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Buying Health Insurance? Get All Your Health Insurance Questions Answered!

Published On Apr 15, 2019, Updated On Oct 20, 2020

It is health that is the real wealth!

Isn’t it true?

Not many value health when they have time and end up repenting their ignorance when face-to-face with medical issues. If you are one among those who mostly put their health in the back seat, realize the importance of health before it gets too late.

While taking care of oneself is the best way to avoid health problems, opting for health insurance is the perfect solution to ensure financial stability, in case of a medical emergency.

In today’s time, the rising cost of medical care has become a cause of concern for every individual. It’s not that easy to go for the best possible treatment without spending a significant amount. However, investing in health insurance is the only way to escape financial instability and stress.

If like hundreds and thousands of people, you too have been thinking of buying health insurance, make sure you go through the frequently asked health insurance questions and answers that all look for while buying health insurance.

The list comprises:

Q. What is cashless claim settlement?
A. The cashless claim facility allows the policyholder to avail treatment at the network hospital without having to worry about the expenses. The bill in cashless case is directly settled between the insurer and the hospital. However, the policyholder has only to pay for expenses that aren’t a part of or covered under the cashless facility. Lastly, the policyholder can avail this facility at any of the insurer’s network hospital that provides cashless claim settlement.

Q. What are the network hospitals in the insurer’s network?
A. For availing cashless settlement of their claim, it is important for the patient to be admitted in a network hospital. Take note that every insurer has a list of network hospitals that provide the cashless facility. Also, that it is important for every policyholder to know whether or not the hospital in the company’s network is the preferred one and/or location area is suitable.

Q. Does the health insurance policy cover you across India?
A. You never know where a medical emergency will occur. Therefore, it is best to be aware of the geographical limitations of the claim settlement in the policy beforehand. Usually health insurance policies offer coverage across India, however, it is best to clarify the same before buying health insurance. Note that there are also certain medical insurance plans that offer international coverage as well.

Q. Are pre-existing diseases covered under the health insurance policy?
A. Coverage for pre-existing diseases is something that varies from policy to policy. Usually, a policy providing cover for a pre-existing condition will come with a certain waiting period applicable on the coverage. Make sure you find out the waiting period for your pre-existing diseases and how soon can you be covered. Lastly, having a clear understanding of whether your pre-existing condition is temporarily not covered or is it completely excluded from the scope of coverage is a must before buying the policy.

Q. In case, the need for an emergency hospitalization arises, who should you call?
A. Medical emergencies demand quick attention, therefore it is recommended that you focus on taking the patient to the closest network hospital for hospitalization in the first place. Once admitted, the family members of the patient must contact the insurer or the TPA (Third Party Administrators) to inform about the hospitalization and receive the best possible guidance related to the claim settlement process.

Q. How to make a claim for treatment availed at a non-network hospital?
A. There are emergency situations in which there is no option but to get the insured hospitalized at a non-network hospital. When the same happens, one can file for a reimbursement claim once the treatment is complete. In a case like such, the insured can get treated, pay for the treatment availed, and file for a reimbursement claim thereafter. This claim will provide coverage for all expenses which are covered under the policy overage, except for the ones which are not.

Q. What are the documents required for filing health insurance claims?
A. Submission of documents at the time of filing a claim on the health insurance policy is a must. Generally, a health insurance company asks the policyholders to provide the ID proof of the insured individual, in addition to the health card issued by the insurer as well as the receipts or bills for the treatment availed. In case of cashless hospitalization, the insured is asked to also submit a pre-authorization form to the TPA. Those willing to avail reimbursement facility are required to provide relevant bills along with other documents for the claimed amount to the TPA.

Q. What process do the insurance companies follow for the health insurance claims?
A. Generally, insurance companies appoint a TPA for the claims process.

Once the health insurance policy is sold, the insurer passes on the control to the TPA.

In the cleaning process, the insured individual is required to contact the TPA for verification and formalities. In case of a cashless treatment at only authorized network hospitals, the TPA is required to be notified in advance (for planned hospitalization) or within the stipulated time limit (for emergencies). The claim amount has to be approved by the TPA so that the hospital settles the amount with the TPA/insurer.

Note that the process also involves exclusions, the amount for which is settled directly at the hospital. Talking about the reimbursement facility, it can be availed at both the network and non-network hospitals. The insured avails the medical treatment and settles the hospital bills directly at the hospital. The insured can claim reimbursement for hospitalization by providing relevant bills/documents to the TPA.

There are ‘n’ number of things that come to one’s mind while buying health insurance. Lack of knowledge or using wrong information to go ahead with the health insurance purchase and claim process can lead one to ultimate regret.

If you don’t want to end up being in an unfortunate situation, make sure you go through every health insurance FAQ that you are always ready to deal with whatever comes your way.

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