health insurance faqs in India

Frequently Asked Questions on Health Insurance (FAQs)

Health Insurance

Last Updated on 28/06/2020 by Deepak Singla

Q. What is a Health Insurance?

Ans. Health insurance refers to a special kind of insurance which can be used to cover medical expenses. It is basically an agreement between the insurance company and an individual or a group of individuals where the insurance company signs an agreement to provide medical insurance to the individual to cover the medical charges in case of emergency or otherwise against a certain premium what the individual or group of individual pays for a year.

Q. Is Health Insurance and Mediclaim the same thing?

Ans. Yes, Health Insurance/ Medical Insurance and Mediclaim are synonymous. It stands for the coverage an insurance company pays against a certain individual or group of individuals for any medical emergency or surgical cost.

Q. When and why do I need a Health Insurance?

Ans. The requirement for a health insurance is same as any insurance except for its urgency. The costs of surgeries and medical aspects are quite high these days and it might not be possible to incur the immediate expenses by individuals at all times hence having a medical coverage for you and your family might be a good decisions in case some emergency situation arises.

Q. What are the kinds of Health Insurances?

Ans. There are 5 basic types of Health Insurances. They are:

  • Individual Health Insurance Plan
  • Family Insurance (Family Floater Plan)
  • Senior Citizen Health Insurance
  • Critical Illness Health Insurance Plan
  • Accidental Insurance

Q. When should I get a Health Insurance? At what age?

Ans. Given the current lifestyle of most people as well as the onset of disease, it is advisable to get a health insurance as early as possible. There is not particular age to get a Health Insurance as such. However there are certain special health plans available for senior citizens and illness due to old age provided from various health insurance companies at present.

Q. How much would a Health Insurance cost me?

Ans. Now there are a number of decisive factors as to how much a Health Insurance might cost you. Some of the most important factors include:

  • The company you choose for the Health Insurance and their claim policies
  • The number of people covered in the particular Health Insurance plan.
  • Health condition of the individual or the group of individuals to be covered
  • Age of the individual or individuals insured
  • Location of the insurance to be covered. For example in case of high risk metro cities it is more compared to small villages and towns with lesser populations
  • Additional riders/ covered individuals. If you want to add any members to the Health Insurance plan over and above the ones already covered then the cost might go up as per the coverage.

Q. Do I get a tax benefit for the Health Insurance?

Ans. Yes, Mediclaim and Health Insurance are eligible for tax benefits on the premium paid as per section 80D of Income Tax Act.

Q. Is the insurance going to remain constant for a lifetime?

Ans. Generally, when a person decides to sign up for a Health Insurance company they decide on a particular amount of premium every year. Until and unless the individual decides to increase the claim amount or add on riders to the individual or group insurance plan the premium remains more or less constant. However if there is a claim or claims in any particular year, the premium for that particular year might get hiked for the renewal of the policy.

Q. Does Health Insurance cover homeopathic treatments?

Ans. Generally Health Insurances cover only allopathic treatments. However it is advisable to read the policy before signing it.

Q. What is meant by TPA?

Ans. TPA stands for Third party Administrator. They are generally different from the insurance and are responsible for processing and claiming your medical insurances for you and providing Cashless services.

Q. What is meant by a Cashless facility?

Ans. the insurance companies have tie-ups with different hospitals and facilities all over the country. In the cashless facility the Insurance holder can visit any cashless facility and get treatments done without having to pay the hospital bills. The hospital bills are completely taken care of by the TPAs directly in behalf of the insurers. However in case the hospital charges goes beyond the stipulated limits or sub-limits provided, the individual needs to pay it directly to the hospital.

Q. How would I know which hospital is cashless under my policy?

Ans. In the beginning of the year or while signing the policy the insurance company with provide you will a clear list of hospitals and facilities which are covered under cashless by them. You can keep a note of that and if convenient enough could get your treatments done at that particular facility to get the cashless benefit.

Q. How long do I have to wait to be able to make a claim from my Health Insurance?

Ans. Generally most health Insurance plans what a waiting period of 30 days from signing the policy. In case of any hospitalization during this period the Insurance companies does not have to pay anything. However this waiting period is not applicable in case of emergency hospitalization and accident claims.

Q. Does health insurance companies in india cover any pre-existing medical conditions?

Ans. No, pre-existing medical conditions are not covered under the medical insurance until and unless it has completed 48 months after a continuous insurance cover.

