Frequently Asked Questions

Health Insurance

• What is a health insurance policy? Is it different from a mediclaim policy?  911 Views

  A health insurance policy is an insurance coverage that covers medical expenses such as - in-patient hospitalisation costs, surgery costs, emergency ambulance cost, hospital per day allowance, medicines bill etc. of life insured; if he/she becomes sick or gets injured in any accident.

  A mediclaim policy, in general, very much similar to a health insurance policy; but it’s ambit of coverage is not as comprehensive as a health insurance policy has. A mediclaim policy pays-out medical expenses towards accident and pre-specified illness, and for specific sum insured; whereas, a health insurance policy covers maximum diseases including critical illness, and accidents as well. A health insurance policy gives you flexibility to review your sum insured and policy term after a specific period; but in mediclaim policy, you can’t.

• What does a health insurance cover?  619 Views

  A health insurance policy covers expenses that incurred due to the medical treatment/surgery. In order to get the benefits of the health plan, the policyholder has to go for at least 24 hours of continuous hospitalization. There are some day-care procedures that are also covered under a health plan, but you also need to get hospitalized to avail benefits.

   

  Read your policy document to ascertain what is included and excluded under your policy.

• Do I need to buy a health insurance policy even if I’m young and healthy?  407 Views

  Yes, it’s always advisable to buy a health insurance policy of adequate sum insured when you are young and in good health. Here are the two points why to buy a Health Plan.
   

  First and most important reason is- ‘peace of mind’. Having a health insurance policy, you won’t have to worry about the doctor’s fee and other medical expenses. Also, the possibility of any mishap or accident cannot be ruled out; it can happen to anybody, anywhere.

   

  By buying a health plan in the young age, you can save on premiums. The possibility of becoming sick in younger age is lesser; you, therefore, can get a health insurance policy of adequate sum insured at best premium rate in your early age.

• Is there any eligibility criterion for having health insurance policy?  337 Views

  Anyone between the age group of 3-month (for the health floater plan) to 65-years can take a health insurance policy. However, the insurer may ask you to go through a medical check-up to ascertain your health condition before issuing the policy.Basis the underwriting guidelines which include age, health condition, family history, etc. the insurer will determine to give you a health plan or not.

• What is cashless health insurance policy?  363 Views

  A cashless health policy provides facility to get treatment at network hospitals (may vary from insurer to insurer) without making any payment. To avail this facility, the policyholder only needs to take approval from the insurance company/assigned TPA in advance in case of planned surgeries, and within the stipulated time in case of emergencies. Policyholders, in order to avail cashless treatment at network hospitals, need to produce health cards provided by insurers, with valid identity proofs to hospitals/TPAs.

• What are TPAs?  470 Views

  TPAs or third-party administrators are intermediaries between insurance companies, policyholders and hospitals. A TPA helps policyholder settle his/her claim hassle-free by establishing communication between the policyholder, the treating hospital and the insurer.   

• What are network hospitals?  298 Views

  Network hospitals are hospitals/health units that have tied-up with TPAs or directly with the health insurance companies. With hospitalization in one of the network hospitals of the insurer, the policyholder can avail cashless hospitalization depending on the terms of the policy.

• What if there is no network hospital in my vicinity?  260 Views

  If there is no network hospital in your vicinity, don’t worry, get treatments at the hospital of your choice and pay all the medical bills at the time of discharge. And your insurer, later on will reimburse the medical expenses incurred after making claim under the policy.

• I already have a health insurance policy provided by my employer; do I still need to buy a separate one?  269 Views

  It’s good that you are covered under a group health insurance policy provided by your employer. But generally, insurance covers provided by employers are of a lesser sum insured, which seems to be insufficient in case of any medical emergency. Most group insurance policies have co-payment and high deductibles in-build, due to which you may require to pay from your own pocket.
   

  Another reason, why you should have a separate policy is, you cannot be working with the same company for whole life, and as soon as you leave the job, your previous employer may take back health benefits, and you might not get such benefits from your current employer. As a result of this, you’ll have to buy a fresh policy in which you’ll lose pre-existing benefits that you have accrued over the period.
   

  By buying a separate health policy, you can choose cover amount and other benefits as per your medical requirement.

• What are points-to-ponder while buying a health insurance policy?  235 Views

  Cost has always been a critical element in the entire decision making process for most of the Indians for any purchase. However, while buying insurance products, you must assure if the sum insured is sufficient.
   

