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Home   Health Insurance   FAQs on Health Insurance in India

FAQs on Health Insurance in India

Let us check out below the most frequently asked questions (FAQs) on Health Insurance in India. The following FAQs are excerpts from itrust financial advisers (http://www.itrust.in)

I am young and healthy. Do I really need health insurance?

Yes. You will need insurance. Even if you are young and healthy, you will need insurance coverage against unforeseen events like accidents or an emergency. While your health insurance coverage may not pay for your routine doctor's visits or other small issues, but it provides protection against the large treatment expenses of serious injury or illness. It is best to buy health insurance, to save money when an emergency strikes.

Is Health Insurance the same as Life Insurance ?

No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death. On the other hand, health Insurance protects you against diseases by covering the expenses you might incur.

My employer provides me with health insurance coverage. Is it advisable to take another policy on my own?

It is always necessary to have health insurance on your own as well because of reasons of continuity. If you change your job, you might not necessarily get health insurance from your new employer. The track record that you have built in health insurance at your old employer will not transfer to the new company policy. Covering pre existing diseases might be a problem. In most policies pre-existing diseases are covered only from the 5th year onwards. Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group health insurance policy.

Are Maternity/Pregnancy related expenses come under Health Insurance plans?

No.

Is there any tax benefit that one can avail of while purchasing Health Insurance?

Yes, there is a tax benefit available under Section 80D of the income tax act 1961.

Is a medical checkup necessary before buying a policy?

Yes, for those who are above 40 years.

What are the minimum and maximum policy durations?

Health insurance policies are general insurance policies usually issued for a period of 1 year only and you need to renew your policy.

What is coverage amount ?

Coverage amount is the maximum amount payable in the event of a claim. Also referred as "sum insured" and "sum assured".

My wife and children are residing at Mysore while I am here in Bangalore. Can I cover all of us in one policy?

Yes. You just have check whether there are any network hospital near to your as well as your family's place of residence. If there are no network hospitals at the place of your residence, you could opt for reimbursement mode of settlement.

Are naturopathy and homeopathy treatments covered under a health policy ?

No

Does it cover diagnostic charges like X- ray, MRI or ultrasound ?

Yes, only if it is in the treatment process of the patient and he stays in the hospital for at least one night.

Who is a Third Party Administrator ?

A Third Party Administrator is an Insurance Regulatory and Development Authority (IRDA) approved specialized health care service provider.

What do you mean by Cashless Hospitalization?

Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This facility is available only at the network hospitals of the TPA.

Can I buy more that one Health Insurance policy?

Yes

Are there any waiting periods when my expenses will not be settled, in case of a contingency?

When you get a new policy, there will be a 1 month waiting period starting from the policy start date, during which period any hospitalization charges will not be payable. However, this is not applicable to any emergency hospitalization occurring due to an accident.

What happens to the policy coverage after a claim is filed?

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement.



What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period.

What papers are required for buying a health insurance?

No documents are required for purchasing health insurance. You might need to furnish documents like ID proof at the time of submitting a claim.

Can I avail this policy if I am not an Indian National but living in India? Yes

What are exclusions in a health insurance policy ?

Every health insurance policy has a set of exclusions like coverage not included for AIDS,cosmetic surgery and dental surgery. Cataract & sinusitis are not covered in the first year of the policy but are covered in subsequent years. Conditions arising from diseases existing before the purchase of the policy are not covered.

What are the factors which determine the premium payable for health insurance ?

Age. Usually, younger people pay lower annual premium as they are considered more healthy. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher.

Who will receive the claim amount if the policyholder dies during the time of treatment ?

In cashless mediclaim settlement, it is settled directly with the network hospital. In other cases, the claim amount is paid to the nominee of the policyholder.

Is mediclaim the same as health insurance ?

Yes, it is the same.

What is the difference between Health Insurance & Critical Illness policies or Critical Illness Riders in insurance?

A Health Insurance policy is a reimbursement of the medical expenses. On the other hand, a critical illness insurance is a benefit policy in which the insurance company pays the policyholder a lump sum amount if the policy holder is diagnosed with any critical illness.

What happens when I cancel the policy?

If you cancel the policy, your cover will cease to exist from the date of cancellation of policy. Additionally, your premium should be refunded to you on short period cancellation rates.

Can I seek treatment at home and get health insurance?

Most policies offer the benefit of treatment at home only when the patient's condition is such that he cannot be moved to the hospital or when there is no bed available in any of the hospitals.

What do you mean by coverage amount ? Is there is a minimum or maximum limit ?

Coverage amount is the extent to which the insurance company will reimburse you for the medical expenses incurred by you. The coverage starts at a minimum amount Rs 25,000 and go to a maximum of Rs 5,00,000.


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