What is Health Insurance?
Medical insurance or health insurance is an agreement whereby an insurance provider agrees to reimburse for medical costs incurred by the policyholder during the tenure of the policy. The insured may incur medical expenses if they get ill or meet an unfortunate accident that leads to treatment at the hospital. The policyholder must pay a specific amount periodically, called a premium, in order to avail of coverage benefits under the policy. The insurance company decides the health insurance premium which must be paid by the policyholders without any fail on a monthly, quarterly, half-yearly or even yearly basis.
Importance of Health Insurance Plans in India
To Protect Your SavingsOne hospitalisation has the potential to drain entire savings of lifetime. But if you get hospitalised with a comprehensive health insurance plan, you can save this hard earned money. There are different health insurance plans in the market to cater to different requirements of individuals. But most commonly, they cover the insured for in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, daycare expenses, health check-up, ambulance expenses, domiciliary expenses, organ donor expenses, and so on
To Deal With Medical InflationAn unforeseen illness can put anyone in stress. And the rising cost of medical treatment in such times only makes the situation worse. And the healthcare expenses are not only limited to hospitalisation expenses, but also include pre-hospitalisation and post-hospitalisation expenses. These include ambulance expenses, expenses related to medicines, diagnostic tests, doctor’s consultation, room rent, etc. All these expenses can be saved by purchasing an affordable health insurance policy timely.
Lifestyle ChangesAnother reason to get health insurance cover is that it helps you fight lifestyle diseases such as cancer, kidney failure, stroke, paralysis, heart diseases, etc. These diseases are most common in people above 45 years of age but due to sedentary lifestyles, stress, pollution, etc. these are now affecting youngsters as well. A comprehensive health insurance plan that covers you for regular medical check-up not only helps you identify the diseases, but also offers financial protection in case of their treatments.
To Secure the Health of Your Family MembersA single health insurance policy can cover your entire family. Many insurance companies offer health insurance plans that allow you to cover oneself, legally wedded spouse, dependent parents, dependent children, dependent parents-in-law, brother, sister, aunt, uncle, brother-in-law, sister-in law, etc. It reduces the hassle of maintaining multiple health insurance plans and keeps you stress free by keeping your entire family protected at all times. Also, purchasing health insurance plans on a family floater basis prove to be more affordable.
Timely and Good Quality Medical TreatmentWith a reliable health insurance plan, one can avail of timely and good quality treatment without draining their entire life savings. To avail the treatment, all the insured has to do is visit the nearest network hospital and avail the required treatment as per the terms and conditions mentioned in the policy document. The insured can avail treatment for up to the sum insured, at these hospitals, without paying anything from his/her own pocket. The facility can be availed in case of planned hospitalisation as well as emergency hospitalisation.
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Health Insurance Renewal
All health insurance plans come with a policy tenure. Your health insurance plan is valid for a specified time period that varies from one insurance provider to another. Renewing your health insurance policy is very important because it helps you get continued coverage and also lets you make necessary changes and add-ons to your health insurance policy. Every insurance provider offers a renewal period under which the policyholder can renew their health insurance policy, in case they are not able to make the renewal, the insurance company offers a grace period which also differs from one insurer to another.
If you do not renew your health insurance policy on time your health insurance policy can lapse and you will not be able to avail health coverage and other benefits such as No Claim Bonus (NCB). Here are some basic steps that you can follow to renew your health insurance policy.
Step 1: Review your health insurance policy: Before renewing your health insurance policy it is essential that you review your existing health insurance policy to assess the type of coverage and other benefits offered under the existing health insurance policy. This way you will be able to make necessary changes at the time of renewal.
Step 2: Visit the insurer’s website to renew your policy: You can easily renew your health insurance policy by visiting the insurance provider’s website. You can use your policy details such as name, registered mobile number/email address, policy number, date of birth etc. to login on the website. After logging in you will be able to review the health insurance policy and make changes or additions to your existing cover.
Step 3: Make renewal payment: Once you have made changes to your existing policy, you can proceed to make the renewal payment. If you have opted for add-on covers it can increase your premium. You can make the payment through your choice of payment method such as credit/debit card, NEFT, net banking, e-wallets, UPI etc.
Why Should You Buy Health Insurance Online?
Convenience in buying as well as a wide variety of health insurance plans online are major reasons why most people prefer buying health insurance plans online. Explained below are some more reasons why you should buy medical insurance online:
Time-Saving - Buying health insurance plans online helps you save time as it does not involve any insurance agent whom you need to explain your requirements too, or ask for suggestions. All you need to do is fill a quote and shortlist the most relevant medical health insurance policy from the ones displayed on your screen.
Easy to Compare Different Health Insurance Plans - With a health insurance premium calculator, it becomes easy to calculate premiums as well as compare different health insurance plans. Also, it is easy to compare policies online as it offers a simplified way to do so instead of doing it on paper.
Right Decision - When buying health insurance plans online, you have complete flexibility to choose the most suitable one for yourself and your family. You have access to all the information like policy quotes, coverage benefits, exclusions, and other terms and conditions. All you have to do is a comparative study of the most suitable plans.
Information Available 24x7 - You can buy a health insurance policy anytime. There is no time limit to buy insurance plans online on portals like InsuranceDekho.
Discounts - Many health insurance companies offer you discounts if you buy their health insurance plans online. This helps you avail of similar or better benefits at comparatively affordable premiums.
Instant Coverage - Online purchase of health insurance plans provides you with instant investment proof, which makes your coverage active from immediate effect. Also, flexible modes of premium payment are available when buying health insurance plans online. You can choose the mode at your convenience and pay the premium via a secured payment gateway.
If you want to ensure a smooth medical health insurance buying process, then you must pick a reputed insurance company that offers you enough information about the health insurance plan purchased.
How to Buy Health Insurance Plan Online?
Getting a health insurance plan which meets all your requirements while meeting your budget is very simple and quick with InsuranceDekho.
- Step 1: Enter Your Personal Details
Enter your personal details like Name, Mobile Number, Email ID, Gender, City, etc to see top health insurance plans matching your specific requirements.
- Compare Health Insurance Plans Online
From all the available health insurance quotes, select the plan which meets your budget and requirements in the best manner.
- Make Payment Online
Pay the plan premium online via secured payment gateway through a payment mode of your choice and receive the policy document at your registered email ID.
Key Features of Health Insurance Plans
Following are the key features of medical health insurance plans. It is recommended to compare these features with similar health insurance plans before shortlisting one online.
Sub-Limits on Room Rent - Some insurance companies come with a feature of sub-limits on room rent. This means that there is a maximum amount that an insurance company shall pay in case of a claim. Generally, this limit is up to 1% of the sum insured and a maximum of 2% in case of ICU expenses. But there are several general insurance companies that offer health insurance plans without any sub-limit on room rent. Hence, it is recommended to go for such plans.
Pre-Existing Diseases - Pre-existing diseases are those which you already have been suffering from before buying a medical insurance policy. This is why health insurance plans come with a waiting period instead of offering cover since day 1. During this waiting period, no claims are admissible. Hence, you should choose a health insurance policy with a minimum waiting period.
Co-Payment - Co-payment is when the insurance company and policyholder share the cost in case a claim arises. A co-payment can be decided in percentage or in amount. So, to take care of your savings, you must choose a health insurance policy that comes without any co-payment.
Network Hospital - Network hospitals are the hospitals that have tie-ups with health insurance companies where the insured can avail treatment without paying anything at the hospital. The benefit of availing cashless treatment comes with this feature. If a policy does not offer this feature, then you will be required to pay the expenses incurred at the hospital, from your own pocket, and the insurance company will reimburse you for the same later.
So, when choosing a health insurance company, make sure you go with the one that has a high number of network hospitals nearby your place of residence.
Benefits of Comparing Medical Insurance Plans Online
Explained below are some benefits of comparing health insurance plans online:
Utmost Ease - It is extremely easy to compare different health insurance plans online. You can compare different plans using InsuranceDekho’s health insurance premium calculator. It is a free tool which makes it easier for you to decide which health insurance policy you must opt for.
Free Quotes - InsuranceDekho’s premium calculator is a free tool that you can use to check quotes and coverage benefits n number of times without having to pay anything.
Convenience - Comparing health insurance plans offline is not as convenient as comparing them online. It would be way too tedious if you have to visit one office to another, get quotes and understand coverage benefits before shortlisting one health insurance policy. Hence, it becomes easier when you compare health insurance plans online.
24*7 Availability - You can compare health insurance plans anytime as per your convenience. Unlike the online process, the offline process has fixed working hours and hence you won’t be able to visit an insurance company’s branch office late at night to compare health insurance plans.
Saves Time - When comparing health insurance plans online, you will not be required to spend so much time filling forms or discussing with agents or executives. All you need to do is fill a quote and several health insurance plans will be displayed on your screen which you can compare easily. This saves you enough time.
Saves Money - Another advantage of comparing health insurance plans online is that it helps you save money as you do not have to visit different offices to compare policies. Also, you get to check even the most low-priced health insurance policies online, which the agents might not recommend you to buy.
