Health Insurance Excellence
Layered mediclaim strategy – base floater + super top‑ups + critical illness & OPD benefits. We optimise limits, remove hidden sub‑limits and handhold every claim for minimal financial friction.
Strategic Coverage Layers
We structure health portfolios to hedge medical inflation, catastrophic events & out‑of‑pocket leakages.
Base Family Floater
Core hospitalization cover consolidating all dependents into one shared pool for cost efficiency & uniform benefits.
Super Top‑Up Layer
High sum insured at a fraction of cost triggered after deductible – shields large medical events & multi‑claim years.
Critical Illness Lump Sum
One‑time payout on diagnosis – funds income gap, domiciliary care & lifestyle adjustments beyond hospital bills.
OPD & Day Care Add‑Ons
Out‑patient consults, diagnostics & minor procedures – reducing cash drain & prescription cost creep.
Room Rent Uncapping
Eliminates proportional deduction surprises; ensures full eligibility for ICU, advanced facility & network choice.
Claim Concierge Desk
Admission pre‑auth tracking, shortfall query drafting, escalation matrix navigation & final settlement variance review.
Layer Economics Overview
Illustrative cost allocation helps justify moving from single oversized base cover to layered structure.
| Layer | Indicative Purpose | Efficiency Insight |
|---|
Core hospitalization up to moderate sum insured addressing routine + mid severity events. Select plan with minimal sub‑limits & broad cashless network.
Activates after threshold; extreme value per rupee at higher coverage bands. Ideal for large organ, oncology or multi‑claim years.
Lump sum free of hospital invoice constraints funds rehab, travel, income replacement & domiciliary care beyond policy fine print.
Advisory & Claim Workflow
Transparent, SLA‑anchored process to minimise friction & leakage.
Discovery
Profile age mix, pre‑existing conditions, city tier, cash flow & employer coverage gaps.
Gap Mapping
Room rent impact, sub‑limits, PED waiting, deductible modelling & inflation stress test.
Design
Layer selection (base + top‑up + CI), rider logic, network adequacy & premium affordability grid.
Placement
Proposal scrutiny, medical underwriting liaison & policy wording variance capture.
Claim Desk
Pre‑auth monitoring, shortfall negotiation, escalation matrix & TAT benchmarking.
Annual Review
Usage analytics, inflation reload, top‑up trigger review & PED / bonus optimisation.
Health Insurance FAQs
Clarity on common structuring & claim concerns.
Why not just buy a very large single floater?
Layering (moderate base + top‑up) reduces cost per lakh substantially, allows flexible deductible resets & easier future scaling vs paying high blended premium on entire amount.
Is a top‑up useful if I have corporate cover?
Yes; corporate covers are revocable & may have room rent / disease capping. A personal top‑up with low deductible creates continuity + portability safety net post employment change.
Should I add critical illness rider inside base plan?
Standalone CI policies offer clearer definitions, wider condition upgrades & portability. Riders can be restrictive; we evaluate cost vs flexibility & claim independence.
How to remove room rent cap risk?
Select plan variants with ‘any room category including single private’ or upgrade riders. This prevents proportional deduction across all line items on higher room selection.
What triggers a CI payout vs hospital bill policy?
Diagnosis of listed condition per definition (e.g., first heart attack of specified severity). Lump sum paid irrespective of actual hospital invoicing enabling income & lifestyle support.
Upgrade Your Health Cover Architecture
Send your existing policy schedule(s) – receive a structured gap & redesign report with inflation, PED & claim impact notes.
- Integrated multi‑layer design
- Claim escalation advantage
- Annual inflation recalibration
- Tax optimisation mapping
- Transparent fee / benefit model
*Claim Support Score: Internal experience-weighted metric combining responsiveness, settlement time & deduction recovery efficiency. Insurance products are subject to terms, conditions & exclusions. Read all policy documents carefully.