Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. It is intended to protect an individual from financial ruin in the event of unexpected medical emergencies. Health insurance plans typically fall into one of two categories: government-sponsored or employer-sponsored, or those that are individually purchased.
Most countries have their own national health insurance systems, and in some countries, like the United States, health insurance is also available through private companies. The benefits and coverage can vary widely between plans and it is important to understand the details of a plan before purchasing.
Health Insurance in India
Health Insurance is an insurance policy that ensures that you get cashless treatment or expense reimbursement, in case you fall ill. A health insurance policy reimburses the insured for medical and surgical expenses arising from an illness or injury that leads to hospitalization.
Health insurance in India is primarily offered by both public sector and private sector insurers. The public sector insurers include the Employees’ State Insurance Corporation (ESIC) and the Central Government Health Scheme (CGHS). These are typically available to government employees and their families.
Private sector health insurance in India is offered by various insurance companies and can be purchased by individuals, families, and groups. The Insurance Regulatory and Development Authority of India (IRDAI) regulates the health insurance industry in India.
India has a mixture of public and private healthcare, with government-run hospitals and clinics providing healthcare to the majority of the population, and private healthcare facilities catering to those who can afford it.
The Government of India also runs a number of health insurance schemes for specific sections of the population, such as the Rashtriya Swasthya Bima Yojana (RSBY) which provides health insurance to below-poverty line (BPL) families, and the Pradhan Mantri Jan Arogya Yojana (PMJAY), which is a government-funded health insurance scheme that aims to provide health coverage to around 100 million vulnerable families. These schemes are intended to provide access to healthcare for those who might not otherwise be able to afford it.
The insurance company provides the insured with the facility of cashless hospitalization at a network hospital or provides reimbursement for the incurred expenses. Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.
Importance Of Health Insurance Today
Health insurance is more important now than ever before. The high cost of healthcare can cause financial ruin for those who do not have insurance, as the cost of medical treatments and procedures can be very expensive.
Having health insurance can provide peace of mind and protect against unexpected medical expenses. It can also give individuals access to preventative care and early treatment, which can help prevent illnesses from becoming more serious and more expensive to treat.
In addition, with the ongoing COVID-19 pandemic, the importance of having health insurance has been highlighted as many people have been faced with unexpected medical expenses and the need for medical treatment. Many have found out the hard way that unexpected medical expenses can quickly become overwhelming and can cause financial ruin.
Furthermore, with the advancement in Medical Science, the treatment of many diseases are quite costly and in some cases, health insurance is mandatory to afford the treatment. It helps to pay for treatments and procedures that are not covered by government-funded healthcare, or that may not be covered by basic insurance plans, such as certain cancer treatments or organ transplants.
Overall, health insurance is an essential form of protection that can help protect individuals and families from the high cost of healthcare and provide access to important medical treatments and services.
Best Health Insurance Policies in India By Top Health Insurance Companies
There are many health insurance policies available in India, and the best one for you will depend on your specific needs and budget. However, some factors to consider when choosing a health insurance policy include the coverage offered, the network of hospitals the policy is valid at, the premium, and the claims process.
Here are a few of the top health insurance policies in India for individuals and families,
|Incurred Claim Ratio
|Niva Bupa Health Insurance
|4 members of the family (2 adults + 2 children)
|HDFC ERGO Health Insurance
|4 members of the family (2 adults + 2 children)
|Guaranteed Lifelong Renewal
|SBI Health Insurance
|4 members of the family (2 adults + 2 children)
|1 to 4 years
|Bajaj Allianz Health Insurance
|6 members of the family (2 adults + 4 children)
|Reliance Health Insurance
|6 members of the family (2 adults + 4 children)
|National Health Insurance
|6 members of the family (2 adults + 4 children)
Note: Figures shown in the table above belong to the Financial Year 2020-21.
Types of Health Insurance Policies in India
There are several types of health insurance policies available in India, each with its own set of features and coverage options. Some of the most common types of health insurance policies in India include:
- Individual Health Insurance: These policies provide coverage for a single individual and are typically the most basic type of health insurance policy. They typically cover hospitalization expenses, pre and post-hospitalization expenses, and daycare procedures.
- Family Floater Health Insurance: These policies provide coverage for an entire family under a single policy. It means the coverage amount is shared among all the members insured under the policy. These policies typically include coverage for hospitalization expenses, pre and post-hospitalization expenses, and daycare procedures.