Q. Can an Insurance policy be transferred from one company to another without losing the renewal benefits?

Ans Yes, an insurance policy can be transferred from one company to another without losing any benefits as per the IRDA (Insurance Regulatory and Development Authority).

Q. I forgot to renew my policy before the expiry date. Will I be denied renewal now?

Ans. There is a grace period of 15 days after the expiry date, if you pay the premium within that period you are good to go. However until the premium is paid, you will not be allowed to make any claims from the insurance company. Furthermore if you fail to pay the premium within the grace period, the Insurance policy will lapse and you will have to open a new policy over again.

Q. What is the maximum number of claims allowed in a year?

Ans. There is no limit to the number of Insurance claims that one can make in a year, unless there is a cap provided by the company on it. You can make the maximum claim of the sum assured to you.

Q. what happens to the policy coverage once a claim is made?

Ans. If you make an insurance claim, the coverage will get reduced by the amount that is paid by the insurance company for that year. Only the sum assured for that year gets reduced, you can still claim the maximum amount from the sum assured throughout the year.

Q. What is Family Floater Policy?

Ans. A Family Floater Policy refers to the policy which covers the illness and disease of a whole family instead of individuals. This is often better and beneficial than individual Insurance policies. There are facilities of adding riders to these kinds of policies as well. Any kinds of sudden illness, accidents and surgeries can be claimed under this policy.

Q.What all does a health insurance cover?

Ans. An insurance company is eligible to pay for:
Pre-hospitalization charges: refer to any medical expenditure which are incurred right before hospitalization and which lead to hospitalization.
In-patient treatment – any kinds of expenses, surgeries, medications, laboratory tests happening within the hospital to the patient during his/her stay or any other related expenses.
Post-hospitalization charges – the expenses incurred right after the discharge from the hospital is claimed under the policy of medical insurance.
Day care treatment – in case a patient is admitted to the hospital on a particular day and he/she is discharged after treatment within 24 hours, the patient or patient party is eligible to make claims from the insurance company for that as well
Domiciliary Hospitalization – If the patient is under critical condition and treatment needs to be provided at home, medical insurance can be claimed.

Q. What are exempted from Medical Insurance policies?

Ans. The medical insurance companies are not responsible for covering the following expenses:

  • Congenital medical diseases and conditions
  • Any pre-existing disease before signing the insurance policy
  • Medical conditions and costs due to any self-inflicted injuries or suicidal attempts
  • Accidents caused due to drunken driving
  • Cosmetic surgeries and dental treatments
  • Costs of spectacles and contact lenses
  • Treatment of HIV/AIDS
  • Along with few other exemptions

Q. Does the health insurance cover X-Ray, MRI and similar tests?

Ans. only if the tests are a part of pre-hospitalization, post-hospitalization or during hospitalization the individual can claim the charges from the insurance companies after providing the necessary proofs. Otherwise the insurance policies are not liable to cover such charges.

Q. How do I make my insurance claim?

Ans. In case of a planned hospitalization you need to submit a letter to the TPA along with the doctor’s recommendation for the hospitalization and other necessary documents. In case of unplanned and emergency hospitalization you should inform the TPA within 24 hours of hospitalization to be able to make the claim in time.

Q. What documents are required for claiming a Health insurance?

Ans. Essentially you would be asked for the identity proof of the person or persons covered in this policy, along with the health card, the hospital bills at the time of claiming. In case of cashless claims, pre-authorization forms are needed from the TPA. The policy documents should also be kept handy in case they are asked as a proof by the health insurance authorities of TPAs.

Q. Can a claim be denied or refuse?

Ans. Yes, under certain circumstances which are not covered under the policy a claim might get rejected. If you are dissatisfied with the rejection you can represent to the insurance company within a period of 15 days, after which any representation will become null and void.

Q. Can the whole insurance amount be claimed?

Ans. Yes, the whole insurance amount can be claimed, provided the conditions for the claims are covered under the policy and the claim is supported by proper documentations and proofs.

Q. Will my Health Insurance policy cover me overseas?

Ans. A domestic policy generally do not cover overseas conditions, however you need to discuss it with your insurer and have a closer look at the policy you have signed up for, to get clarity on this.

Q. What happens if I cancel my policy?

Ans. if you cancel your policy you are no longer eligible for the claims from the date of cancellation. Furthermore you premium will be refunded after deduction of a short period cancellation charge.

Q. How to buy the policy?

Ans. these days there are many different ways of buying the policies, you can buy them online as well by making the premium payments online as well.