Useful Premium Calculator - A health insurance premium not only allows you to calculate premiums of different health insurance plans and customize them as per your budget and requirements but also to compare them. As you change the variables, you will see the premium change. This way, you can choose the most economical health insurance policy for yourself and your loved ones.
Right Coverage - When comparing medical insurance plans offline, you may be restricted to a few of them when it comes to understanding the coverage benefits under them. But when comparing them online, you can search for the desired coverage by comparing as many insurance plans as you want.
Power to Choose - You should have the power to make decisions when it comes to your health. Comparing health insurance plans does this job for you as it eliminates any influence from the agents or insurance executives. This way, it also helps you make an informed choice.
Customer Support - You can compare different medical health insurance plans in a simple manner online. The process is very transparent and you can easily go through the information related to sub-limits, critical illnesses, and sub-limits. If you have any doubts, then you can contact the customer care executives and they will solve your doubts or queries overcall.
Key Factors To Consider Before Buying Health Insurance Plans
In order to make the best buying decision, you must consider the following factors before shortlisting a health insurance policy:
Claim Process - The smoother the claim settlement process of a medical insurance company is, the better it will be for the insured. This is because if the insurance company is not good at handling the claims of the insured, then it fails the entire purpose of having a health insurance policy. Good customer support is an additional benefit that you must look for.
Family Members to be Covered - You must consider the family members for whom you want coverage. Under family floater health insurance plans, you can seek cover for yourself, your legally wedded spouse, children, parents, and grandparents. You must also keep their age, present ailments, and family medical history in mind. Also, you must be aware of any pre-existing conditions that they have and share with the insurance company, before buying the policy. So, choose a health insurance policy that covers all of them at an affordable premium.
Sum Insured - Sum insured should be chosen wisely as it covers you and your loved ones for medical expenses incurred during the entire policy term. You should look at the income as well as your age to decide the sum insured that you should opt for under your medical insurance policy. Make sure to choose a sum insured that is not insufficient as well as the one for which the premium is not too high.
Add-on Benefits - Add-ons are additional benefits that you can include in your health insurance policy, for extensive coverage. You can choose them voluntarily by paying an extra premium at the time of policy purchase.
Network Hospitals - Availing treatment at network hospitals is very convenient as they allow cashless treatment to the insured. This is why you should check the number of network hospitals an insurance company has. It is recommended to choose an insurance company that has a high number of network hospitals. Also, make sure to select the one nearby your place of residence in order to save time in case of an emergency.
Coverage Benefits - One of the most important factors to consider is coverage benefits. Different health insurance plans come with different coverage features which you should choose as per your requirement. Common coverage benefits under health insurance plans include in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, road ambulance expenses, daycare expenses, domiciliary expenses, etc.
Lifetime Renewability Benefit - The chances of getting ill in old age are higher and hence if you buy a new health insurance policy at that time, it would cost you comparatively more. Therefore, you must choose a health insurance policy that comes with a lifetime renewability benefit.
Free Medical Check-Up - Many health insurance plans cover you for free medical check-ups. You must check the same before shortlisting a policy.
Waiting Period - The waiting period is the time at which an insurance company does not cover you. This is why you should choose a health insurance policy that comes with the least waiting period. There are different types of waiting periods such as initial waiting period, waiting period for pre-existing illnesses, waiting period for specified illnesses, etc, which you should be informed about, before shortlisting a health insurance policy.
Premium - It is recommended to choose a health insurance policy that comes at an affordable premium so that you are able to continue with the policy for a long period of time without any financial strain. However, choosing a medical insurance policy with a low premium is not always advisable as it may not get you enough coverage in case of an emergency.
Type of Policy - To identify which type of health insurance policy you want for yourself or your loved ones, you must evaluate your needs thoroughly. After that, you can choose from different types of health insurance plans available in the market such as individual health insurance plans, family floater health insurance plans, senior citizen health insurance plans, critical illness insurance plans, maternity insurance plans, children health insurance plans, disease-specific health insurance plans, etc.
Exclusions - Exclusions are the conditions for which you cannot make a claim, under your health insurance policy. Hence, when choosing a policy, you must opt for the one with the least number of exclusions. Some common exclusions under health insurance plans are treatment required due to self-harm, treatment required due to participation in adventure sports, etc.
Partner Health Insurance Companies
Top Health Insurance Companies in India 2022
|Rank||Health Insurance Company||Health Claim Settlement Ratio FY20|
|1||IFFCO Tokio General Insurance||96.33%|
|2||Care Health Insurance||95.47%|
|3||Magma HDI Health Insurance||95.17%|
|4||The Oriental Insurance Company||93.96%|
|5||New India General Insurance||92.68%|
|6||Bajaj Allianz General Insurance||92.24%|
|7||Niva Bupa Health Insurance||89.46%|
|8||Navi General Insurance||86.98%|
|9||HDFC ERGO General Insurance||86.52%|
|10||Manipal Cigna Health Insurance||85.72%|
|11||Edelweiss General Insurance||85.57%|
|12||National Insurance Company||83.78%|
|13||Future Generali General Insurance||82.96%|
|14||Royal Sundaram General Insurance||81.50%|
|15||Liberty General Insurance||81.03%|
|16||ICICI Lombard General Insurance||78.67%|
|17||Star Health Insurance||78.62%|
|18||United India Insurance Company||78.03%|
|19||Reliance General Insurance||76.43%|
|20||Tata AIG General Insurance||76.04%|
|21||Kotak Mahindra General Insurance||75.45%|
|22||Acko General Insurance||74.09%|
|23||Aditya Birla Health Insurance||70.81%|
|24||Universal Sompo General Insurance||70.75%|
|25||SBI General Insurance||66.08%|
|26||Go Digit General Insurance||63.56%|
|27||Cholamandalam MS General Insurance||56.25%|
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Benefits of Health Insurance
Comprehensive CoverageA health insurance policy keeps you covered for major healthcare expenses incurred in case of medical emergency. Usually, health insurance plans keep you protected for in-patient hospitalisation expenses pre-hospitalisation and post-hospitalisation expenses, ambulance expenses, domiciliary hospitalisation expenses, daycare procedures, organ donor expenses, treatments taken under AYUSH systems of medicines, etc.
Lifetime RenewabilityAs per the guidelines issued by Insurance Regulatory and Development Authority of India (IRDA), the insurance companies offering health insurance plans are supposed to offer lifetime renewability benefits to the policyholders. It allows you to renew your health insurance policy without any upper restriction on the maximum age limit. The feature is most beneficial for parents and senior citizens as they can renew their insurance plans without any pressure of looking for new health insurance plans in old age.
Cashless TreatmentInsurance companies have tie-ups with certain hospitals, known as network hospitals, where the insured can avail cashless treatment. If you avail treatment at these hospitals, the insurance company will directly settle the bills at the hospital, and you will not be required to pay anything for the treatment availed, except for non-medical expenses incurred.
PortabilityHealth insurance portability allows the policyholders to switch from their existing health insurance company to another, in case they are not satisfied with their existing health insurance plan, or find a more suitable plan. Portability feature saves the policyholders from being taken for granted and offers them flexibility to switch in case of dissatisfaction.
Tax Benefits Under Section 80D of the Income Tax Act, 1961The government of India promotes health insurance by offering tax exemptions of up to Rs. 1.5 Lakh on the premium paid for health insurance plans, under Section 80D of the Income Tax Act, 1961. An individual can also claim a deduction of up to Rs. 25,000 for insurance cover for self, spouse, and dependent children. You can also avail a tax deduction of up to Rs. 25,000/Rs. 50,000 for health insurance plans purchased for parents aged 60 years/ more than 60 years.
Health Insurance Portability
Health insurance portability refers to porting your existing health insurance policy from one insurance provider to another. Health insurance portability allows the policyholder to switch their health insurance company without losing the current benefits of their existing health insurance policy. In case the policyholder is not satisfied with the current health insurance policy or they are looking for a better health insurance plan, then they can choose to change their health insurance provider and their health insurance policy within the same insurance provider with all the benefits or credits that they have gained in their current health insurance policy. Below mentioned are some options that a policyholder need to decide while switching their health insurance policy or insurance provider:
- The policyholder can switch from one health insurance company to another.
- The policyholder can switch between health insurance or medical plans with the same health insurance company.
- The policyholder can switch from Individual Health Plan to Family Floater Health plan and vice versa.
- The policyholder can apply for revised Sum Insured with a new insurance company.
- The policyholder can also enhance the existing coverage of a health insurance policy. However, it may require medical examination and can also result in new waiting periods for the enhanced coverages.
Health Insurance Portability Criteria:
Below mentioned is the portability criteria of a health insurance policy:
- The health insurance policy can be switched only at the time of renewal.
- When thinking of porting a health insurance policy, the policyholder should approach the new health insurance company at least 30-45 days prior from the expiry of the existing health insurance plan.
- Provide necessary documents at the time of porting health insurance policy. The documents can be - Previous policy documents, claim experience, age proof, identity proof, proposal form and other documents requested by the new health insurance company.
- Ensure that there are no breaks in between the health insurance renewal process.
Why Choose InsuranceDekho For Health Insurance?
