FAQs

Get answers to your questions under various topics in an easy to read manner. Feel free to write to info@investguru.in if you do not find your query here. We shall be happy to reply you back.

New Investor

What is a mutual fund?

A Mutual Fund is an investment tool that allows investors access to a well-diversified portfolio of equities, bonds and other securities, as per the objective of the scheme. Each investor participates in the gain or loss of the fund. Units are issued and can be redeemed as needed. The fund's Net Asset Value (NAV) is determined each day.

Mutual Funds are financial intermediaries registered and authorized by SEBI(Securities and Exchange Board of India) to carry on the mutual fund business in India. They are companies set up to receive your money, and then having received it, make investments with the money via an AMC(Asset Management Company).
It is an ideal tool for people who want to invest but don't want to be bothered with complexity of choosing the right shares or bonds for investment. A mutual fund manager proceeds to buy a number of stocks from various markets and industries. Depending on the amount you invest, you own part of the overall fund.

Mutual Fund invests investor’s money in shares/bonds/money market instruments depending upon the objective of the scheme. An Income scheme may invest the money in bonds and money market instruments whereas a growth oriented scheme may invest in stocks of promising companies.

Primarily, there are two kinds of funds. Equity funds and Debt Funds.
Equity Funds are high risk funds which tend to provide growth to investments by investing in stocks of companies, over long period of time say, 5-10 years. Debt Funds invest in bonds and money market instruments and try to preserve the capital and generate moderate income over shorter periods of time.
Both Equity and Debt funds could further be classified into sub categories depending upon the objective of the fund.

All mutual funds do not guarantee capital safety, hence risky in nature. However, the degree of risk varies in different kinds of mutual funds. An Equity fund may be the most risky and volatile fund whereas a Liquid Fund may be a low risk and least volatile fund.

Who can invest in mutual funds?

Mutual Fund investment is open to Resident / Non-Resident Individual, HUF (Hindu Undivided Family), Companies/Body Corporate, Partnership Firms, Trusts and Cooperative Societies.

Mutual Funds are simple, low cost, liquid and transparent investment options.
There are various kinds of mutual funds to cater different needs of investors. Mutual funds provide investment options for short duration investment as well as for long term, from high risk-high return to low risk-moderate return.
Mutual funds are tax efficient in nature. Nomination and Joint Holding in mutual funds provides easy wealth transfer from one individual to another in case of unforeseen circumstances.

Following documents are required to be submitted by the investor to subscribe in any mutual fund scheme:
For All Investors:
* Duly filled in Common Application Form (To be downloaded for the desired scheme) * Any of the below Payment instrument to be issued in favor of the scheme in which the investment needs to be made a. Local cheque b. Payable at par cheque c.Demand Draft payable locally
Additional Documents
2. Resident / Non-Resident Individual Investor *PAN Copy *KYC Acknowledgement Copy irrespective of the investment amount 3. HUF (Hindu Undivided Family) *PAN Copy of the HUF *KYC Acknowledgement Copy irrespective of the investment amount *HUF Stamp required on the Application Form 4. Companies/Body Corporate *Certified copy of the Board Resolution authorizing investments/ disinvestments in Mutual Funds Schemes, certified by the Company Secretary / Authorized Signatory *List containing names and signatures of the signatories, authorized as per the above Board Resolution, duly attested by the bankers/ Company Secretary on the Company's letterhead *Copy of the Memorandum and Articles of Association of the Company duly attested by the Company Secretary or any other authorized signatory *Other relevant documents governing the statute (in case of Body Corporate not covered under the Companies Act, 1956) *PAN Copy *KYC Acknowledgement Copy irrespective of the investment amount 5. Partnership Firms *Copy of the Partnership Deed duly attested by any of the partners *Signatures of the partners attested by their bankers *Copy of the Resolution, signed by the partners, authorizing investments/ disinvestments in the Fund and corresponding operational procedures *PAN Copy *KYC Acknowledgement Copy irrespective of the investment amount 6. Trusts *Copy of the Trust Deed attested by the Trustees/ Secretary *Copy of the Resolution passed by the Trustees authorizing investments/ disinvestments in Mutual Fund Schemes, duly certified by the Trustees/ Secretary *List of Trustees and signatures, authorized as per the above resolution, duly attested by the bankers/ Secretary of the Trust on the Trust's letterhead *PAN Copy *KYC Acknowledgement Copy irrespective of the investment amount 7. Co-operative Societies *Copy of the Registration Certificate attested by the Secretary/ office bearer of the society *Copy of the Resolution authorizing investments/ disinvestments in the Fund and corresponding operational procedures, duly attested by the Secretary/ office bearer of the society *List of members and their signatures, attested by the bankers *PAN Copy *KYC Acknowledgement Copy irrespective of the investment amount.