  There are some other salient elements that should be taken into account while buying a health insurance policy.
   

  (a) Adequate cover
   

  (b) List of Network hospitals

   

  (c) Cashless facility 

   

  (d) Deductibles 

   

  (e) Waiting period for specific illnesses/condition

   

  (f) Room-rent capping

   

  (g) Exclusions

   

  (h) Insurer’s claim settlement ratio.

• Is premium paid for health insurance policy tax exempted?  247 Views

  Yes, premiums paid under any health insurance policies are entitled for income tax exemption under section 80D of the Income Tax Act

• What are the major factors on which health insurance premium is determined?  212 Views

   Premium for a health insurance policy is calculated taking several factors on account, such as – sum insured, age, coverage provided, risk pool of your profession, estimated overall health expenditure and on your living style. It’s also determined on whether you are a tobacco user or not. Previous medical history is another factor that determines your premium. If you are in good health, your health insurance premium will automatically be lower.

• Is there any waiting period to make claims under a health insurance policy?  230 Views

  Yes, normally there is a waiting period of 30 days from the date of inception of the policy; during which, the insurer will not be bound to pay you any hospitalization bill. However, in case of an emergency occurring due to an accident, there is no such restriction, and the insurance company will pay your medical expenses.

• What are pre-existing conditions? Is here any waiting period for these conditions to make claims?   186 Views

  A pre-existing condition is a disease/illness that existed before you buy a health insurance policy. Insurance companies do not cover pre-existing conditions that had symptoms or treated within 48 months of buying the first health policy. The pre-existing conditions are liable to be covered after a regular health cover of 48 months.

• Is online purchase of policy cheaper than that of the traditional mode?   213 Views

  Yes, purchasing a policy online is cheaper than buying it offline or through an agent. By buying it online, there is no agent or broker commission to be paid by the insurance company. Also cost related to policy issuance is also low in case of online buying. So,the insurer lower down the premium amount to be charged and you can get the higher cover at lower premiums.

• What is NCB (No Claim Bonus)?   285 Views

  ‘No Claim Bonus’ is a discount offered by the insurer on the policy renewal to encourage policyholders stay healthy, and avoid claims. If the policyholder does not make any claim in the preceding policy year, the insurer offers the NCB benefit.

   

  The policyholder also has the option to accumulate the NCB for a couple of years and this simply leads to lowering of premium amount of the health policy. Some insurers also offer this bonus in the form of increment of the basic sum insured. For every claim free years, insurers increase the basic sum insured at pre-defined percentage.

• Can a health insurance policy from one insurer be transferred to other insurer?  230 Views

  Yes, as per recent guidelines of the insurance regulator IRDAI, you can port your existing health policy to the insurer of your choice. Now you can switch your health insurer without losing the benefits of your existing policy. The premium and policy benefits may differ depending on the plan you choose from the new insurer.

• What is the maximum number of claims I can make in a policy year?  279 Views

  You can make any number of claims in a policy year. However, the sum insured is the maximum limit you can claim for in a policy year. If the sum insured is exhausted, you can’t make more claim in the same policy year. But some health insurance companies have come up with top-up and super top-up health cover that covers your additional medical expenses incurred over and above the limit of the sum assured.

• Should I include my parents in my health insurance policy?  176 Views

  It’s not a wise decision to include parents in your health insurance policy. Since premium is calculated on the basis of the age of the senior most members included in the policy, the premium will automatically go up compared to the premiums charged for two separate policies. Today, there are numerous health insurance policies for senior citizen; it’s advisable to buy one separate policy out of them for your parents.

• Can I return my health insurance policy once bought?  215 Views

  Yes, you can return your health insurance policies within 15 days of receiving policy documents (called free-look period), mentioning the reason for your objection, if you disagree to any of the terms & conditions. As per IRDA’s guidelines, this feature is in policies for term of at least 3 years. However, insures can provide this facility even to the policies for lesser term.

   

  The refund premium will be adjusted for – expenses incurred in medical examination and stamp duty. In cases free-look period claims, claim amount will be deducted from the premium paid.

• How can I make claims under health insurance policy?  185 Views

  In case of cashless hospitalization, you need to show the health card to the network hospital and also need to get approval from your insurer/its assigned TPA. If you are admitted in a non-network hospital of the insurer, you firstly need to pay all the medical bills on your own and then claim the reimbursement for the expenses incurred.