- Get Health Insurance Within 5 MinutesInsuranceDekho offers a quick and simple health insurance buying process. At the portal, you can compare and select the best health insurance policy for yourself and your family at best price, within 5 minutes. All you have to do is enter a few personal details and you can be insured in a transparent and hassle-free way.
- More than 5.5 Lakh Happy CustomersInsuranceDekho aims to instill confidence among its customers by putting them at utmost ease when it comes to buying health insurance online. InsuranceDekho, over the years has provided a delightful experience to more than 5.5 Lakh customers who bought health insurance plans offered by popular insurers, from us.
- Dedicated Customer Support TeamInsuranceDekho has a dedicated team that works 7 days a week to solve all your health insurance related queries and grievances, if any, thereby making the process smooth for you. You can get in touch with us in case of any confusion related to health insurance policy purchase, claim settlement process, health insurance renewal,etc.
Coronavirus Health Insurance
Standard health insurance plans provide coverage for the treatment of coronavirus (COVID-19). However, the treatment of coronavirus involves numerous types of pre-hospitalisation, hospitalisation, post-hospitalisation, and treatment expenses during quarantine. Thus, it is wise to opt for short-term health insurance policies, namely Corona Kavach and Corona Rakash, especially designed to provide coverage only for coronavirus treatment expenses.
Corona Kavach Policy
Corona Rakshak Policy
Corona Kavach Policy is specially designed to provide for medical expenses that may arise due to Coronavirus. Insurance Regulatory and Development Authority of India (IRDAI) has launched this policy making it mandatory for all general and health insurance companies in India. In case the insured is tested positive for COVID-19, the Corona Kavach Policy will cover hospitalisation, pre-hospitalisation, home treatment expenses or AYUSH treatment for Coronavirus. This policy can be purchased individually and for families as well. Corona Kavach Policy covers Covid hospitalisation expenses, Ambulance cover, home treatment expenses, pre and post hospitalisation expenses, AYUSH (non allopathic) treatment and ICU expenses. Corona Kavach Policy provides financial aid to an individual in case he/she is diagnosed with COVID-19. This policy has a waiting period of 15 days. For the initial 15 days after the policy has been purchased no expenses shall be covered that may arise due to Coronavirus.
Below mentioned are some things which are not covered under a Corona Kavach Policy:
Corona Kavach Policy also covers Comorbid conditions which may be triggered due to COVID-19 during the hospitalization for the treatment. However, this policy does not cover any other treatment other than treatment for COVID-19.
Corona Rakshak Policy is a single premium, standard benefit health insurance policy that provides financial protection to an individual in case he/she is diagnosed with COVID-19. 100% of the sum assured shall be provided in lump sum in case the insured is tested positive for COVID-19 and requires hospitalization. This policy was also launched by Insurance Regulatory and Development Authority of India (IRDAI). This policy helps individuals ensure financial aid for themselves and their loved ones to seek treatment without worrying about funds for the treatment of COVID-19. Corona Rakshak Policy provides coverage for hospitalization expenses, ICU cover, ambulance cover, home treatment, AYUSH (non allopathic) treatment and pre/post hospitalization expenses. Pre-medical screening is not required while purchasing Corona Rakshak Policy. This policy also has a waiting period of 15 days under which any expenses for the treatment of COVID-19 shall not be covered.
Below mentioned are some expenses and aspects which are not included in a Corona Rakshak Policy:
One unique feature of this policy is that 100% of the sum assured shall be provided as a lump sum to the insured in case he/she is diagnosed with COVID-19 during the policy tenure.
Does Your Medical Insurance Policy Cover COVID-19 Treatment?
As per the mandate of the Insurance Regulatory and Development Authority of India (IRDAI), all the general insurance companies and health insurance companies offering health insurance plans cover expenses related to COVID-19 treatment, in the existing plans. The regulatory authority issued a circular on March 4 that directed insurance companies offering health insurance plans to include cover for COVID-19, irrespective of which policy the insured is covered for.
If you already have a medical insurance policy, then you must note the following:
• An initial waiting period is applied, which is 30 days in most health insurance plans.
• The claim process for COVID-19 is the same in regular health insurance plans like any other medical condition.
• Cover for pre-hospitalisation and post-hospitalisation expenses is offered as per the terms and conditions of the policy selected.
Apart from COVID-19 cover in existing health insurance plans, the IRDAI had also launched COVID-19 health insurance policies namely Corona Kavach and Corona Rakshak policies. Both are short-term health insurance plans that cover families and individuals, wherein the former is an indemnity-based health insurance policy, and the latter is a benefit-based health insurance policy. Both the plans help you feel financially secure in case of a positive diagnosis of COVID-19.
Arogya Sanjeevani Health Insurance Policy
Arogya Sanjeevani Policy is a standard health insurance product which aims to simplify health insurance for people by providing them with a basic and standard plan. An Arogya Sanjeevani Health InsurancePolicy is offered by all health insurance companies with exactly the same benefits. An Arogya Sanjeevani Health Insurance Plan comes with the following features -
- No medical check-up up to the age of 45 years
- Sum insured between Rs. 1 Lakh to Rs. 5 Lakh
- Policy tenure of 1 year with lifetime renewability benefit
- No claim bonus of up to 50% of the insurance premium
- Waiting period of 30 days for all illnesses except accidents.
What Is The Difference Between Health Insurance And Mediclaim Policy?
In case of medical emergencies, you can avail of medical insurance coverage benefits by either having a health insurance policy or with a mediclaim policy.
What is Mediclaim?
Mediclaim is a health insurance policy that gives you specified financial protection only for expenses arising due to hospitalisation. It covers you for hospitalisation required due to an accident, in case of sudden illness or surgery, or in case of any surgery during the policy term. Mediclaim is of two types, viz., cashless and reimbursement.
What is Health Insurance?
Health insurance is an insurance cover that provides you complete protection for medical and surgical expenses in case of emergencies. With a health insurance policy, you can avail of cashless treatment or get reimbursement for the amount paid to avail of the treatment covered.
To understand the difference between a medical insurance and mediclaim policy, kindly refer to the table below:
Health Insurance Policy
It covers you only for hospitalisation expenses
It offers a comprehensive cover more than the only hospitalisation. For example, AYUSH treatment expenses, in-patient hospitalisation expenses, pre-hospitalisation, and post-hospitalisation expenses, daycare expenses, etc.
It does not offer an add-on cover
You can choose from different add-on covers as per your requirement, such as hospital cash, critical illness, room rent waiver, etc.
It comes with a limited hospitalisation cover of up to Rs. 5 Lakh
It comes with an extensive hospitalisation cover that may exceed Rs. 5 Lakh, which is decided on the basis of several factors such as age, the number of members covered, pre-existing conditions, etc.
It is not flexible
It is flexible and can be customized as per your budget and requirements
When choosing between a health insurance policy or a mediclaim policy, you must consider the following factors:
- Your financial condition
- Your and your family members’ pre-existing conditions if any, age,
- Add-on covers
- Sum insured
- Policy term
- Members to be covered under a health insurance policy
Health Insurance Coverage
- What is Covered?
- What is Not Covered?
In-Patient Hospitalisation ExpensesExpenses incurred due to hospitalisation of 24 hours or more, like nursing and boarding expenses, Nurse’s /Surgeon’s/ Doctor’s/Anaesthetist’s fees, cost of blood, medicines, oxygen, ICU/ICCU expenses, etc.
Pre-Hospitalisation And Post-Hospitalisation ExpensesExpenses arising before and after hospitalisation, for a specific number of days as per the policy terms and conditions. These include expenses related to tests, doctor’s fee, medical reports, etc.
Daycare ProceduresTreatments that do not require hospitalisation of at least 24 hours, are known as daycare treatments. These include cataract, sinusitis, chemotherapy, radiotherapy, etc.
Organ Donor ExpensesExpenses arising due to harvesting the organ from the donor and for the transplant surgery as covered under the policy. The hospitalisation expenses include room rent, doctor’s fee, and other expenses.
Domiciliary Hospitalisation ExpensesTreatment taken at home because of unavailability of hospital beds, or when the insured cannot be shifted to hospital due to health conditions. It covers for treatment that exceeds three days, for any injury or illness
Road Ambulance ExpensesExpenses incurred due to transportation of the insured to the nearest hospital in case of a medical emergency are covered up to a specific limit. The ambulance has all the facilities required to transfer the patient.
AYUSH TreatmentsIt covers in-patient treatments taken under AYUSH systems of medicines which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. The expenses are covered for up to a specific limit.
Cosmetic TreatmentsPlastic surgeries, face lifts, nose jobs, cosmetic implants, botox, etc. are not covered under most health insurance plans.
HIV/AIDSMost health insurance plans do not cover expenses related to treatments for HIV or AIDS.
Self-Inflicted InjuriesAny injury due caused due to self-harm including suicide or attempt of suicide is not covered.
Injuries Due to Alcohol or Drug AbuseInjuries due to alcohol or drug abuse, or other addictive substances are not covered.
Participation in Adventure SportsAny treatment required due to participation in adventure sports like mountain climbing, etc. are not covered.