- Critical Illness Insurance: These policies provide a lump-sum benefit to the policyholder in the event of a critical illness, such as cancer, heart attack, or stroke.
- Senior Citizen Health Insurance: These policies are specially designed for elderly people above 60 years of age. They typically include coverage for hospitalization expenses, pre and post-hospitalization expenses, and daycare procedures.
- Group Health Insurance: These policies provide coverage to a group of individuals, such as employees of a company, members of an association, or residents of a society.
- Health Insurance with Maternity Benefits: These policies are designed to provide coverage for the medical expenses associated with pregnancy, childbirth, and postnatal care.
- Top-up Health Insurance: These policies provide additional coverage on top of the existing health insurance policy, and typically have a high deductible.
It’s important to carefully consider the different types of health insurance policies and compare the coverage and benefits offered by each before making a decision.
Benefits of Having A Health Insurance
There are many benefits to having health insurance, including:
Financial Protection: Health insurance helps protect individuals and families from the high costs of medical treatment and hospitalization. This can help to ease financial strain and prevent the need to rely on savings or loans to pay for medical care.
Access to Medical Care: Having health insurance gives individuals and families access to quality medical care that they may not otherwise be able to afford. This can include regular check-ups, screenings, and treatments that can help to detect and prevent serious health issues.
Tax Benefits: Health insurance premiums are tax-deductible under certain circumstances in India, which can lead to tax savings for the policyholder.
Cashless Hospitalization: With many insurance policies, the policyholders can access the network of hospitals that are affiliated with the insurance company and enjoy the benefits of cashless hospitalization
No Claim Bonus: Some insurance companies offer a No Claim Bonus for continuous renewal of health insurance policy without making any claims, which can increase the coverage amount on the policy.
Peace of mind: Having health insurance can provide peace of mind, knowing that you and your loved ones are protected in case of unexpected medical expenses.
It’s important to have good health insurance coverage in order to provide financial security to you and your family in case of any medical emergency. And also helps in accessing good medical care which otherwise might be difficult due to financial constraints.
What is Covered in a Health Insurance Plan?
The coverage provided by health insurance plans can vary widely, but some common items and services that are typically covered include:
Hospitalization expenses: This includes the cost of a hospital room, meals, nursing care, and other related expenses during a hospital stay.
Medical treatments: This includes the cost of surgeries, prescription drugs, diagnostic tests, and other medical treatments that are deemed medically necessary.
Pre and post-hospitalization expenses: This includes expenses incurred before and after a hospitalization, such as doctor consultations, diagnostic tests, and follow-up treatments.
Daycare procedures: This includes treatments and procedures that do not require a hospital stay of more than 24 hours, such as chemotherapy and dialysis.
Ambulance services: The policy may also cover the cost of ambulance services that are required to transport the patient to the hospital in case of an emergency.
Organ transplants: Many insurance companies cover the cost of organ transplants such as heart, kidney, lung, liver, pancreas, etc.
Maternity and newborn baby cover: Some policies may include coverage for medical expenses related to pregnancy, childbirth, and postnatal care.
Ayurveda, Unani, Siddha, Homeopathy, and other alternative treatment coverage: Many policies now include coverage for these alternative forms of medicine.
It’s important to carefully review the coverage provided by a health insurance plan and make sure that it meets your needs. Some policies may have exclusions or limit coverage for certain conditions or treatments, so it’s important to be aware of these before purchasing a policy.
Exclusions In Health Insurance Policy
Exclusions are certain conditions or treatments that are not covered under a health insurance policy. These can vary depending on the specific policy, but some common exclusions found in health insurance policies include:
Pre-existing conditions: Many health insurance policies have a waiting period for pre-existing conditions, which means that treatments for these conditions will not be covered for a certain period of time after the policy is purchased.
Cosmetic surgery: Most policies do not cover the cost of cosmetic surgery unless it is deemed medically necessary.
Experimental treatments: Treatments that are considered experimental or investigational may not be covered by health insurance policies.
Self-inflicted injuries: Health insurance policies typically do not cover the cost of treatments for injuries that are the result of intentional self-harm or suicide attempts.
Mental health: Some policies may have limited coverage or exclusions for mental health treatments such as psychiatric care, counseling, and therapy.