Choosing the right mutual fund is dependent upon the goal you wish to achieve as an investor. If you are looking for growth over a long period of more than 5 years and ready to take risk on capital, Equity and Balanced Funds are the right vehicle. If you are looking for regular income with low risk and volatility, then Debt Funds can be considered.
You can use the InvestGuru Guide’s two step process to identify the right mutual fund for your financial goal. InvestGuru Guide compares various mutual funds for every specific goal and suggests the most attractive schemes available in an easy format.
You may also talk to us on 09910423232 for a personalised advice.

Existing Investor

I am looking for making fresh investment in mutual fund. Which are the best funds to invest?

The choice of best funds depends upon your financial goal. If you are looking for growth of your capital over long investment horizon(5 years plus), then you can choose equity funds. If you are looking for safety with moderate returns, you may choose debt funds.
We recommend you to use the InvestGuru Guide to identify the best mutual funds for yourself. Depending upon your goal and time horizon, InvestGuru Guide shall compare various schemes and list the most appropriate schemes at one place. From there, you shall be able to finalise the right schemes for yourself with ease.

You can start a new SIP in the existing fund by downloading SIP/Auto Debit form of the respective fund house from our Download Centre.
Apart from filling various details, do remember to mention existing folio no. of the existing fund in this form.

You may download the Stop SIP form from the Download Centre for the respective fund house. Fill in the details and submit it with one of the Investor Service Centre.
From the date of submission of Stop SIP form, it takes 30 days to stop the sip. So, be informed that at least one sip amount may get deducted from your account before it stops completely.

You may redeem your funds, whether partially or fully, by filling in the Common Transaction Form and submitting it with Investor Service Centre.
In case your bank account, which is mentioned in your investment, is no longer active, remember to get your bank details changed first in the investment and then proceed with redemption.

You can make additional investment in an existing fund by filling the Common Transaction Form with additional purchase details and attaching a cheque payable to the Scheme Name.
The same can be submitted with Investor Service Centre of respective fund house.

You may make partial withdrawal from your fund by filling in the desired amount and other details in the Common Transaction Form and submitting it with Investor Service Centre of respective fund house.

After your SIP stops or matures, your amount remain invested in the fund till you switch or withdraw it. The value of the investment changes with the changes in the NAV of the fund.

Please refer Taxation FAQs.

To get the contact details changed in the fund, one needs to get the details changed in KYC first through KYC Change form(Refer KYC updation procedure in KYC FAQs). Once the details are updated in KYC, a request need to be placed with the fund house to update their details from KYC agency.

How do i add/change nominee in my existing fund?

You can add/change nominee in your fund by downloading and filling nomination form of respective fund house.
Nomination form can be downloaded from our Download Centre.

Yes. You can make upto three nominations with combined sharing being 100% of the fund.

A particular scheme may not be generating enough returns as per your expectations due to various reasons..Economic Environment, Quality of Fund Management, Nature of the Scheme etc.
It is advised that you speak to your financial advisor or contact us to have a clear understanding of the same.

You may change your bank details in the fund by downloading Common Transaction Form and filling in the new bank account details. You need to attach a proof of the old account and new account alongwith the common transaction form. The proof of old and new account could be a. cancelled cheque with your name printed or b. copy of updated passbook showing your name and account details.
These documents need to be submitted with Investor Service Centre of respective fund house.

You need to write to the respective fund house requesting issue of new cheque and mentioning the folio no., scheme name and date of redemption.
You may also download and use Lost Redemption Cheque format for the same and submit it with Investor Service Centre of respective fund house.
It may take 15-20 days after submission of request to receive newly issued cheque.