Injuries Due to War, RiotsInjuries due to war, riots, nuclear contamination, and related perils are not covered.
Unproven And Experimental TreatmentsTreatments which are unproven, experimental or done solely for the purpose of investigation.
Rest Cure, Rehabilitation, And Respite CareExpenses related to admission for enforced bedrest and not for treatment.
Health Insurance Riders
Critical Illness CoverWith this add-on, you become eligible to receive a lump sum amount on diagnosis of serious and long-term illnesses such as cancer, stroke, kidney failure, etc. With the amount received, you can make up for the loss of income resulting due to critical illness, pay for debts, if any, or even avail treatment abroad.Some insurance companies provide cover for critical illness as a part of standalone policy, whereas others offer it as an add-on cover, for up to 50 critical illnesses.
Maternity CoverMaternity add-on cover can be opted under an individual or family floater health insurance policy. If planning a child, then maternity add-on cover works best for you. It provides financial protection against medical expenses arising due to childbirth. Some insurance companies also provide coverage to newborn babies for several healthcare expenses such as vaccination, etc. the add-on cover comes with a waiting period, which may differ from one insurer to another, but generally ranges between 2 years to 4 years.
Hospital CashThe add-on cover of hospital cash provides you cover all the non-medical and out of pocket expenses arising during hospitalisation, that are not covered under the health insurance plan. The policyholder gets daily cash allowance as per the limit specified in the policy document, for a particular policy year. Different insurance companies offer different coverage amounts for daily hospital cash benefit, but it generally ranges between Rs. 500 to Rs. 5,000 per day.
Room Rent WaiverThe type of room you choose at the time of hospitalisation, reflect majorly in your hospital bills. A standard health insurance plan comes with a limit on the per day charges of the room. This means that the extra charges incurred due to change in the type of room, let’s say from general room to a deluxe room, will have to be borne by the insured. But with the room rent waiver add-on, you can opt for any room of your choice and you will not be charged anything extra, as it provides you for extra cost during your stay.
OPD CoverOPD (outpatient department) refers to that department of a hospital wherein a patient is required to simply visit it to avail the required treatment and pay the consultation fees to the doctor, instead of getting admitted as a daycare patient. Generally, health insurance plans do not cover you for OPD expenses, but with this add-on cover, you can secure yourself from expenses arising due to the same. The add-on covers you for the cost of medicines, consultation fees, pathological tests, etc
Personal Accident CoverConsidering the rising number of road accidents in India, personal accident add-on cover is a good choice as it offers financial protection in case the insured meets an accident, which results in outcomes such as permanent total disablement, permanent partial disablement, total disablement, or in case of death due to accident. You can opt for this add-on along with a base health insurance policy voluntarily, by paying an extra premium at the time of policy purchase.
International Second Opinion CoverInternational second opinion add-on cover provides you the option to consult international doctors before availing the required treatment. You can use this add-on cover in case you are not satisfied with the diagnosis. Choosing this add-on is an empowering method for the insured as they can review the treatment advice and recommendations offered for a particular illness. It will help the insured get insights on additional treatment options and be doubly sure of the treatment they require.
Air Ambulance CoverThis add-on cover helps transfer the sick/injured insured person, to the nearest hospital, in case of domestic as well as international emergency, as per the terms and conditions specified by the insurance company. This add-on cover saves lives in different scenarios like if you require specialised medical treatment during transportation, if you require to be transported in a swift manner on getting injured when visiting a remote area, or require transportation for medical treatment, if cannot be transported via road.
Reduction in Pre-Existing Diseases Waiting PeriodHealth insurance plans usually come with a waiting period for pre-existing diseases of 48 months. But with add-on cover of reduction in pre-existing waiting period, you can get the waiting period reduced, from let’s say 48 months to 24 months. The period of reduction of waiting period may vary from one insurance company to another. You can get this add-on by paying some extra premium. It does require pre-medical check-up though, to be eligible for this add-on cover.
Which Health Insurance Plan Should You Buy?
There are several medical health insurance plans in India that you can choose from, at the time of policy purchase. These are individual health insurance plans, family floater health insurance plans, senior citizen health insurance plans, critical illness insurance plans, maternity insurance plans, hospital daily cash etc.
If you have a big family or one with senior parents, then an individual health insurance policy is recommended as a family floater policy might not be sufficient for you. You can also buy a separate senior citizen health insurance policy for parents in this case.
Whereas a family floater medical insurance policy is recommended for a young couple or a small family. Kindly note that when going for a family floater health insurance policy, you must choose a higher sum insured so that it is sufficient for all family members.
When choosing which type of health insurance policy you should buy, you must consider a few things other than just the premium. The right approach will be to seek maximum coverage for all the family members at the most affordable premium. It is recommended to do enough research in order to zero down the most suitable health insurance policy for yourself and your family.
Also, once you decide which health insurance policy to buy, you can also add add-on covers to it for extensive coverage. It is not mandatory to buy add-on covers but you can include them in your policy voluntarily at the time of policy purchase, by paying an extra premium. Some popular add-ons offered under health insurance plans are room rent waiver, hospital daily cash, second e-opinion, critical illness cover, air ambulance cover, etc.
Why Buy A Health Insurance Plan at An Early Age?
Following are the reasons why it is recommended to buy medical insurance at an early age:
Lower Premium - As you age, you are required to pay higher health insurance premiums. This is because, in old age, you have a higher possibility of getting ill, due to a weaker immune system. For instance, a person aged 20 years will be required to pay a lesser health insurance premium than someone aged 52 years, due to lesser health issues involved.
Lesser Exclusions - Many medical insurance plans come with restrictions on coverage offered, due to which you may not be able to avail full-fledged cover on buying a policy in later years of life. But if you buy a health insurance policy at an early stage in life, when you do not have any health condition, then you will be able to enjoy a full-fledged health cover.
No Health Check-Up - Another reason why buying health insurance at an early stage in life is recommended is because you would not be required to undergo a medical check-up then. But if you buy the policy in old age, let us say 50 years, then most health insurance companies will ask you to undergo the same. Also, in case there is a health condition in the medical test results, then you might be required to pay a higher premium due to higher chances of hospitalisation involved.
No Claim Bonus - You will be able to start accumulating No Claim Bonus early on by buying a health insurance policy timely. You can use this NCB in the later years of life when you might be more vulnerable to illnesses and may need to make a claim. But if you buy the policy during later years of life, then you would not be able to enjoy such increased coverage.
Aligned Finances - If you buy a health insurance policy at a young age, then you have time to plan your finances for a long term. But if you buy it in later years of life, then financial planning may go haywire. Hence, it is recommended to buy a health insurance policy when young so that financial planning can be started early, and also that you are prepared for emergencies irrespective of their magnitude.
Waiting Period - Health insurance plans come with waiting periods for specific conditions, cover for some of which you may require in old age. The advantage of buying health insurance plans when young is that you can complete the waiting period early and avail of the coverage benefits when you actually require them.
Rejections - As you will be more prone to illnesses in your old age, therefore there are higher chances of your health insurance application getting rejected then. Therefore, buying health insurance plans when young is recommended so that there are lesser chances of your application getting rejected.
Pre-Existing Conditions - When you buy a health insurance policy in later years of life, then there are chances that you may already be suffering from pre-existing diseases. But then, you will be required to complete a waiting period to get coverage benefits for the same. On the other hand, if you buy the policy when young, then by the time you may need cover for pre-existing illnesses, you would already have completed the waiting period and will be able to avail the required coverage.
Tax Benefits of Health Insurance
Every HUF can claim tax benefits, under Section 80D of the Income Tax Act, 1961, on the premium paid for medical health insurance plans. You can avail of tax benefits on the premium paid for yourself and your family members including spouse, dependent children, or parents.
The deduction from the total income can also be availed on the premium paid for top-up health insurance plans as well as critical illness plans, apart from regular health insurance plans.
To understand the amount of deduction currently available to an individual taxpayer in different scenarios, refer to the table below:
Deduction under Section 80D of the Income Tax Act
Self, Family, Children
When the policyholder and parents are aged below 60 years
When the policyholder and family members are aged below 60 years with parents aged above 60 years
When the policyholder, family members, and parents are more than 60 years of age
Members of the HUF (Hindu Undivided Family)
Non-Resident Individuals (NRIs)
Understand Terms Included in Your Health Insurance Policies
Explained below are terms that you must know in order to understand your health insurance policy better:
Co-Payment - Health insurance plans reimburse you for the healthcare expenses during a treatment that is covered under the policy. But if the insured, as well as the insurance company, share the expenses at the time of claim, then it is a case of co-payment. Generally, health insurance plans with a co-payment clause come at comparatively lesser premiums. Mostly, this feature can be seen in senior citizen health insurance plans.
No Claim Bonus - It is a reward that a medical insurance company gives to the insured for not making a claim in a particular year. For instance, an increase in the sum insured by a fixed percentage according to the policy, not more than 50% of the sum insured, if the policy has been renewed continuously.
Deductible - Deductible is similar to co-payment. It is a fixed amount in rupee terms that are shared by the policyholder, and not the insurance company, at the time of claim. It is, however, decided by the insurance company if the insured is required to pay this amount per year, per life, or per event.
