Edelweiss Health Insurance

Edelweiss General Insurance is an insurance provider serving since 2017. The company sells products across health, motor, travel, and other segments.

With the claim support of 99.72 and a solvency ratio of 2.2, this health insurance company provides coverage for different health treatments as well as malignant diseases like cancer.

Edelweiss Health Insurance offers health insurance policies for individuals and families at affordable rates and ensures that all your healthcare needs are looked after. With comprehensive coverage of Edelweiss Medical Insurance, one can protect their savings during an emergency hospitalization.

Awards and Achievements of Edelweiss General Insurance

• Top 25 Financial Innovations of India 2020
• Best Customer Experience Team of the Year 2020
• Best BFSI Technology Award - Cloud
• SAP - Process Innovation 2018 Game-Changing 'SAP Cloud For Insurance' Showcase
• SAP ACE Award 2018 Special Recognition
• MINT - SAP Digitalist Award 2018 Rama - Digitalist 2018

Key Features of Edelweiss Health Insurance

Treatment at a good hospital, even for something as minor as fever and cough, can cause serious damage to your hard-earned savings. Thus, it is very important to have the best health insurance plan that provides protection to you and your family.

To evaluate the performance of Edelweiss Health Insurance, we have identified several factors such as network hospitals, claim support, annual premium, and solvency ratio, which are important indicators of how reliable an insurance provider is.

Let's understand in detail.

1. Renewability

   The plan offers a lifelong renewability option. It saves your pocket from financial stress caused due to medical emergencies and keeps you prepared to handle any critical/ difficult situation.

2. Network Hospitals

   Network hospital list is an important criterion that people consider while buying health insurance. The longer the list of hospitals, the easier it is to find one in nearby places.

   Insurers appoint network hospitals, doctors or medical practitioners, or clinics that charge lower fees to their policyholders. The policyholders can also avail of cashless facilities thereafter filing a claim at these hospitals. It simply means that your treatment will be done without paying money to the hospital. With a cashless hospitalization, all the medical bills get settled upon the completion of the treatment or after the discharge.

   Edelweiss Health Insurance Company has a tie-up with 3281+ network hospitals across India providing cashless facilities to its customers.

   Comparison of Network hospitals of Edelweiss health insurance with other general insurers

   

   You can check the Edelweiss Health Insurance network hospitals list with PolicyX.com as per your state and city.

   Have you ever thought of a case when you get admitted to a non-network hospital? Who will bear your medical bills? In that case, the company offers an option of reimbursement where the paid amount is refunded to the insured after 10-12 working days.

3. Solvency Ratio

   The solvency ratio is another crucial factor to consider while selecting the best insurance company. It helps to determine the survival capacity and reliability of the insurer. As per IRDAI, it is mandatory for every insurer to maintain a solvency ratio of 1.5.

   The solvency ratio of Edelweiss health insurance company is 2.2 which fulfills the set standards of IRDAI.

   Solvency Ratio of Edelweiss Health Insurance over the years

   

   Here, we have assessed the company's solvency ratio of the last 3 years i.e. from 2017-20.

   IRDAI publishes solvency of four months for the year 2019-20 i.e., June 2019 - March 2020.

   Solvency Ratio of Edelweiss Health Insurance 2019-20

   

4. Claim Support

   Claim support determines the claim settling ability of an insurance company and is also used as a rating criterion of the health insurance companies. IRDAI publishes it annually in the first month of every year.

   The claim support of Edelweiss Health Insurance within 3 months is 99.72 that means out of 100 claims, they have settled 99 claims.

   Let's understand the claim support of general insurers with the help of a graph.

   Comparison of Claim support (within 3 months) of Edelweiss with other general insurers

   

   A higher claim support percentage ensures a smooth settlement.

5. Market Share

   Market share determines the volume of a business that determines the total number of policies sold by an insurance company and the premiums collected.

   As per the IRDAI Annual Report 2019-20, the Annual Gross Premium of Edelweiss Health Insurance is Rs.45.06 crores. The bar graph shows the Annual Premium of Edelweiss across India from the Financial year 2017-2020. Let's take a look.

   Annual Gross Premium of Edelweiss Health Insurance over the years

   

   Go through the table for more understanding,

   Renewability	Lifetime
   Network Hospitals	3281
   Solvency Ratio	2.2
   Claim Support (within 3 months)	99.72
   Annual Gross Premium 2019-20	45.06 Crores

   **Last Updated on March, 2022

Other Key Apects

• This plan provides coverage to individuals above the age of 3 months.
• A maximum of 8 members is covered including self, spouse, three children, and other relatives (as per the policy documents).
• Offers cover up to Rs. 2 Crore
• This policy involves medical monitoring, medical referral cover, second medical opinion, and compassionate visit.
• Co-payment of 20% is applicable

What are the different types of Edelweiss Health Insurance Plans?