You need to write to the respective fund house requesting cancelling the issued cheque and for issuance of new cheque mentioning the folio no. and scheme name.
You may also download and use Revalidation of Redemption Cheque format for the same and submit it alongwith the outdated cheque to the Investor Service Centre of respective fund house.
It may take 15-20 days after submission of request to receive newly issued cheque.

InvestGuru provides online portfolio tracker to its investors to keep a track of their portfolio performance.
If you are an existing client of InvestGuru, you would have received login details from us. In case you do not have the login id, please write back to invest@investguru.in and we shall send you your login details.
If you are not an existing client of InvestGuru, you may still write to us on invest@investguru.in with your investment details. We shall try to incorporate your current investments and issue a login id and password to you to monitor your portfolio online.

You need to call the customer care centre of the respective fund house and inform them about the non-receipt of cheque. Kindly mention your folio no. and the scheme name in which you have made the redemption.
On the basis of the information provided by the customer care, you may act accordingly.

You need to write to the respective fund house requesting cancellation of the issued cheque and for issuance of new cheque with new bank details.
You need to submit the received cheque along with documents required for bank details change. Kindly refer Change in Bank Details FAQ for the same.
You may also download and use Revalidation of Redemption Cheque-Bank Details format for the same and submit it alongwith the received cheque to the Investor Service Centre of respective fund house.
It may take 15-20 days after submission of request to receive newly issued cheque.

KYC

What is the new KRA regulation issued by SEBI and what is the effective date?

Presently for a client to invest with different intermediaries in the security market including mutual funds, he/she had to undergo the process of KYC separately with each of them. To create standardization and avoid duplication, SEBI has mandated uniform KYC for the securities market effective Jan 1st, 2012 through the KYC Registration Agency(s) (KRA).

If an investor is KYC compliant and wishes to invest in an existing folio and the KYC / PAN status is updated in mutual fund records, he does not need to complete formalities again.

However, in case the investor wants to invest in a new folio with same fund house, or wants to invest in a scheme of some other fund house for the first time, the KYC formalities need to be updated as per the new guidelines before investing in the MFs.

The New KYC forms has additional information requirement as compared to the Old KYC. Also IPV (in-Person Verification) is made mandatory for all the investors initiating the KYC.

An Investor, Individual/Non Individual/NRI who wishes to invest in Mutual Funds or with different intermediaries in the security market needs to be KRA verified.

Following documents are required to be submitted by the investor for KYC verification alongwith duly filled KYC application form, Individual/Non Individual, as per the status of applicant (pls read the application form for further details).

KYC Individual Form
KYC Non Individual Form

1. Resident / Non-Resident Individual Investor
   *PAN Copy
   *Address Proof

2. HUF (Hindu Undivided Family)
   *PAN Copy of the HUF
   *Bank Statement
   * Address Proof
   * List of Co Parceners

3. Companies/Body Corporate
   *Certified copy of the Board Resolution authorizing investments/ disinvestments in Mutual Funds Schemes, certified by the Company Secretary / Authorized Signatory
   *List containing names and signatures of the signatories, authorized as per the above Board Resolution, duly attested by the bankers/ Company Secretary on the Company's letterhead
   *Copy of the Memorandum and Articles of Association of the Company duly attested by the Company Secretary or any other authorized signatory
   *Other relevant documents governing the statute (in case of Body Corporate not covered under the Companies Act, 1956)
   *PAN Copy of company
   * Address Proof of the company
   *Two year balance sheet and IT returns
   * KYC documents of the authorized signatory(ies)

4. Partnership Firms
   *Copy of the Partnership Deed duly attested by any of the partners
   *Signatures of the partners attested by their bankers
   *Copy of the Resolution, signed by the partners, authorizing investments/ disinvestments in the Fund and corresponding operational procedures
   *PAN Copy of the firm
   * Address proof of the firm
   *KYC documents of the authorized Signatory
   * Two years balance sheet with IT returns

5. Trusts
   *Copy of the Trust Deed attested by the Trustees/ Secretary
   *Copy of the Resolution passed by the Trustees authorizing investments/ disinvestments in Mutual Fund Schemes, duly certified by the Trustees/ Secretary
   *List of Trustees and signatures, authorized as per the above resolution, duly attested by the bankers/ Secretary of the Trust on the Trust's letterhead
   *PAN Copy of the trust
   *KYC Acknowledgement / KYC documents of authorized signatories
   * Two years balance sheet with IT returns