Addiction treatment: Most policies do not cover the cost of treatment for drug or alcohol addiction.
Dental treatment: Dental treatment costs are not covered in many policies.
Naturopathy and Yoga: Many insurance policies do not cover treatments related to naturopathy and yoga.
It’s important to carefully review the exclusions of a health insurance policy and make sure that you understand which conditions or treatments will not be covered before purchasing a policy. Some policies may have specific exclusions so it’s important to check them before signing up for a plan.
Key Factors to Consider Before Buying a Health Insurance Plan
When purchasing a health insurance plan, there are several key factors to consider in order to find the right policy to meet your needs:
Coverage: Understand the coverage provided by the policy, including what is covered and any exclusions or limits on coverage. Make sure that the policy covers the types of medical treatments and services that are most important to you and your family.
Network of hospitals: It’s important to check which hospitals are included in the network of the insurance company. This can be important in case you need to be hospitalized, as you may have to pay more out of pocket if you go to a non-network hospital.
Premium and deductibles: Compare the premium and deductibles of different policies. A lower premium may mean a higher deductible, which means you will have to pay more out of pocket before the insurance coverage kicks in.
Claims process: Be sure to understand the claims process, including how to file a claim, how long it takes to process, and any required documentation.
Renewability: Check the Renewability option provided by the policy, how long it’s renewable and does it need a medical checkup for renewal.
No claim bonus: Understand if the policy provides any No Claim Bonus for continuous renewal without making any claim.
Add-ons and riders: Consider if you need any add-ons or riders such as critical illness coverage, accidental death coverage, and personal accident cover.
Reputation of Insurance Company: Research the reputation of the insurance companies and their claims settlement ratio.
Customer service: The level of customer service provided by the insurance company can be an important factor to consider, as you want to ensure that you will be able to get the help and support you need if you need to file a claim.
It’s essential to weigh all the above factors when making a decision on a health insurance plan. It’s important to consider your needs, budget, and priority before buying a plan. It’s always recommended to read the policy document in detail and understand the terms and conditions of the plan before purchasing it.
Does Health Insurance Policy Cover Coronavirus (COVID-19) Treatment?
Many health insurance policies in India do provide coverage for the treatment of COVID-19, however, it is important to check the specific details of the policy to confirm this.
It’s highly recommended to check the policy documents and contact the insurance company directly to confirm if the policy covers COVID-19 treatment. Some policies may have specific exclusions for COVID-19 treatment or may have a waiting period before coverage begins, so it’s important to be aware of these before purchasing a policy.
It’s important to note that, the Indian Insurance Regulatory and Development Authority (IRDAI) issued guidelines in April 2020 for insurance companies for providing a standard health policy for COVID-19 treatment in India. As per the guideline insurance companies are required to provide coverage for COVID-19 treatment in their policies, but this may depend on the type of the policy and terms of the contract.
It’s always recommended to check with your insurance company and the policy documents to understand if your policy covers COVID-19 treatment and if there are any exclusions or waiting periods that apply.
Eligibility Criteria to Buy a Health Insurance Plan
The eligibility criteria for purchasing a health insurance plan can vary depending on the specific policy and the insurance company. However, some common criteria include:
- Age: Most health insurance policies have an age limit for purchasing the policy, with some policies being available for individuals as young as 18 and others only available to those who are older. Some policies may have different age limits for different types of coverage, such as higher limits for senior citizen plans.
- Residency: Most health insurance policies require the policyholder to be a resident of India in order to be eligible to purchase a policy.
- Medical history: Many insurance companies may require disclosure of personal and family medical history, some companies may also require a medical examination before issuing a policy.
- Pre-existing conditions: Many policies have a waiting period for pre-existing conditions, which means that treatments for these conditions will not be covered for a certain period of time after the policy is purchased.
- Occupation: Some policies may have certain eligibility criteria for certain occupations like dangerous jobs.
- Policyholder and Dependents: Most policies cover the policyholder and the dependents like spous, children, and parents.
- Group Policies: In group policies, the coverage is extended to a group of people working in the same organization or members of the same association.
It’s important to check the eligibility criteria of a particular policy and the insurance company before purchasing a policy. Keep in mind that certain policies may have different criteria for different types of coverage, so be sure to review the criteria for the specific coverage that you are interested in.