**Last Updated on March, 2022

1. Edelweiss Health Insurance Policy

   It's standard health insurance, which provides comprehensive financial coverage to its customers against long-lasting medical worries. The policy is divided into three variants: Silver, Gold, and Platinum. Let's know more about them in detail.

   Eligibility Criteria:

   Parameters	Silver	Gold	Platinum
   Minimum Entry Age	3 months
   Maximum Entry Age	65 years	65 years	No limit
   Sum Insured (Rs.)	1, 2, 3, 4, 5 lakhs	5, 7.5, 10, 15, 20 lakhs	15, 20, 50, 75, 100 lakhs
   Policy Term	1/2/3 years
   Premium Payment Options	Single
   Renewal Age	Lifelong

   **Last Updated on March, 2022

   Key Features of the Silver Plan:

   • Hospitalization- In case the policyholder is hospitalized due to an illness/injury, the plan will look after its expenses like nursing charges, room rent, medical practitioner fees, operation theater charges, medications, ICU charges, among others.
   • Pre and post hospitalization- All the expenses incurred up to 30 days before hospitalization and up to 60 days after hospitalization are covered.
   • Daycare treatments- Treatments not exceeding 24 hours of hospitalization are covered under this plan.
   • Ambulance cover- If the insured needs to be transported to the hospital due to a medical emergency, the plan will take care of its expenses (up to Rs. 1,500).

   Key Features of the Gold Plan:

   • Pre and post-hospitalization- The plan provides coverage up to 60 days before arrival at the hospital and up to 90 days after discharge from the hospital for the incurred medical expenses.
   • Ambulance cover- The plan covers the ambulance expenses (up to Rs. 3,000) if the insured requires an ambulance for an emergency.
   • Organ donor expenses- The medical expenses incurred against an organ donor's inpatient treatment for harvesting an organ are covered (up to Rs. 1 lakh).
   • Maternity benefit: Under this plan, maternity benefit (up to Rs. 50,000) is provided for 2 deliveries and lawful termination of a pregnancy of an insured (as per policy's TnCs).

   Key Features of the Platinum Plan:

   • Hospital cash- The plan shells out hospital cash benefits (Rs. 1,500) to the insured if the hospitalization exceeds 3 continuous days. This is applicable up to 7 days of hospitalization.
   • Pre and post hospitalization- Under this plan, pre and post-hospitalization expenses are covered for 90 and 180 days respectively.
   • Ambulance coverage- In the need of an ambulance for transportation of the insured to the hospital, the plan takes care of its expenses (up to Rs. 10,000).
   • Organ donor treatment- Expenses arising out of inpatient treatment of an organ donor are covered up to Rs. 2 lakhs.
   • Ayush treatments- The plan covers the expenses for any treatment taken under Unani, Ayurveda, Homeopathy, and Siddha in any government-recognized hospital/institution.

2. Edelweiss COVID Healthcare

   To assist you with treatment expenses due to COVID-19, the company has come up with two COVID-specific plans. These are:

   • Corona Kavach
   • Corona Rakshak

   1. Corona Kavach Policy

   The policy is designed to look after the expenses in case the insured falls ill with COVID-19. Corona Kavach policy can be purchased on an individual or family floater basis.

   Eligibility Criteria:

   Entry Age	18-65 years
   Sum Insured (Rs.)	50,000 - 5 lakhs
   Policy Period	3.5. 6.5 & 9.5 months

   **Last Updated on March, 2022

   Key Features:

   • Pre and post-hospitalization- The plan will cover any expenses incurred before hospitalization (up to 15 days) and after discharge from the hospital (up to 30 days).
   • Home care treatment- If the insured undergoes treatment for COVID-19 at home after approval from the government-certified doctor, the plan is liable to cover its expenses up to 14 days.
   • Pre-policy medical check-up- Individuals up to 60 years don't have to undergo medical screening to buy this plan.
   • Daily hospital cash- The plan will pay 0.5% of the sum insured (each day) for every 24 hours of continuous hospitalization to the insured. This benefit is payable up to 15 days in a policy period.