Dependents - Dependents are family members of the insured who are financially dependent on him/her. These can be a legally wedded spouse, and unmarried children (natural or adopted).
Exclusions - Every health insurance policy comes with a list of conditions that the insurance company will not cover the insured for, during the policy term. These are known as exclusions. Some common exclusions under health insurance plans are treatments required due to participation in adventure sports, Injuries due to self-harm, insured committing a breach of law, etc.
Grace Period - The grace period is a specific period starting immediately after the expiry of the due date or premium payment, given to the policyholder to pay the premium to continue availing coverage benefits under the policy. If the premium is paid during this period, then you can continue availing of the policy benefits. But if the premium is not paid even during the grace period, then your policy will lapse and you will lose all the accumulated benefits. Hence, it is recommended to keep renewing health insurance plans when the premium is due.
Insurer - The insurance company.
Premium - A fixed amount to be paid periodically in order to keep availing of health insurance policy benefits.
Policy - It is a legal contract between an insurance company and the insured, that contains all the terms and conditions of the insurance.
Pre-Existing Disease - It is any condition, ailment, or injury for which the insured already had symptoms, within 48 months prior to buying a health insurance policy. Generally, pre-existing conditions are covered by the policy after a specific waiting period. Hence, it is recommended to disclose pre-existing diseases, if any, to avoid any hassle at the time of claim settlement.
Network Hospital - Every insurance company has a tie-up with hospitals wherein the insurer can avail cashless treatment. These hospitals are known as network hospitals. It is recommended to choose an insurance company with a high number of network hospitals, for utmost convenience in case of an emergency strike in the future.
Portability - Portability is an individual health insurance policyholder’s right that allows him/her to switch from one insurer to another or from one health insurance policy to another of the same insurer if the policy was maintained without any lapse. Portability allows you to transfer the accumulated benefits as well such as waiting for period benefits, NCB, etc.
Sum Insured - It is the payout amount that an insurance company is liable to pay to the insured in case of a claim. For instance, if the sum insured of a health insurance policy is Rs. 5 Lakh and the hospitalisation expenses incurred are Rs. 2 Lakh, then the insurance company will cover the expenses. But if the expenses exceed the sum insured limit, then the insured will have to bear the remaining expenses.
Waiting Period - This is a fixed time period for which the medical insurer does not cover you, even after the commencement of the policy term. Waiting periods can be of different types such as initial waiting period, waiting period for specific diseases, waiting period for pre-existing diseases, etc. The waiting period is calculated from the date of commencement of the policy.
Free Look Period - Free look period is the time that an insured gets to understand his/her health insurance policy better. During this period, if not satisfied, the insured can cancel the policy.
Waiting Period In Health Insurance
Even throughout the duration of the policy of a certain health insurance policy, the covered individual is not entitled to receive the entire value chain for some mentioned conditions due to a waiting period in health insurance. This means that any insured person will only be eligible to get coverage benefits for pre-existing diseases after finishing a four-year waiting period, which is determined from the start date of the policy.
Types Of Waiting Period In Health Insurance
Following are the types of waiting period in health insurance-
- Initial Waiting Period: After receiving a health insurance policy, the policyholder must wait a certain number of days before receiving any claim benefits under the policy. In health insurance, this period is known as the initial waiting period or cooling period. All health insurance policies come with a holding period of at least one month and up to ninety days as typical in the industry.
- Pre-Existing Diseases (PED) Waiting Period: It is a pre-existing disease waiting period that the insured acknowledges at the time of policy purchase. According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing disease is defined as any condition, accident, ailment, or disease detected within 48 months of the policy acquisition. Pre-existing illnesses include thyroid, hypertension, and diabetes. Pre-existing conditions are usually subject to a 1-4 year waiting period in most health insurance coverage.
- Waiting Period for Specific Diseases: Several conditions, such as hernias, tumours, ENT disorders, cancer, strokes, and cardiac problems, have a specified waiting period. The illnesses that qualify for this waiting period vary per insurer and can be found in the policy provisions of each one.
- Maternity Waiting Period: Pregnancy and newborn baby insurance can be added as an add-on feature to health insurance plans for people and families. Maternity coverage is a regular component in many insurance plans. After a two- to four-year waiting period, coverage can be acquired in either instance.
- Waiting Period for Bariatric Surgery: Bariatric surgery is also covered by several health insurance. Bariatric surgery is a procedure that involves surgery on the stomach and/or intestines to assist a patient with severe obesity-related disorders. Those with a BMI of over 40 and who are experiencing health problems as a result of it are usually candidates for surgery.
- Waiting Period for Coronavirus: Many people in India are obtaining coronavirus-specific health insurance for themselves rather than their families due to the increased frequency of the virus. However, the insured must wait up to 30 days before receiving coverage benefits such as hospitalisation and therapy under these plans.
What Is The Importance Of Waiting Period In Health Insurance?
The purpose of a waiting period in health insurance is to prevent people from claiming benefits under a policy for the wrong reasons. Individuals without health insurance have acquired plans after being identified with a particular diagnosis, in some cases without informing the insurance provider of the diagnosis. Health insurance policies also include the idea of a waiting time to prevent unethical behaviours like these.
How To Calculate Health Insurance Premium Online?
Getting an estimate of your health Insurance or medical insurance policy is very easy and convenient with a health insurance premium calculator. The tool evades the tedious task of calculating health insurance premiums by doing it for you within a few minutes. It is a free tool that you can use not only to calculate premiums but to compare different health insurance plans to shortlist the most suitable one as per your requirements and budget.
The tool does the calculation after considering several factors such as BMI, age, income, lifestyle, gender, members to be covered under the policy, etc. You must note that the premium is decided on the basis of these factors and hence you must provide the correct information to avoid any discrepancy in premium calculation.
To use a health insurance premium calculator, you must follow the below-mentioned steps:
• Visit InsuranceDekho and click on ‘Health’.
• Fill in your personal details as required in the form. You will be required to enter your name, Age, Gender, City, Mobile Number, Email ID, Members to be covered, etc. Then click on ‘View Instant Quote’.
• As per the information entered, you will see the most suitable health insurance plans displayed on your screen with their premiums.
• From them, you can select the most suitable one as per the premium and coverage benefits offered.
What Are The Factors That Affects Health Insurance Premium?
There are several factors that decide the health insurance premium for an individual for a particular health insurance policy. These are explained below:
Age - Generally, companies offering medical health insurance plans follow the rule-higher the age, the higher the premiums. This is because, in old age, people are more vulnerable to illnesses, which increases their chances of making health insurance claims. Hence, the higher the age, the higher the premiums, and vice versa.
Past Medical History - If you have a history of any medical condition, then you will have a higher chance of hospitalisation and hence you will be required to pay a higher health insurance premium. But if there is no history of a medical condition, then you will be charged a comparatively lesser premium.
Lifestyle Habits - Lifestyle habits such as excessive smoking or drinking deteriorate your health and make you more prone to illnesses. If you follow this lifestyle, then you may be at higher health risk and hence will be more likely to make a claim. This is why your health insurance premium will be higher as compared to someone who does not smoke or drink regularly.
Policy Term - Policy term is another crucial factor that decides the premium for a health insurance policy. You can choose from different policy terms such as 1 year, 2 years, or 3 years, according to its terms and conditions. The higher the policy term you opt for, the higher premium you will be required to pay, due to the higher coverage offered.
Add-On Covers - You can include add-on covers to your health insurance policy for extensive coverage. For this, you will be required to pay an extra premium at the time of policy purchase. The greater the number of add-ons covers you buy, the higher premium you will be required to pay for it.
Co-Payment - Premiums for medical insurance plans that come with a co-payment clause are generally low, due to the cost-sharing involved. Therefore, if you choose a health insurance policy with a co-payment option, then you will be required to pay a lesser premium and vice versa.
Body Mass Index - If your Body Mass Index is higher than normal, then you will be at higher risk of suffering from health issues. This is why your premium will be high. But if it is normal, then you will be charged a lesser premium.
How To File A Health Insurance Claim?
Claim under a health insurance policy can be made in two ways - in a cashless manner and in a reimbursement manner. A cashless claim is when you receive treatment at a network hospital of the insurance provider who is servicing your policy. If the claim request is accepted, the insurance company directly settles the bills at the hospital. Whereas in reimbursement claims, you are required to pay for the hospital bill from your own pocket first, and make a claim request with the insurance company later. The insurance company will process your claim and reimburse you for the same after accepting the claim. You can make a health insurance claim by following the simple steps given below:
- Step 1: Visit the network hospital or the hospital of your choice and inform the insurance company about the hospitalisation.
- Step 2: Fill the pre-authorization form at the hospital’s TPA (third-party administrator) desk.
- Step 3: You will receive an approval letter by the claim management team.
- Step 4: Respond to the query raised by the claim management team, if any.
- Step 5: Avail the required medical treatment.
- Step 6: The insurance company will directly settle the bills at the network hospital as per the terms and conditions mentioned in your policy.
Documents Required For Health Insurance Claim Reimbursement
Listed below are the documents required in case of reimbursement claim:
• Valid identity proof.