6. Co-operative Societies
   *Copy of the Registration Certificate attested by the Secretary/ office bearer of the society
   *Copy of the Resolution authorizing investments/ disinvestments in the Fund and corresponding operational procedures, duly attested by the Secretary/ office bearer of the society
   *List of members and their signatures, attested by the bankers
   *PAN Copy of the cooperative
   *KYC Acknowledgement Copy or KYC documents of the authorized signatory
   * Two years balance sheet with IT returns

Individuals need to fill and submit KYC Change-Individual Form along with required documents to make changes in existing KYC details. Corporates/Firms etc. need to use KYC Non Individual Form and complete the formalities just like doing new KYC registration.

KYC form alongwith the required documents and application form can be submitted with respective fund house or at any of the offices designated as Intermediaries by the KYC Registration Agency (KRA).

The investor has to follow the below steps for being KYC Compliant starting 01st Jan 2012

Fill up the new KYC Application form as available on our website as well as any of the KRA’s web site viz.www.cvlkra.com.

The investor has to submit the application form in person at any of the offices designated as Intermediaries by the KYC Registration Agency (KRA).

Obtain a temporary acknowledgement for submission of all the documents and completion of IPV; Once all the documents are verified by a KRA, they will send the investor a letter within 10 working days from the date of receipt of necessary documents by them from the Fund or its Registrar and Transfer Agent informing the investor either about compliance by the investor of the new KYC compliance procedure (“final acknowledgement”) or any deficiency in submission of details or documents.

Notary Public, Gazetted Officer / Manager of a Scheduled Commercial / Co-operative bank or Multinational Foreign Banks (name , Designation & Seal should be affixed on the copy).

In case of Mutual Funds, their Asset Management Companies (AMCs) and the distributors who comply with the certification process of National Institute of Securities Market (NISM) or Association of Mutual Funds (AMFI) and have undergone the process of ‘Know Your Distributor’ (KYD), can perform the IPV.

Distributors who are NISM /AMFI certified and have done their KYD

For direct applications received, IPV may be done by Scheduled Commercial Banks

Yes, purely based on the requirement of the In-Person Verification with the validation of the original documentation.

Yes. The list of documentation is furnished on the KYC Individual Application form.

No, The investor can attach the acknowledgement and give it with the Investment to the MFs.

What type of communication will be issued for the KYC completion at the Intermediary?

The Intermediary will provide an acknowledgement letter confirming the acceptance and processing of the KYC. Post the same, the KRA will also send a communication from their end within 10 working days of receipt of the documents from the intermediary.

The intermediary generates the KYC acknowledgement letter immediately, if the requisite documentation is complete. The communication from the KRA takes 10 working days from the date of receipt of the original documents from the intermediary.

Yes. To make investment in mutual funds, NRIs need to be KYC compliant.

The acceptance of the requisite documents and the IPV formalities remain the same as already mentioned in the FAQs.

In case of NRIs, authorized officials of overseas branches of Scheduled Commercial Banks registered in India, Notary Public, Court Magistrate, Judge, Indian Embassy / Consulate General in the country where the client resides are permitted to attest the documents.

As of now CDSL Ventures Limited (CVL) will act as the KRA for processing the KYC Application forms effective 01st Jan 2012. Also the investors can continue to call the existing helpline nos. provided by CVL for any clarifications on KYC processing.

No.

No, the KYC Change Details form needs to be duly filled in with the requisite documentation for getting the change effected.

Yes, provided all the documents/IPV formalities as referred in the FAQs are adhered to.

Yes.

Yes, under the PAN exempt cases. The same will be processed with the required POI and POA alongwith the IPV formalities as defined in the KYC application form.

Yes.

Yes. No stand-alone KYC is allowed.

Taxation

Tax Reckoner 2021-22

NRI FAQs

Can NRIs Invest in Mutual Funds in India?

Yes, NRIs are allowed to invest in Mutual Fund schemes in India. No RBI approval is required for the same.

For an NRI the procedure of applying in a mutual fund is similar to the one followed by residents.