What is health insurance premium & how to calculate it?
A health insurance premium is the amount of money that an individual or a group pays to an insurance company in order to have a health insurance policy. The premium is paid on a regular basis, such as monthly or annually, and is used to cover the cost of medical treatments and hospitalization in the event of an illness or injury.
The calculation of health insurance premiums depends on various factors, such as the coverage amount, the age of the policyholder, the medical history of the policyholder and the dependents, the area of residence, the type of policy, and more.
Here are some factors that may affect the calculation of the health insurance premium:
- Age: Typically, younger policyholders are charged lower premiums as they are considered to be less of a risk for insurance companies.
- Coverage amount: The higher the coverage amount, the higher the premium will be.
- Network of hospitals: Some insurance companies offer a lower premium if the policyholder uses a network of hospitals that are affiliated with the company.
- Medical history: The policyholder’s medical history and the medical history of their dependents may affect the premium.
- Family size and age of dependents: If a policy includes coverage for dependents, their ages and the number of dependents also affect the premium.
- Add-ons and riders: Additional coverage options such as critical illness coverage, accidental death coverage, and personal accident cover may increase the premium.
- Premium frequency: Choosing to pay the premium annually instead of monthly may result in a lower premium.
Insurance companies typically use this information to determine the premium for the policy. Some insurance companies may also use additional information such as occupation, lifestyle, and other factors, to determine the premium.
It’s essential to compare different policies from different insurance companies and check the coverage, exclusions and premium before purchasing a policy. Also, it’s always a good idea to check with your insurance company directly to understand the exact calculations of premiums in your specific case.
Tax Benefits of Health Insurance
In India, health insurance policies are eligible for tax benefits under section 80D of the Income Tax Act, of 1961. These benefits can help reduce your tax liability and potentially increase your refund. The tax benefits can be availed by an individual or HUF(Hindu Undivided Family)
Here are the tax benefits available for health insurance policies:
- Tax deductions on the premium paid for health insurance policies for self, spouse, children, and parents. The maximum deduction under this section is Rs. 25,000 for self, spouse, and children, and an additional Rs. 25,000 for parents if they are senior citizens.
- Additional tax deductions of Rs. 50,000 on the premium paid for health insurance policies for senior citizens (who are 60 years of age or above).
- If an individual pays a premium for their health insurance policy, the premium paid is eligible for tax deductions under section 80D.
It’s important to note that you must submit proof of the premium paid for health insurance, usually the premium receipt/policy, along with your tax return to claim the deduction.
It’s recommended to consult with a tax professional or a financial advisor to fully understand your tax liability, and how you can optimize your tax deductions and benefits.
Some Myths about Health Insurance
Health insurance is an important aspect of financial planning and it’s important to have accurate information about how it works. Here are a few common myths about health insurance that many people believe:
- Health insurance is not necessary: Some people believe that they don’t need health insurance because they are healthy and never get sick. However, unexpected illnesses or accidents can happen to anyone at any time and health insurance can help to protect against the financial impact of these events.
- Health insurance is too expensive: Some people may believe that they cannot afford health insurance. However, there are various options available such as group policies, family floater policies, individual policies with different premium options, government-subsidized schemes etc.
- Health insurance covers only hospitalization: Some people believe that health insurance only covers the cost of hospitalization, but most policies also cover the cost of medical treatments, diagnostic tests, and other medical expenses, including pre and post-hospitalization expenses.
- My employer’s health insurance is enough: Some people may believe that their employer-provided health insurance is enough to cover all their needs, but this is not always the case. Employer-provided health insurance may have limits on coverage or may not cover certain types of treatments, so it’s important to review the policy and consider additional coverage if necessary.
- Health insurance only covers illnesses: Many people believe that health insurance only covers illnesses, however, most policies also cover injuries, including those sustained in accidents.
- I can’t change my policy once I’ve bought it: Some people believe that once they’ve bought a health insurance policy, they can’t change it or switch to another one. However, this is not true. You can switch or change your policy, but you’ll need to carefully review the terms and conditions and may have to pay additional fees.
Why Buy A Health Insurance Plan at An Early Age?
Buying a health insurance plan at an early age can have several advantages, including:
- Lower premiums: Health insurance premiums tend to be lower for younger policyholders as they are considered to be less of a risk for insurance companies. The earlier you buy a policy, the longer you’ll be paying the lower premium rate.