• Duly signed and completed original claim form.
• Doctor’s prescription recommending hospitalisation.
• Original pharmacy bills.
• Original prescription for medicines, consultation, and diagnostic tests.
• Indoor case papers.
• Ambulance receipt.
• First Information Report (FIR), if applicable.
• Policy details with the insured person(s) name, policy number, illness, and address.
• Any other document if required by the insurer.
Listed below are additional documents required in case of a cashless medical insurance claim:
• Pre-authorization form.
• Valid identity proof along with a photograph.
• Documents like voter ID card, driving license, PAN card, and Aadhar card.
Am I Eligible to Buy a Health Insurance Plan?
Eligibility Criteria to Buy Health Insurance
Buying a health insurance policy is essential because medical care, especially in the private sector is expensive and can burn a hole in your pocket. To avoid a tough situation during medical emergency or illness, paying a small annual premium can certainly help to lessen your stress.
You can easily purchase a good insurance plan online that usually covers expenses incurred towards doctor consultation fees, ambulance services, hospitalization to a certain extent. Here are the eligibility criteria-
- Entry age for adults- 18-65 years (exclusive plans are provided for people above 70 years of age.)
- Entry age for children-90 days-18 years.
Buying a health insurance policy during early age can be cost-effective as one might not necessarily have to undergo medical tests conducted by the insurers.
Documents Required to Buy Health Insurance Online
There are a few documents that you must be able to show to buy a health insurance policy online. These are-
- Age proof: Either of the following-Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter’s ID, etc.
- Identity proof: Either of-Passport, Driving License, Voter ID, PAN Card, Aadhar Card, which proves one’s citizenship.
- Address proof: Either of-Electricity bill, Ration Card, Telephone Bill, Passport, Driving License with your permanent address clearly mentioned on it.
- Medical check-up: Some plans require health check-up to ensure that the individual is not suffering from any chronic illness.
How To Buy Health Insurance Plans With InsuranceDekho?
The following mentioned are some of the steps to buy health insurance from InsuranceDekho-
- Fill Your Details: Visit the official website of Insurance and browse to “Health Insurance”, enter your personal details like gender, name and mobile number. You can also communicate on WhatsApp as per your convenience. Click on the “View Plans” Button to see available plans. Select the family members you want to insure like your father, mother, son etc.
- Compare Different Health Insurance Quotes: Once you enter the above details, different health insurance quotes will get displayed to you. Compare the available plans and select the health insurance that suits you and your requirements perfectly.
- Make the Payment: After selecting the best health insurance plan for yourself, select or adjust the sum assured and the term of the policy.
- Once all the details are provided by you, make the payment. You can make the payment through credit\debit card or netbanking.
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Some Myths About Health Insurance
Due to lack of knowledge and understanding, people in India have a lot of misconceptions when it comes to health insurance plans. These misconceptions should be cleared in order to make the best buying decision. Here are some common myths and reality behind them:
Myth 1: Health insurance plans is not required when young and healthy
Reality: The ideal time to buy health insurance is when you are young and healthy. This is because if you buy a health insurance policy at a young age, then you will be able to get the cover at an affordable premium as the risk of getting hospitalised then is minimum. Also, health insurance plans come with waiting periods during which no claims are admissible. On buying health insurance when healthy, you can complete this waiting period without any worries as you may not need to make a claim then.
Myth 2: I will only be covered for hospitalisation
Reality: It is true that health insurance plans cover you for hospitalisation expenses only when the hospitalisation of at least 24 hours takes place. But it is not true that the plans only cover you for these expenses. In most cases, they also cover you for daycare procedures such as sinusitis, radiotherapy, chemotherapy, etc, which do not require hospitalisation of at least 24 hours. Other expenses covered are OPD expenses, road ambulance expenses, second medical opinion, medical check-up, etc.
Myth 3: People who smoke cannot be covered under any health insurance policy
Reality: You can still buy a health insurance plan even if you are a smoker. But medical insurance companies are concerned about pre-existing conditions, which may even lead to the cancellation of your health insurance application form. So, if there is any pre-existing condition due to smoking, then you must disclose the same to your insurer. It will not deny you the policy but may charge you a higher premium because as a smoker, you will be more prone to illnesses.
Myth 4: Health insurance plans are bought to save taxes
Health insurance plans do not only help you save taxes as per the prevalent tax laws but most importantly, cover you for healthcare expenses, which may help you save even more in the long term.
Myth 5: It is not safe to buy health insurance plans online
It is completely safe as well as quick to buy health insurance plans online at reliable platforms such as InsuranceDekho. All you need to do is fill a quote, compare the most suitable health insurance plans from the ones displayed on the screen, shortlist the one you wish to buy for yourself and your family, and pay the premium online via a secured payment gateway. These are different premium payment modes like Credit card, Debit card, or e-wallets that you can choose as per your convenience.
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FAQs About Health Insurance Policy
- Plan Coverage
- Claim Settlement
- Critical Illness
What is a health insurance plan?
Health insurance policy is an agreement whereby an insurance company agrees to undertake a guarantee to compensate the insured for medical expenses in case of a medical emergency. A health insurance policy protects the insured for several surgical expenses, critical illnesses, and daycare expenses, for a policy term, for up to the sum insured limit.
Can I purchase more than 1 health insurance plan? How are the claims settled in this case?
Yes. You can be covered under more than one health insurance plan. In this case, the claims are settled as per the contribution clause, when the claim is higher than the sum insured for one health insurance policy.
Why should I buy a health insurance plan?
A health insurance policy not only protects the insured financially for future, but also offers relief in the present. Lifestyle habits such as drinking, smoking, or sedentary lifestyle invite health issues, which can be minor or serious, may be expensive to treat. To stay financially protected in such times, you need a reliable health insurance plan that covers you at all times. Apart from this, buying a health insurance policy also reduces your overall tax liability by allowing you tax deductions on the premium paid, under Section 80D of the Income Tax Act, 1961.
Can I cancel my health insurance policy? If yes, will I get a refund for the same?
Yes. You can cancel your health insurance policy. Every health insurance company provides you a free look period to understand the policy terms and conditions. During this period, if you find any objectionable clause in your health insurance policy, then you can cancel the policy and ask for a refund. Note that you will receive the refund only if no claim has been made during the policy term. The amount of refund will be calculated after taking into consideration the expenses incurred on medical check-ups, stamp duty, and proportionate risk premium, i.e. the number of days you have been covered for risks under the policy. To know more about a premium refunds, it is recommended to go through the policy document.
What Is The Right Age To Buy A Health Insurance Policy?
The ideal age to buy a health insurance plan is when you are still young. This is because when you are young, the chances of acquiring a disease is less and you are in a better position physically as well. This even reduces your chances of health insurance denial.
Can A Minor Buy Health Insurance?
No, a minor is not eligible to buy a health insurance plan. However, a minor can get health coverage under child health plans bought by either of the parent or a guardian.
What To Do If I Am Admitted In A Non-network Hospital?
When an individual gets admitted to a non network hospital, they are required to pay treatment expenses from their pocket. These expenses can later get reimbursed after showing the necessary proofs to the respective insurance provider.
Which Health Insurance Is Good For Young Adults?
If you are aged 26 years or above and not residing in a metro city, then a family floater plan ranging between Rs. 5 Lakh to Rs. 10 Lakh sum insured would be sufficient to meet any health emergency.
Why Is Health Insurance Important To Us?
In case of health emergencies, having a reliable health insurance policy helps as it offers the much needed financial backup. A health insurance policy can reimburse you for the expenses arising due to injury or illness or pay directly at the hospital.
What Is The Benefit Of Health Insurance?
There are several benefit of having health insurance, some of which include cashless hospitalisation, tax benefits, No Claim Bonus, cover for expenses related to ambulance and transportation, in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, daycare expenses, domiciliary hospitalisation expenses, etc.
Can A Person Have More Than One Health Insurance Plans?
Yes. A person can have more than one health insurance policy as there is no limit for the same. However, one cannot claim reimbursement for the healthcare expenses incurred, from multiple insurance companies.
Does Health Insurance Provide Tax Benefits?
Yes. If covered under health insurance plans, you can avail tax benefits on the premium paid, under Section 80D of the Income Tax, 1961. Kindly note that the tax benefits can be availed only if the premium is paid in any mode other than cash.
Why Is Health Insurance Important To Us?
In case of health emergencies, having a reliable health insurance policy helps as it offers the much needed financial backup. A health insurance policy can reimburse you for the expenses arising due to injury or illness or pay directly at the hospital.
What Is The Benefit Of Health Insurance?
There are several benefit of having health insurance, some of which include cashless hospitalisation, tax benefits, No Claim Bonus, cover for expenses related to ambulance and transportation, in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, daycare expenses, domiciliary hospitalisation expenses, etc.
Can I Increase The Sum Insured Under My Existing Health Insurance Policy?
Yes. Most health insurance plans allow you to increase the sum insured of your existing health insurance policy but you can do the same only at the time of renewal. To do the same, you can get in touch with either InsuranceDekho or the insurance company.
Can Health Insurance Be Paid In EMI?