For investment in mutual funds, KYC verification of NRIs is mandatory(read KYC verification process in KYC FAQ).

The completed application form must be submitted at the investor service centers along with cheques or bank drafts.

Investment cannot be made in foreign currency. Rupee cheques drawn from the investor’s bank account in India or from abroad payable in a bank in India or Rupee drafts purchased abroad payable at the city where the application is made must be provided.

Details of the Indian bank account of the investor must be furnished at the time of application.

Redemption proceeds are paid in Indian Rupees by cheque to the account number provided at application. For select banks they may credit proceeds to the account directly.

If investments are made on non-repatriable basis redemption proceeds will be credited to the NRO account of the investor.

Similarly if a person turns an NRI after purchasing of units the maturity proceeds will not qualify for repatriation. However dividends are fully repatriable in all cases.

Mutual fund units are treated as capital assets and attract capital gains tax in India.

If held for more than 12 months long term capital gains tax is applicable and for periods equal to or less than 12 months, short term capital gains tax is applicable. Indexation benefits are available for long term capital gains.

No tax is to be paid on dividends received.

TDS applies on capital gains tax. TDS certificate or Form 16 A is dispatched to the investor along with redemption warrant.

Mutual fund units do not attract wealth tax.

The summary of income tax rates applicable for NRIs on mutual funds for the year 2013-2014 is given below:

Fund TypeShort Term Capital Gains TaxLong Term Capital Gains Tax
Equity15%Nil
Debt 30% 10% without indexation or 20% with indexation, whichever is lower


TDS applicable for NRI investors

Fund TypeShort Term Capital Gains TaxLong Term Capital Gains Tax
Equity15%Nil
Debt 30% 20% with indexation

The three types of rupee accounts permitted, that can be maintained by NRIs are as follows :

a. NRE : Non-Resident (External) Rupee Account
b. NRO : Non-Resident (Ordinary) Rupee Account
c. FCNR – B : Foreign Currency (Non –Resident) Accounts (Banks)

To invest on a repatriable basis, you must have an NRE or FCNR Bank Account in India. The Reserve Bank of India (RBI) has granted a general permission to Mutual Funds to offer mutual fund schemes on repatriation basis, subject to the following conditions :

* The amount representing investment should be received by inward remittance through normal banking channels, or by debit to an NRE / FCNR account of the non-resident investor.

* The net amount representing the dividend / interest and maturity proceeds of units may be remitted through normal banking channels or credited to NRE / FCNR account of the investor, as desired by him subject to payment of applicable tax.

The Reserve Bank of India (RBI) has granted a general permission to Mutual Funds to offer mutual fund schemes on non-repatriation basis, subject to the following conditions :

* Funds for investment should be provided by debit to NRO account of the NRI investor. Alternatively, funds may be invested by inward remittance or by debit to NRE / FCNR Account.

* No permission of Reserve Bank either by the Mutual Fund or the NRI investor is necessary. In case of an application under a Power of Attorney, the original Power of Attorney and Certificate of Registration should be submitted to the Mumbai ISC within 7 days from the date of the application. The NRIs may also be required to furnish other documents needed to process their investments.

How will the redemption proceeds be paid?

Redemption proceeds will be paid by cheque. The cheque will be payable to the first unitholder and will include the bank account number.

Alternatively the redemption proceeds will be credited directly to the investor’s bank account. This facility is available with select banks. Redemption proceeds/repurchase price and/or dividend or income earned (if any) will be payable in Indian Rupees only. The fund is not liable for any loss due to exchange fluctuations, while converting the Rupee amount into US Dollar or any other currency.

The investments shall carry the right of repatriation of capital invested and capital appreciation so long as the investor continues to be a resident outside India.

Where the investment is made out of inward remittance or from funds held in the NRE/FCNR account of the investor, the maturity proceeds/repurchase price of units (after payment of taxes) may be credited to the NRE/FCNR/NRO account of the non-resident investor maintained with an authorised dealer in India [Clause 5(ii) of the Regulations].

Where the purchase of units is made on a non-repatriable basis, the maturity proceeds/repurchase price of units (after payment of taxes) will not qualify for repatriation and may be credited to the NRO account of the non-resident investor [Clause 5(ii) of the Regulations].