- Coverage for pre-existing conditions: Some health insurance policies have a waiting period for pre-existing conditions, which means that treatments for these conditions will not be covered for a certain period of time after the policy is purchased. If you buy a policy at an early age, it’s more likely that any pre-existing conditions will be covered by the time you need treatment for them.
- Long-term protection: Health insurance provides long-term protection, so if you buy a policy at an early age, you’ll be protected for a longer period of time.
- Peace of mind: Having a health insurance policy can provide peace of mind, knowing that you and your loved ones are protected in case of unexpected medical expenses.
- Tax Benefits: Health insurance premiums are tax-deductible under certain circumstances in India, which can lead to tax savings for the policyholder. The earlier you buy a policy, the longer you’ll be able to claim these deductions
- No Claim Bonus: Some insurance companies offer a No Claim Bonus for continuous renewal of health insurance policy without making any claims, which can increase the coverage amount on the policy.
- Discounts: Some insurance companies may offer discounts for purchasing policies at an early age, making it an even more cost-effective option.
It’s important to keep in mind that healthcare costs are constantly rising, so having a health insurance policy can provide financial protection in the event of an unexpected illness or injury. Buying a policy at an early age is a smart financial decision that can help to ensure that you and your loved ones are protected in the long term.
How to Buy Health Insurance Plan Online?
Buying a health insurance plan online can be a convenient and easy way to purchase coverage, here are some steps to help you with the process:
- Research: Start by researching different health insurance policies and companies to find one that meets your needs and budget. Compare the coverage, exclusions, and premium of different policies before making a decision.
- Get a quote: Many insurance companies allow you to get a quote online by entering your information and answering a few questions about your coverage needs and budget.
- Review the policy documents: Carefully review the policy documents and read the terms and conditions of the policy to ensure that you understand the coverage provided and any exclusions that may apply.
- Fill out the application form: Once you’ve chosen a policy, you can fill out an application form online. Make sure to have your personal information and that of your dependents ready.
- Submit the required documents: You will be required to submit some documents for the verification of identity, age, and residence proof. You may be asked to upload these documents online or send them via email.
- Pay the premium: After the application form and documents have been submitted, you will need to pay the premium in order to activate the policy. Many insurance companies offer online payment options such as credit or debit cards, net banking, UPI, etc.
- Confirmation: Once the application and payment are complete, the insurance company will send you a confirmation of the policy via email or post, along with a digital copy of the policy documents.
Keep in mind that, some insurance companies may have a different process for buying a policy online and the policy documents may have different formatting, so it’s important to follow the instructions provided by the company. And also before finalizing the purchase, it’s important to check the reputation of the insurance company, claims settlement ratio and online reviews of the company.
How To Renew A Health Insurance Policy Online?
The process for renewing a health insurance policy online can vary depending on the insurance company and the specific policy you have, but in general, the following steps are typically involved:
- Visit the website of the insurance company that issued your policy.
- Look for a link or button on the website that says something like “renew policy” or “renew insurance.”
- Log in to your account on the insurance company’s website, if you have one.
- If you don’t have an account, you’ll need to create one by providing some basic personal information, such as your name, address, and policy number.
- Once you’re logged in, you should be able to access your policy details and see the option to renew it.
- Follow the prompts to provide any additional information that may be required, such as updated personal information or proof of identity.
- Review your policy details to ensure that all of the information is correct and that any changes you’ve requested have been applied.
- Pay the premium, the due date and charges can be seen on your policy details. You can pay via Credit Card, Debit Card, Net Banking, or through UPI.
- Once the payment is successful, You will get an updated policy document as an email, hard copy in some cases or through the insurance provider’s mobile application.
It’s important to note that some insurance companies may require you to renew your policy by phone or in person, rather than online. It’s best to check the insurance company’s website or contact them directly if you’re unsure about how to renew your policy.
How To File A Health Insurance Claim?
The process for filing a health insurance claim can vary depending on the insurance company and the specific policy you have, but in general, the following steps are typically involved:
- Gather all of the necessary documents: Before you start the claim process, you’ll need to gather all of the necessary documents, including a copy of your health insurance policy, a copy of your ID proof, original bills and receipts from the hospital, doctors, and other medical professionals involved in your treatment, and any other documents that may be required by your insurance company.