Yes. You can pay the premium for a particular health insurance policy in EMI for which you will be required to pay a fixed amount every month. It is a recommended option as it helps you reduce the stress of paying a hefty amount of premium in one go.
Can I Cancel My Health Insurance Policy? If Yes, Will I Get A Refund For The Same?
Yes, you can cancel your health insurance policy and get a refund for the same. But for this, you will be required to follow a procedure and notify the insurance company about the same. Also, you would be required to pay the premium for the days you were already covered.
How much health insurance do I require?
It is advised to have a health insurance coverage amount equal to 50% of your annual income. So if you earn Rs. 20 Lakh on a yearly basis then you should consider a health insurance policy for Rs. 10 Lakh. However, there are many factors that you consider before how much health insurance coverage you require, these factors can be income, age, eligibility criteria and health condition.
What are the benefits of the health insurance portability for the policy holders?
There are several advantages of porting a health insurance plan. While porting your health insurance policy you can choose a new sum assured, avail lower premiums, opt for an add-on cover and avail continued benefits. You can choose a health insurance company that you can fully rely on.
What is a free-look period in health insurance?
Under a health insurance policy, a free look period of 15 to 30 days is provided to the policyholder, the free look period depends on the insurance provider. During the free-look period one can cancel their health insurance policy in case they are not satisfied with the terms and conditions of the health insurance policy.
What are pre and post-hospitalization expenses?
Pre-hospitalization expenses refer to expenses/medical cost of tests incurred before a person gets hospitalized such as X-rays, CT Scans, MRI Scan, consultation fee etc. On the other hand post hospitalization expenses are expenses incurred by a person after they get discharged from the hospital, these expenses include medicine follow ups, medicines, diagnostic tests etc.
What do you mean by pre-existing disease?
A pre-existing disease refers to any health condition that the proposer has been facing prior to purchasing a health insurance policy. A pre-existing medical condition can be high blood pressure, diabetes, thyroid, asthma etc.
Do I have to undergo any medical examination before buying health insurance ?
When purchasing a health insurance policy the insurance provider may require you to undergo some medical examination to assess your health condition. These medical tests play an important role in determining your eligibility for getting health insurance and determining the premium of the health insurance policy. However, it does not mean that you cannot purchase a health insurance policy without medical examination.
How can I add my family members to my existing health insurance policy?
You can add your family members to your existing health insurance policy at the time of renewal but you can’t add your family members between the policy tenure except for newborn. By adding a family member into your existing health insurance policy, the premium for the health insurance policy may increase.
What is 'domiciliary Hospitalization?'
Domiciliary hospitalization refers to medical treatment for an illness, disease or an injury which normally requires care and treatment at a hospital but the treatment is actually provided at home.
What to do if I am admitted to a non-network hospital?
In case you are admitted to a non-work hospital for a treatment, you must pay the bills and admission fees of the hospital from your own pocket. After being discharged you can apply for a reimbursement claim under your health insurance policy by submitting all the supporting documents such as reports and bills. The insurance provider will check all the documents and settle the claim accordingly.
What are the benefits available under in-patient hospitalization?
Under in-patient hospitalization, compensation for room rent, ICU charges, operation theater charges, consultation fee, nursing charges, cost of medicines etc. is provided in case the insured person requires to be hospitalized for more than 24 hours.
Can a minor buy health insurance?
Yes a health insurance policy can be purchased for a minor. One can purchase a health insurance policy for their child. A child health insurance policy can be purchased separately which covers the child from day one.
Where can I find my health insurance number?
When you purchase a health insurance policy you get a health insurance card under which the policy number or policy ID is given that helps you and the insurance provider to keep a track of your health insurance policy. You can find your health insurance number on your health insurance card which shall be denoted as ‘Policy ID’ or ‘Policy Number.
Why would my health insurance claim be denied?
There are a few reasons that explain why your health claim can be denied. Below mentioned are some of those reasons:
- Filing a claim during the waiting period.
- In case the insurance provider finds the treatment unnecessary, the claim can be denied.
- Providing false or inaccurate information.
- Failing to submit required documents at the time of filing the claim.
Why is health insurance important for employees?
Employee health insurance is not only beneficial for the employees but also for employers. The main point of providing corporate health insurance to employees is to protect and support the health and wellbeing of the employee.
Can I cancel my health insurance at any time?
Yes, you can cancel your health insurance during the free look period and any time after the free-look period if you are not satisfied with your health insurance policy. However, when you choose to cancel your health insurance policy, the insurance company will provide a refund of premium after deducting applicable charges and proportional risk charges or the time you have been covered under the policy.
What is the right age to buy health insurance?
It is advised to purchase a health insurance policy as early as possible i.e between the age of 20 and 30 years. At this age a person is most likely to be in their best health and can avail comprehensive coverage at an affordable premium rate.
From what age can I include my children in my existing health insurance plan?
This depends on the type of health insurance policy and the insurance provider’s terms and conditions. Generally, under many health insurance policies the dependent child is covered upto the age of 25 years. Check the terms and conditions of the policy to know all about the policy.
Do I need to purchase an additional health insurance plan to get high coverage?
You can purchase an additional health insurance plan to get high coverage and extra help to bear medical costs. Having additional health insurance can be a way to maximize the benefits and receive more coverage but there can be difficulties in maintaining two health insurance policies at once. It can be expensive also. You can always opt for add-on covers at the time renewal or at the time of purchasing the policy. These add-on covers increase the coverage and eliminate the need of purchasing an additional health insurance policy.
What is the sum insured in health insurance?
Sum assured in a health insurance refers to the maximum amount that the insurance company provides to the policyholder in case he/she is hospitalized. Any cost of hospitalization which is above and beyond the sum insured shall be borne by the policyholder.
Can the nominee be changed in the middle of the policy term of the health insurance policy?
Yes, the nominee can be changed anytime during the policy term of a health insurance policy. The policyholder can change the nominee and appoint a new nominee by informing their insurance provider.
I am a Foreign Citizen. Can I take a health policy for my child who is continuing further studies in India?
Yes, you can purchase health insurance for your child who is studying in India. Although the scope of coverage shall be restricted i.e the scope of coverage will be for the treatment taken in hospitals in India during the policy tenure.
What are the best health insurance plan for omicron variant of covid-19?
As we step into the new year 2022 with a lot of hope keeping in mind the effect of COVID-19 back in 2021. However, a new variant of COVID-19 known as ‘Omicron’ has become a matter of concern in the first week of this new year. Cases of the Omicron variant of Covid have been increasing in all parts of the country.
The impact of the second wave of COVID-19 is still in our minds, it becomes very necessary for us to be prepared this time as the Omicron variant spreads like a wildfire all around the world. Health insurance is the need of hour as health emergencies are very unpredictable. It is the most crucial step one can take to ensure the security of their loved ones and themselves in difficult times like this. Health insurance provides comprehensive coverage for hospitalisation and treatment cost for health emergencies.
Health insurance for Omicron variant will provide coverage for the expenses incurred after getting diagnosed with Omicron variant and for the treatment expenses of the disease. Since ‘Omicron’ is a variant of COVID-19 it is covered under all the health insurance policies available in India. If you are planning to purchase a health insurance policy, don’t wait to see if the third wave will arrive or not. It's never too early to plan for a secure future. Now is the correct time to get covered with the best health insurance policy available in India which can help you take care of medical expenses to secure both your present and future.
How is health insurance premium determined?
Different health insurance plans have different premiums. The insurance companies determine premiums after considering various factors that are explained below:
1. Type of Insurance Plan: Your health insurance premium is based on the type of plan you choose. If you choose a critical illness insurance plan, then the premium will be high. If you choose an individual health insurance policy, then the premium will be different from that of a family floater plan. To know the difference in health insurance premiums, you can use InsuranceDekho’s health insurance premium calculator.
2. Age of the Insured: With age, you become more prone to health issues and are more likely to make health insurance claims. Therefore, you are required to pay higher premiums if you buy health insurance plans in later stages of life. This is why it is recommended to buy health insurance policy when young.
3. Policy Term: Most health insurance plans come for a period of 1 year, 2 years, or 3 years. Greater the policy term you choose, the greater will be your coverage, and hence higher will be your health insurance premium, and vice versa.
4. Lifestyle Habits: If you drink alcohol or smoke regularly, then you may be denied health insurance completely. However, there are some insurance companies that cover you for the same, for which they charge high premiums. This is because, with these lifestyle habits, you are more prone to health issues.
5. Family Medical History: Before deciding your health insurance premium, the insurance company will ask about your family medical history. This is because if someone in your family has a certain disease that you are also vulnerable to, then the insurance company will charge you a higher premium due to increased risk.
6. Sum Insured: Health insurance plans come with different sum insured options that you can choose from as per your budget and requirement. The higher the sum insured, the higher the medical coverage and hence higher the health insurance premium. But it is not recommended to compromise on the sum insured to save on premiums. This is because it will not cover you adequately in the time of need.
What Is a cumulative bonus in a health insurance plan?
A cumulative bonus in health insurance refers to the financial benefit which you receive as a reward for not making any health insurance claims in a policy year.