Similarly, investments in units purchased in Rupees, where the investor was a resident of India and subsequently becomes a non-resident, will not qualify for repatriation of repurchase proceeds of units.

The entire income distribution on the investment will, however, qualify for full repatriation.

Investors are advised to contact their banks/tax consultants if they desire remittance of the income distribution on units abroad.

Yes.

Yes.

Please read FAQ on reptration and non-reptriation given above.

FAQs about InvestGuru

How does Investguru help me in my investments?

Investguru works as your personal financial advisor. It first understand your needs and suggests you well researched investments on the basis of your current investment profile and future financial needs(goals). It helps you in making these investments online or through physical forms and monitors them on periodical basis.

Investguru believes in reviewing every bit of money invested on regular intervals in order to keep up with the market. Your personal advisor will review your portfolio periodically and suggest you the changes for your portfolio, if needed.

Investguru provides a comprehensive online portal for you to plan and manage your investments better. Our online services helps you investment planning, analysis and updates, keeping track of portfolio progress and providing suggestive changes in your portfolio in line with your personal financial goals.

All investments are subject to market risk. However, our researchers make sure that your investments reap you the best possible returns. At any time, if the investment is not performing up to our expectations, we will review and revise your portfolio in order to continue to get the desired result.

InvestGuru does not charge any advisory fee from the clients. Investguru is directly remunerated by the fund houses and insurance companies.

InvestGuru works with you as your personal financial advisor. We recommends you to invest through us so that we provide the right advice in the beginning and can also keep track of your investments to support you throughout your investment period.

You can redeem your investments either online through your login id and password or by submitting physical forms. You may also let us know your requirement and we will help you to complete the documentation required for redemptions. After the redemption is made, you shall receive the money from the fund house/insurance company directly in your bank account, or through cheque(in some cases).

In that situation, your investments will still be safe and continue to perform as the your money is invested with SEBI registered mutual fund companies or IRDAI regulated insurance companies. The money is not invested or given to Investguru. InvestGuru works as your financial advisor only who maintains and manages your investments as per your goals.

No, investguru does not hold any right to buy or sell funds on your behalf. However, if you express your desire to make changes to your investments portfolio, Investguru will recommend the desired changes and will guide you through the process of making such changes. Any change is possible only with your approval, whether given electronically or through physical forms.

There is no extra risk of investing through Investguru other than the inherent market risks that comes with any investment.

Claims

To whom will the claim money be paid?

The claim money will be paid to the beneficiary who generally is the nominee / assignee / appointee (in case of a minor) as mentioned by the Life Assured in the Application Form for Insurance.

In such an eventuality, a "Succession Certificate" will have to be submitted by the Claimant. A Succession Certificate is issued on application by a competent court on the question of the right to the property of the deceased. The Succession Certificate should specifically provide for disbursement of policy monies. If, however, the deceased has left a will, a probate of the will is required along with the copy of the will.

The Life Assured should nominate some other person in place of the deceased Nominee under section 39 of the Insurance Act.

After how many days from the date of an incident should a claim be intimated?

Except in some type of claims (e.g. Critical Illness Rider), where a waiting period is involved, all claims including death claims should be intimated as soon as possible.

The claimant or the family members of the Life Assured should inform the BSLI Branch Office about the death of the Life Assured. Alternatively, they can directly intimate the Claims Section at:

The Claims Section,
Birla Sun Life Insurance Company Limited
G Corp Tech Park,
5th & 6th Floor,
Kasar Wadavali, Ghodbunder Road,
Thane - 400 601.

The claim forms can be submitted at the nearest BSLI Branch Office or could be sent directly to the Claims Section at:

The Claims Section,
Birla Sun Life Insurance Company Limited
G Corp Tech Park,
5th & 6th Floor,
Kasar Wadavali, Ghodbunder Road,
Thane - 400 601

New Policy Holder

What does Pre and Post hospitalization mean?

Pre- and Post-hospitalization expenses cover all medical expenses incurred within X days prior to hospitalization and expenses incurred within Y days post hospitalization (X & Y may depend on the Health Policy) provided the expenses were incurred for the same condition for which the Insured Person’s hospitalisation was required.
For Example: A person may be required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses for tests and medicines 30 days prior to hospitalization for that particular disease are covered. Medical expenses for 60 days post-hospitalization after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.