- Fill in the Claim Form: Most insurance companies provide a claim form which should be filled with all the necessary details.
- Submit the form and the necessary documents: Once you have the form filled, attach all the necessary documents and submit the form to the insurance company. This can be done through the insurance company’s website, or you can submit it by post.
- Keep track of your claim status: You will be given a reference number by the insurance company. You can track the status of your claim through the insurance company’s website or by calling their customer service number.
- Get the treatment done: Once the insurance company has approved your claim, you can go ahead and get the treatment done. You will need to make sure that you keep all of the bills and receipts as they will be required for reimbursement.
- Reimbursement: After the treatment, the hospital will send the bill to the insurance company. Once the insurance company has processed the bill, they will reimburse the expenses as per the policy terms.
It’s important to read the policy terms and conditions carefully to understand the process of claim filing, the required documents and the coverage. Also, to avoid any delay in the claims process, it is recommended to follow the above steps as soon as possible after the medical expense is incurred and to keep all the original documents and bills safe and handy.
Documents Required For Health Insurance Claim Reimbursement
The specific documents required for health insurance claim reimbursement can vary depending on the insurance company and the type of claim you’re filing, but in general, the following documents are typically required:
- Claim form: A completed and signed claim form that is usually provided by the insurance company.
- ID Proof: A copy of your identification proof like PAN, Aadhar, Voter ID, Passport, etc.
- Policy documents: A copy of your health insurance policy, including the policy number and the name of the policyholder.
- Discharge summary: A copy of the discharge summary from the hospital that includes the diagnosis, treatment, and the total cost of the treatment.
- Medical bills: Original bills and receipts for all of the medical expenses incurred, including doctor’s fees, hospital charges, laboratory test reports, diagnostic test reports, and other medical expenses.
- Investigation reports: If diagnostic tests or laboratory tests were conducted, the original reports are required.
- Medication bills: Original bills and receipts for all of the medications prescribed during the treatment.
- Any other relevant documents: depending on the nature of the treatment, your insurance company may require additional documents such as ambulance bills, case papers, police reports in case of accidental injuries, etc.
It is important to note that the above is a general guide and you should check with your insurance company for specific requirements, as there might be more documents needed depending on the nature and extent of the treatment.
It is also important to note that Insurance company might ask for original document, it is advisable to keep all the original documents and bill safely, as you may need it again in future.
Frequently Asked Questions
No one wants to invest their hard-earned money somewhere where they remain unsure about the benefits they are liable to get. Before investing, there are a lot of questions that come up in everyone’s mind and to clear the confusions, it’s very necessary to address them and consult them to an expert. Some of the very general questions that are asked by the customers are:
- How does a health insurance policy work?
A health insurance policy works by an individual paying premiums to the insurance company, in return the insurance company promises to pay for the medical expenses incurred during an illness or injury, up to the policy limits.
2. How to choose the best health insurance policy?
When choosing a health insurance policy, consider factors such as the type of coverage you need, the premium amount, the sum assured, the network of hospitals, the claim settlement ratio, and the policy exclusions.
3. What are pre-existing conditions?
Pre-existing conditions are medical conditions or illnesses that existed before the insurance policy was taken. Some health insurance policies may not cover pre-existing conditions for a certain period after the policy is taken.
4. What is the waiting period in health insurance?
A waiting period is a certain period of time that an insurance policyholder must wait before certain benefits under the policy can be claimed. For example, in some policies, there is a waiting period for pre-existing diseases.
5. What is a claim settlement ratio in health insurance?
The claim settlement ratio is the percentage of the claims settled by the insurance company out of the total number of claims received. A higher claim settlement ratio indicates a higher possibility of the insurance company settling claims.
6. What will happen to the policy if the policyholder who had opted for a family plan dies?
If the person was hospitalized and died in the hospital, all the expenses will be covered under the plan and the family will get full reimbursement. If the policyholder was also the eldest in the family and more than two persons are enrolled in the policy, the premium will be set again according to the age of the next person who is the oldest of all.
Also, if the policy only accommodates two people, the plan will get converted into an individual plan.
7. What are the important factors I look at before making the purchase?
The things you must look at before purchasing any health insurance policy are:
- The number of people the policy is willing to provide the insurance for.
