regulatory and Development Authority of India (IRDAI). These exclusions include –  

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes.
2. Rest cure, rehabilitation, respite care: Admission to a facility for bed rest where no active medical treatment is administered.
3. Obesity/weight control: Any treatment or surgery designed for weight control or obesity.
4. Change of gender treatment: Any medical treatment designed to alter the characteristics of the body to that of the opposite gender.
5. Plastic/cosmetic surgery: Any surgical or medical procedures for the modification of appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical costs incurred while engaging as a professional in adventure activities such as skydiving, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses incurred for treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment received from a hospital or medical practitioner excluded by the insurance company.
9. Narcotics: Procedures for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses related to receiving treatments from health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements/substances purchased without prescription: Vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses related to 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: Expenses related to contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ICSI, ZIFT, GIFT, gestational surrogacy, etc.
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.

• Additional permanent exclusions: Other than the standard permanent exclusions defined by the IRDAI, insurance companies also list other specific exclusions based on certain medical conditions or situations. If the insurance company considers certain diseases or medical conditions as too risky for coverage, they may permanently exclude them from your policy. You should also note that insurers can only apply permanent exclusions to a list of pre-approved illnesses outlined by the IRDAI and cannot permanently exclude any disease or medical condition beyond this list.
• Non-standard exclusions (Specific exclusions): These are basically specific exclusions that extend beyond the standard permanent exclusions set out by the IRDAI and can differ between one insurer to another. These are some of the specific exclusions under the United India Family Medicare Policy –

1. Injuries or illnesses caused by foreign invasions, civil wars, warlike activities, etc. by foreign enemies.
2. Injuries or illnesses caused by nuclear events or chemical and biological attacks, whether directly or indirectly.
3. Domiciliary treatments taken at home.
4. Treatments for sleep-related disorders.
5. Use of a ventilator for patients in a vegetative state with no chance of recovery.
6. Switching treatments from one type of medicine to another unless recommended by the current treating doctor or hospital.
7. Circumcision, unless it is deemed necessary for treating a disease, injury, or accident.
8. Expenses for treating external birth defects.
9. Expenses for hearing and vision treatments or devices.
10. Cost of routine medical check-ups or preventive health exams.
11. Dental treatments unless they are necessary due to an accident.
12. Treatments for intentionally self-inflicted injuries or attempted suicides.
13. Cost of routine medical check-up glasses or contact lenses.
14. Expenses for stem cell implantation, except for bone marrow transplants for certain blood conditions and growth hormone therapy.
15. Treatments like hyperbaric oxygen therapy, enhanced external counterpulsation, and similar methods.
16. Treatments other than allopathy, ayurvedic, homoeopathic, and unani medicine.
17. Cost of prostheses, corrective devices, or durable medical equipment used for diagnosis or treatment.
18. Costs of vaccinations and inoculations, except for treatments needed after an animal bite.

What to expect in terms of claims experience if you buy from United India Insurance Company Limited?

• Speed of claims: The United India Insurance Company Limited has settled 89.79% of claims, in less than 30 days. This suggests that you might have to go through an inefficient claim settlement process.
• Claim-related complaints: As per our research, the percentage of complaints received on overall claims for the United India Insurance Company Limited is not available.
• Claims incurred ratio: It is a measure of the financial performance of an insurer. It is the ratio of the total claims incurred by the insurer to the total premiums collected in a financial year. The United India Insurance Company Limited’s claims incurred ratio is 109.23%.
• Claim settlement ratio: The United India Insurance Company Limited’s claim settlement ratio is not available. It is the percentage of claims settled by an insurer in comparison to the total claims received in a financial year.
• Network hospitals: The number of network hospitals for the United India Insurance Company Limited is not available on the website.

How is the customer service of United India Insurance Company Limited?

• Policy purchase-related complaints: As per our research, the percentage of policy purchase-related complaints for the United India Insurance Company Limited is not available.
• Response on toll-free: In our research, we observed that the service response on United India Insurance Company Limited's toll-free number is average, as compared to other insurers. 
• Response on Twitter: As per our research, United India Insurance Company Limited is not active on Twitter.

About United India Insurance Company Limited

United India Insurance Company, or UIIC, is a government-owned insurance company in India. They offer a varied range of insurance products, covering everything from traditional bullock carts to advanced satellites. Among their offerings are health insurance, motor insurance, marine insurance, personal accident insurance, shopkeeper's insurance, crop insurance, and more. Established in 1938, the company is based in Chennai, Tamil Nadu, with Satyajit Tripathy serving as the CEO and MD.