Medical expenses, means all those reasonable and medically necessary expenses that an Insured Person has necessarily and actually incurred for medical treatment during the policy period on the advice of a medical practitioner due to illness or accident occurring during the policy period, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

Pre-existing Condition mean any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 36/48 months(depending on the Health Policy) prior to the first policy issued by the insurer.

The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the hospitals.

The cashless facilities are available only at the hospitals that are in insurance company’s network.

You can check the network hospital list from the Download section.

No, this facility does not extend to government hospitals.

When you are admitted to the network hospital, you need to show your Health Card to the treating doctor. The Network Hospital would contact the responsible TPA (Third Party Administrator, mentioned on the card) and fill up the pre-authorization form. Then it would send the same to TPA with estimation of expenses. The TPA checks the policy conditions and the sum insured and approves the estimate.

Yes, the insurance company shall pay the entire admissible amount for the medical expenses incurred subject to the sum insured. You might have to pay for the non-medical and expenses not covered to the hospital prior to your discharge from hospital.

In case of cashless treatments, in whose favour are cheques settled or who gets the payments?

The cheques are sent to the hospital to whom approvals for cashless are given.

Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured.

The claim documents should be submitted to the responsible TPA, mentioned on the ID card and the User Guide.

A waiting period is the length of time the insured have to wait before being eligible for Health Policy benefits.

Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Health Insurance policy will come to your rescue.
Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.

An individual policy is purchased by you directly from us. In a Group Health Insurance Policy, the employer or legally constituted group is the policyholder and the insurance company contracts with the employer or legally constituted group. Insurance certificates, issued to a participating member, acts as your policy.

In addition, group health insurance often contains special coverage's that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.

Coverage under group ends once you cease to be a part of that group, moreover since the insurance contract is between insurer and employer or legally constituted policyholder there is no guarantee that policy would be renewed further.

In some instances Overseas Travel Insurance is required to get a visa to travel to certain countries. Schengen country (many countries of Western Europe constitute the Schengen countries) consulates insist on having Travel Insurance with a minimum of $37,500 coverage. However even if insurance is not required for visa purposes, it is still prudent to purchase health insurance for the following reason:
Health care costs in India are much less when compared to developed countries like the USA, Japan and European countries. In most of these countries medical care is not subsidized by the government, and medical bills can easily exceed thousands of dollars which patients have to pay by themselves. Most people in these countries have some form of Health Insurance; however these insurance policies are not available to visitors. Given this scenario, purchasing Travel Insurance can be viewed as a necessity.

With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. With rise in life expectancy and chronic nature of critical illness there is a requirement of additional funds to afford high medical costs for treating such critical illnesses. Apollo’s policy covers 8 most common critical illnesses were an insured member is compensated by a lumpsum payment.

Existing Policy Holder

How can I add my family members to my existing policy?

At the time of renewing an Individual Policy or Floater Policy you can add dependants to your existing policy subject to necessary procedure and approval from the insurance company.
You cannot add dependants in the middle of a policy except in the case of a new born baby, a newly married spouse and child > 91 days not covered earlier. For product specific conditions kindly refer to the product brochures.

Sum insured can be enhanced only at the time of renewal subject to no claim have been lodged/ paid under the policy. If the insured increases the sum insured one grid up, no fresh medicals shall be required. In cases where the sum insured increase is more than one grid up, the case shall be subject to medicals. In case of increase in the sum insured waiting period will apply afresh in relation to the amount by which the sum insured has been enhanced. However the quantum of increase shall be at the discretion of the company.

You can change contact details in your policy by filling and submitting Policy Change Request form. In case of address change, you need to submit an address proof alongwith the form.

How do I get the correction made in name/details of the proposer or lifeinsured in the policy?

You can get the correction made in Name/Details of the life insured/proposer in your policy by filling and submitting Policy Change Request form. In case of name change, you need to submit a valid Photo ID proof of the insured/proposer alongwith the form.

Kindly contact HDFC Ergo Customer care at Toll Free: 1800-102-0333 or write to customerservice@apollomunichinsurance.com in case you have not received your policy document/health cards.

Claims

What is a ‘cashless’ claim?