- The type of insurance cover, individual, family, or both.
- The total sum insured, an individual should consider a policy good if it’s providing at least 8-10 times of his/her annual earnings as the cover amount.
- Before making the final purchase, the factor that’s a must to look after is if the policy is coming with a cap amount.
- The list of hospitals that are enrolled in the network of the insurance company also plays an important role in judging a policy.
- Always clarify any point in the terms and conditions if it’s creating any confusion. Never make any assumptions.
8. What if I need to increase the total sum insured of an ongoing policy?
Many insurance companies provide the top-up facility where the individual has the option of getting the policy amount risen by filling up a form at the time of renewal. This is the factor that the person should look after at the time of the purchase of the policy will allow him/her in the future to do so.
9. Can I have the option to cancel the policy and get a refund?
The insurance companies provide a time duration of 15-20 days to understand all the clauses and decide if an individual wants to go further with the policy or not. If a person encountered any clause that he/she thinks is not good or suitable, the objection can be made within the specified time and a full refund will be made to you. Ask the company about the allowed cancellation period and then finalize the purchase.
10. Can I have more than one health insurance policy?
Yes, a person can have as many policies as he/she wants. If that person is capable of paying that many premiums, he/she can get as many policies.
11. Is the policy that I enrolled for is valid all over the country?
Nobody knows the time and place when he/she will need a medical requirement. Most of the policies cover this clause and provide coverage anywhere a person gets hospitalized, the only condition is that the hospital must be on the network of the insurance company.
The clause is generally covered by most insurance companies. An individual must make sure that the cover is not limited by any geographical condition. Check if any states/regions are excluded. Some insurance companies also provide the benefit of covering health expenses in some foreign countries as well.
12. What will happen if the policy is exhausted during hospitalization?
In such cases, if you informed about the situation to the insurance company, the company will be liable to pay all the benefits according to the plan you chose and its terms and conditions.
There can be two cases regarding exhaustion, first, the policy got expired, and second, the expenses exceeded the sum insured. In both cases, the insurance company will provide that person with all the benefits of health insurance.
13. Can I add a family member to my existing health insurance policy?
Yes, in most cases, it is possible to add a family member to an existing health insurance policy. You will need to contact your insurance provider and provide the necessary information about the new member to be added.
14. What is a network hospital?
A network hospital refers to the list of hospitals that have contracted with the insurance company to provide medical services to policyholders. Policyholders usually get cashless treatment at network hospitals.
15. What is the role of a Third-Party Administrator (TPA) in health insurance?
A Third-Party Administrator (TPA) is a company that acts as an intermediary between the insurance company and the policyholder. TPAs process claims and manage the reimbursement process on behalf of the insurance company.
16. Can I change my health insurance policy?
Yes, in most cases, it is possible to change your health insurance policy. Depending on the policy, you may be able to make changes to the coverage or the premium. It’s important to check with your insurance provider to understand the process and any fees associated with changing your policy.
17. Can I cancel my health insurance policy?
Yes, you can cancel your health insurance policy, although the process and the refund amount (if any) can vary depending on the insurance provider and the policy. It’s important to check with your insurance provider to understand the process and any fees associated with canceling your policy.
18. What is the role of a Medical Underwriter in health insurance?
A Medical Underwriter is a professional who evaluates an individual’s medical history and risk factors to determine their suitability for a health insurance policy. They assess the risk of an individual’s health conditions and may adjust the policy terms and premium accordingly.
19. Can I buy health insurance if I have pre-existing conditions?
Yes, you can buy health insurance if you have pre-existing conditions, but the coverage for those conditions may be limited or come with exclusions. It’s important to review your policy carefully and understand what’s covered and what’s not.
20. How long does it take to process a health insurance claim?
The claim processing time can vary depending on the insurance company and the complexity of the claim. However, most insurance companies have a defined time frame in which they have to process a claim, usually between 7 to 15 working days.
21. Can I change the hospital during the treatment process?
It depends on the policy terms, some policies do not allow change of hospital during the treatment while other policies do. It is advisable to check with the insurance company before getting treatment from another hospital.
22. Can I file a health insurance claim for the expense incurred for treatment outside India?
Yes, some insurance policies cover the treatment expense incurred outside of India but it will depend on the policy terms and conditions. It is advisable to check with the insurance company before getting the treatment done.