Q. What is health check facility?

Ans. Some insurance policies also cover certain expenses of health check-ups in general once in a few years. Mostly it is once in four years. To know more about it, discuss it with your Health insurer and take a call.

Q. What is meant by ‘any one illness’?

Ans. ‘Any one illness’ means a continuous period of illness which may include certain relapses within certain period of time in the policies; generally it is 45 days.

Q. How long does it take to get the insurance after the claim has been made?

Ans. Generally it does not take even a day. The claims come along within 24hours to a few days depending on the proofs and documentations you provide and how timely you can submit them to the TPA as per your requirement. You can always ask the TPA the reason for the delay in the claim in case of any. Most of the time the claims are made in no time.

Q. Where to get Health Insurances from?

Ans. There are a number of companies which provide health insurances along with other benefits. These companies can be found online. So you can either get a Health Insurance done by applying online or you can do it manually by visiting the insurer’s office. Either way the benefits provided are same for each company.

Q. What are the things to keep in mind while choosing a Health Insurance?

Ans. The things to keep in mind while choosing a health insurance include:

  • The number of members to be covered
  • The type of plan
  • The coverage amount to be applied for and the sum insured.
  • List of hospitals under the network of cashless payments

Q. Can I have multiple Health Insurances?

Ans. Yes, you can have multiple health insurance policies from multiple insurers in your name. It is rather advisable to have multiple health insurances so that you can claim the maximum expenses when necessary,

Q. What should I do to increase the sum insured of the policy I already have?

Ans. In order to increase the sum insured you need to increase it with proper notification to the authorities at the time of renewal of the policy.

Q. Do I get a cashless card if I buy the insurance policy online?
Ans. Yes.

Q. Can the policy be cancelled after it is bought?

Ans. Yes the policy can be cancelled after it is bought. There is a free look period of 15 days within which if you find some objectionable clause in the policy you can always ask to cancel it.

Q. Will I get a refund of the premium if I cancel my policy?

Ans. Refund can only be received if you have no claims over the policy period.

Q. What is meant by first year and second year exclusions?

Ans. First year and second year exclusion refers to the list of diseases and ailments which have a waiting period and which are not covered under the first two years of the policy.

Q. Is there any discount on renewal of policies?

Ans. yes, if you renew your policy with the same company sometimes some companies have certain loyalty benefits for the customer which you can avail.

Q. If I am admitted only for 24 hours in a hospital will the insurance company cover the charges on my behalf?

Ans. Yes, even if you are admitted to the hospital for 24 hours you can claim your insurance coverage. However OPD (out-patient department is not covered under insurance claim.

Q. What will happen if the policy lapses while I’m hospitalized?

Ans. If prior intimation has been given to the company, in most cases the company pays for the charges as per the norms and terms and conditions are applied.

Q. What happens if in a family floater plan the primary insured person expires?

Ans. The insurance company is liable to reimburse all health expenses of the person who has died post hospitalization.

Q. Is maternity covered under insurance policies?

Ans. No, health insurances cover only unforeseen medical expenses. However some insurers provide some added benefits for maternity at a comparatively high premium and a waiting period.

Q. What is the importance of health insurance?

Ans. As the hospital charges and other medical expenses are very high these days it is advisable for everyone to have health insurances for themselves and their families. This would protect them from any health related emergency expenses and unexpected medical costs.

Q. Who should I ask about the cashless facilities covered under my policy?

Ans. You would generally be notified by your insurer while signing the policy or at the beginning of the year as to which facilities are covered under the cashless scheme of their company. They would generally provide you a list for the same. These cashless facilities are distributed all over the country.

Q. Will my insurance plan in India provide coverage for me abroad?

Ans. No, domestic insurance plans will not cover medical charges abroad. However it is best to discuss it with your insurer before signing the policy to be double sure.

Q. Till what age can I buy an insurance policy?

Ans. There is no particular age or the right time to buy insurance policies. The sooner the better it is though.

Q. How long does it take to get an insurance policy?

Ans. The insurance policies are generally quick and do not take much time. However there is a cooling period of 15 days for many policies to be able to make the first claim.

Q. Will the policy cover for the pre-existing condition when I am hospitalized?

Ans. If you are hospitalized as a result of the pre-existing condition then the policy would cover for you. But if otherwise there is a particular waiting period of 45days for the same.

Q. How long can a policy continue?

Ans. The policy can be continued as long as you keep paying the premium on a yearly basis. There is no particular lapse time for a policy if everything else goes fine.

Image Courtesy: Symbo Insurance