In a cashless claim the insured is required to intimate TPA to avail cashless facility. On authorisation by the TPA, the TPA directly settles the claim to the network hospital and insured is not required to pay any charges except non-medical and expenses not covered under the policy. Insured person is entitled for cashless only in our network hospitals.

In a reimbursement claim the insured has to pay upfront for the services of the provider and seek reimbursement from the Insurer for the covered services.

In a pre-authorization process, the insured or the service provider seeks an approval and guarantee of payment from the insurer or it’s TPA for the covered services before the Hospitalization / service for planned treatment and during the course of Hospitalization / service for emergency treatment.

For any emergency Hospitalisation, your designated TPA must be informed no later than 24 hours after hospitalization.

For any planned hospitalization, kindly seek cashless authorization from your designated TPA atleast 48 hours prior to the hospitalization.

TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.

Please pay the non-medical and expenses not covered to the hospital prior to the discharge. In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.

Rejection of cashless in no way indicates rejection of the claim.

You can make claim intimation by informing the insurance company on TPA’s toll-free number or in writing to TPA at any of company’s offices.

Yes, there are quite a few charges, which are not reimbursable and have to be paid by you even though you have been authorized for “Cashless Service” at the Network Hospitals. Some of those charges are enumerated below: • Registration/Admission charges. • Attendant/Visitor pass charges. • Special nursing charges not authorized by the attending doctor. • Service charges not forming a part of the room rent. • Charges for extra bed for attendant etc. • Bed retaining charges. • Charges for TV, Laundry etc. • Telephone/Fax charges. • Food and Beverages for attendants and visitors, toiletries etc. • Purchase of Medicines not related to the treatment. • Stationery, xerox or certifying charges. The above list is only indicative and not exhaustive.

All claims will be payable to policyholder in Indian Rupees within India currency by cheque/DD or through bank transfer.

Your policy allows reimbursement of medical expenses incurred 30 days before and 60 days after discharge(these days may vary from product to product, pls refer you policy document or contact your advisor for more information) from hospitalisation towards pre and post hospitalisation expenses.

The Insured is required to send all invoices in original with supporting documents/prescriptions along with a copy of the discharge summary to the respective TPA. TPA will scrutinize the claim and settle the invoices subject to the overall limit of the policy. The invoices must be sent to TPA within 15 days from the date of completion of treatment.

Pre and post hospitalisation benefit will be enhanced to 60 and 90 days respectively(depending upon the product) if the insurance company is provided with the following at least 5 days before the hospitalisation:

Medical documents with all details about the Illness; and the date and the place of the proposed Hospitalisation.

The insured person or someone claiming on your behalf shall provide HDFC Ergo with any documentation, medical records and information that the insurance company or its TPA may request to establish the circumstances of the claim, its quantum or the company’s liability for the claim within 15 days of the earlier of the company’s request or the insured person’s discharge from hospitalisation or completion of treatment.

Such documentation will include but is not limited to the following:

• Claim form, duly completed and signed for on behalf of the insured person.
• Original bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed which will then become HDFC Ergo’s property.
• All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
• A precise diagnosis of the treatment for which a claim is made.
• A detailed list of the individual medical services and treatments provided and a unit price for each.
• Prescriptions that name the insured person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding doctor’s invoice.

Preferably with the TPA.

General Queries

Are cosmetic treatments or medical attention for cosmetic purposes covered?

Plastic surgery or cosmetic surgery is excluded unless necessary as a part of medically necessary treatment certified by the attending medical practitioner for reconstruction following an accident, cancer or burns.

Health Insurance policies(except overseas travel policies) only covers medical treatment taken within India and payments under these policies shall only be made in Indian Rupees within India.

TPA means the third party administrator that the insurance company appoints from time to time as specified in your schedule. All claims under the policy will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDA.

What are the benefits of your health card?

A health card mentions the contact details and the contact numbers of the TPA along with your policy details. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital.

It’s your choice, but you would have to intimate HDFC Ergo of the same and the concerned insurance company.

You can refer to the list of empanelled hospitals on our website in Download section or the list provided in the guidebook or welcome kit.

Alternatively you can also call HDFC Ergo’s Toll Free Line at 1800-102-0333 or email them at customerservice@apollomunichinsurance.com or call you respective TPA.

No record found