   2. Corona Rakshak Policy

   If the insured is diagnosed with COVID-19 and requires uninterrupted hospitalization for at least 72 hours, this plan provides 100% insurance coverage. It should be detected from a government-authorized diagnostic center.

   Eligibility Criteria:

   Entry Age	18-65 years
   Sum Insured	50,000 - 2.5 lakhs
   Policy Period	3.5, 6.5 & 9.5 months
   Waiting period	15 days

   **Last Updated on March, 2022

3. Edelweiss Arogya Sanjeevani Policy

   Hospital costs are reaching new heights. Everything from simple daycare procedures to hospitalization can damage your wallet. With the Arogya Sanjeevani plan, you can get comprehensive health coverage and protect your savings account.

   Eligibility Criteria:

   Entry Age	18-65 years
   Sum Insured (in Rs.)	1 - 5 lakhs
   Member Covered	8
   Premium Payment Options	Annually, half-yearly, quarterly and monthly

   **Last Updated on March, 2022

   Key Features:

   • Hospitalization costs- If you are hospitalized for at least 24 hours, coverage will be provided up to the sum insured. The plan also includes coverage for daycare treatment procedures.
   • Pre and post-hospitalization costs- All the related expenses incurred before admission and after discharge from the hospital are covered up to 30 and 60 days respectively.
   • Cataract treatments- If your eye(s) needs cataract treatment, the plan will take care of its expenses (Rs.40,000 or up to 25% of SI per eye).
   • Cumulative bonus- In case you don't claim in a policy year, your sum insured will increase by 5% (maximum 50%).

What are the exclusions under Edelweiss Health Insurance Plans?

Below are the general exclusions, which apply to Edelweiss Health Insurance plans. Let's have a look.

• All hazardous activities
• Oral chemotherapy
• AIDS/HIV treatment
• The cost of contact lenses, spectacles, hearing aids, eye and ear examinations, dentures, laser surgery, dentures, and other similar external devices
• Plastic surgery or cosmeceutical surgery
• Treatments undertaken by unauthorized hospitals/doctors

How to buy Edelweiss Health Insurance Plans?

Edelweiss Health Insurance Plans can be brought online through the official website of the company or offline by visiting the nearest branch. However, in case you face any problems, you can turn to PolicyX.com. Read the next section, to understand the buying process:

• Visit the official website of Edelweiss General and tap on 'Health Insurance'.
• Enter the details in the 'Get Quote' tab.
• Choose the plan of your choice, customize its details (if needed) and pay the premium.
• After payment of the premium, the policy document will be sent to your registered email ID.

If you don't wish to buy online, you can visit the nearest branch of the company for a health insurance purchase.

To know more about the plan, get in touch (1800-4200-269) with the experts of PolicyX.com.

We, at PolicyX.com can provide a dedicated agent by your side during the entire process. Below is its buying process.

• Fill in the details in the 'Calculate Premium' form.
• The next page will show all the available plans. Choose the best Edelweiss health plan and click on 'Buy Now'.
• Pay the premium and your policy document will be shared with you on your registered email.

How To File A Claim For Edelweiss Health Insurance Plans?

To avoid any confusion, the company asks its customers to perform a 3-step claim process. Let's take a look at it.

Cashless Claim Settlement Process

1. Claim Intimation

   Whether it's a planned or emergency hospitalization, inform the company about the same (call at 1800 12000).

2. Submission Of Documents

   Submit all the necessary documents like medical records, discharge summary, claim form, etc. to the company within the deadline.

3. Claim Decision

   If you opt for cashless hospitalization, Edelweiss will directly pay the hospital (if the claim is approved). In the case of reimbursement, the company will transfer the amount to the registered bank amount (if the claim is approved).

   For any queries, mail at support[at]edelweissinsurance[dot]com

Reimbursement Claim Settlement Process

• If you wish to reimburse medical bills, you can call the company at 1800 12000 or 022 423 12000.
• Make sure to keep a track of the bills, invoices, doctors' reports and discharge summary.
• The company will work on the claims filed, and once approved, will transfer the amount to your account or the hospital's.

Documents Required For Edelweiss Health Insurance Claim

• Correctly signed & filled claim form
• Medical research reports
• Pre-authorization request
• Medical reference slip
• Copy of Patient Photo ID Card (Hospital Verified)
• Discharge document from the hospital
• Operation Theater Reports
• Chemist bills
• Hospital bills
• Others requested by the company

Contact Details of Edelweiss Health Insurance

Customer care toll-free number: 1800 12000 / 02242312000

Email: support@edelweissinsurance.com