How does smoking affect health insurance premium?
Smokers have to be prepared to make the payment for higher premium cost for their medical insurance policy as health risks increases for smokers and insurance companies charge a higher amount to combat the medical crisis.
Under what conditions are my policy premium likely to increase at renewal?
Here are different situations that increase the premium during the renewal:
- Healthcare Inflation – Inflation in healthcare is soaring at a rate of 12% to 18% which comprise the costs of medicines, hospital admission costs, medical advancements, etc. It leads your insurance companies to increase your sum insured every year which increase your premium too during policy renewal.
- Age of Policyholder – Increase in age can also impact your health insurance premium while renewing the health insurance policy, especially for those touching 60 just before renewal.
- Change in Coverage – If you change your health insurance policy coverage during the renewal process either by adding some add-on covers to your plan or by changing your insurer altogether, it may increase your premium.
What if I forgot to pay my health insurance premium?
If you could not make the payment for the health insurance premium on time, then your policy can be cancelled. After paying the first premium, you will be given a grace period if you do not make the payment for the premium on time. You can renew your health insurance plan by paying the premium within 15 to 30 days of the grace period, which can vary from insurer to insurer, but, if you miss this opportunity too, then it could risk you losing your coverage.
How Much Does Health Insurance Cost Per Month For An Individual?
Different health insurance plans come at different premiums, which depend on various factors, some of which include age, number of members covered, policy term, coverage benefits, add-on covers included, pre-existing diseases, etc.
How much does health insurance cost per month for an individual?
Monthly premium of the health insurance plan depends on the sum assured of the health insurance policy. For example a Rs. 5 Lakh family floater plan which also covers the proposer will cost somewhere between Rs. 10,000 to Rs. 15,000 annually. A Rs. 5 Lakh individual plan will cost somewhere between Rs. 4,000 to Rs. 6000 per month.
Why does health insurance premium increase on renewal?
It is very prominent that time and inflation can affect expenses of your life which include health insurance premiums. It is observed that medical treatment costs increase every year which makes it expensive for the insurance companies to settle the claim which eventually increases the cost of premium for a health insurance policy.
Can health insurance companies increase premiums?
While purchasing a health insurance policy the cost of premium can be affected by several factors such as age of the applicant, past medical history, pre-existing disease, occupation, policy tenure, Body Mass Index (BMI), personal habits such as consumption of alcohol or tobacco, geographical location etc. These factors can determine the premium.
What are the payment modes available for the payment of health insurance policy premium on InsuranceDekho?
You can choose to pay premium through Net Banking, NEFT, UPI, E-wallet, Credit/Debit cards while purchasing a health insurance policy at InsuranceDekho.
How can I renew my health insurance policy?
It is imperative to renew your health insurance policy to avail continued coverage, and save on accumulated benefits such as waiting period benefits and No Claim Bonus (NCB). You can easily renew your health insurance policy by following the simple steps given below:
Step 1: Visit the website of the insurance company and navigate to the ‘Health Insurance Renewal’ page.
Step 2: Enter the required details such as health insurance policy number and the registered mobile number.
Step 3: Check the policy details displayed and renewal premium.
Step 4: Pay the required health insurance premium via Credit card/Debit card or Net Banking.
What to do if my health insurance policy renewal date is missed?
Even if you missed the expiry date of the health insurance policy and failed to pay for its premium on time and renew it, you can still do it within a grace period of up to 7 days to 15 days, where may vary from insurer to insurer. Failure to make your payment, even after the grace period, then your policy will lapse.
Why should you avoid policy renewal during the grace period?
If you could not renew your health insurance plan within the expiry date, you can renew it within the grace period but at this time your policy will not be active and anything that happened to you will not be covered. Hence, you should avoid taking your renewal to the grace period.
Do I get a discount on the renewal of the policy with the same health insurance company?
The provision of discounts on the renewal of the health insurance policy varies from one insurance company to another ranging from 5% to 20%. You can get the discount with the renewal of policy from the same in different forms such as a discount for staying with the plan for a longer tenure, discount for family members on adding more members in the plan during renewal, discount for women is also provided by some insurance companies, and discount for no claim bonus.
Can a health insurance policy expire if it is not renewed on time?
Yes, your health insurance plan can get expired if it is not renewed before its expiry date as well as within the grace period.
What if I miss the health insurance policy premium renewal date?
If you miss the renewal date of your health insurance plan, you can get it renewed within the grace period provided by your insurance company. If you fail to renew your plan even then, your plan can be expired.
Can I increase my health insurance cover during renewal?
Yes, you can enhance the coverage of your health insurance policy by adding some add-on covers to your policy. To include additional covers in your plan, you will have to pay an extra premium during the renewal of your policy.
Is there a grace period for health insurance renewal?
Yes, a grace period is offered by health insurance companies to renew your health insurance plan without getting your policy expired. This period varies from insurer to insurer.
How Can I Renew My Health Insurance Policy Online?
You can renew your health insurance policy online by following a few simple steps given below:
- Visit the official website of the insurer and look for the health insurance page.
After visiting the website, search for the health insurance page and find the renewal tab and choose the ‘Renew’ option.
Click renew and renew your existing health insurance policy.
Enter the policy number of your existing health insurance policy.
Click on ‘Renew’ to initiate the premium payment for renewal of your policy.
Pay the required health insurance premium. You will then receive a confirmation on the Email for successful renewal of your health insurance policy.
- Visit the official website of the insurer and look for the health insurance page.
Can I renew my health insurance with another company?
You can port your existing health insurance policy to another health insurance company and renew your policy. To be able to do so, you will have to inform your existing health insurance provider and approach the new company who you wish to get your health insurance policy ported to. The new health insurance company will send a couple of documents which include portability form and proposal form.
Can I transfer my health insurance policy without losing renewal benefits?
Yes, you can transfer your health insurance policy from one health insurance company to another without the renewal benefits accumulated over years.
Can I renew my health insurance policy at InsuranceDekho?
Yes, you can renew your health insurance policy at InsuranceDekho online. Below mentioned are some steps that you follow to renew your health insurance policy:
Step 1: Visit InsuranceDekho and click on the ‘Renew’’ tab displayed on the home page.
Step 2: Log in using your registered mobile number. An OTP will send for verification, after you enter the OTP, health insurance linked to your mobile number shall be displayed.
Step 3: Check your policy details carefully and proceed to renew your policy.
What if my health insurance policy lapses when I am hospitalised?
There can be two situations. First, where you get hospitalised before the policy expiry date and notify the insurance company before the policy lapses, and the policy lapses when you are still in the hospital. In the second situation, you may be hospitalised during the grace period, the policy lapses then, and you inform the insurance company about the same during the grace period. In both cases, the insurance company will compensate for the coverage availed, as per the terms and conditions stated in the policy document.
Can I avail coverage benefits if I get hospitalised for less than 24 hours?
Yes. Most health insurance plans cover you for medical treatments that do not require hospitalisation of at least 24 hours. These are known as daycare procedures. Daycare treatments are performed under local or general anaesthesia in a clinic, hospital, or daycare center. Some daycare treatments that health insurance plans cover you for are chemotherapy, eye surgery, sinusitis, dialysis, angiography, etc.
Do health insurance plans cover diagnostic charges like X-rays, Ultrasound or MRI?
Yes, most health insurance plans give compensation for various types of diagnostic tests comprise X-rays, MRIs, blood tests, etc., if the policyholder stays in the hospital for at least 24 hours.
Do health insurance covers robotic surgery and modern treatments?
According to the health regulations issued by the Insurance Regulatory and Development Authority of India (IRDAI) in 2019, all insurance companies are required to insure robotic treatments. Therefore, all insurance companies provide it with some sub-limits and policy conditions.
What Are The Diseases Covered Under Health Insurance Policy?
The diseases covered under health insurance plans differ from one insurance company to another. Some of the common diseases that most of the health insurance plan covers include cancer, accident related injury, cataract surgery, dengue, COVID-19, diabetes, amongst others.
What Are The Different Types Of Health Insurance Plans Available In India?
There are several types of health insurance plans available in India. These are-family health insurance plans, senior citizen health insurance plans, individual health insurance plans, personal accident health insurance plans, maternity health insurance plans, children health insurance plans, newborn baby health insurance plans, health insurance plans for self-employed, and women health insurance plans.
Can I avail coverage benefits if I get hospitalized for less than 24 hours?
Yes, you can avail coverage benefits of the health insurance policy in case you are not hospitalized for a minimum of 24 hours as there are some illnesses where hospitalization is not required and health insurance companies have now made it possible to get coverage for day care procedures as well.
Will my health insurance policy cover hospitalization outside India?
Unfortunately most domestic health insurance companies do not provide coverage treatments taken outside India. There are some selective health insurance plans available in India that provide coverage for treatment taken outside India.
Does health insurance policy cover dental implants?
Most health insurance policies do not cover dental treatment as they are considered cosmetic treatment surgery. However, if there is a requirement of dental treatment/procedure that may arise due to an accident it may be covered by the insurance company.
What type of health insurance policy covers pregnancy?
Maternity health insurance policy provides coverage for pregnancy. This type of health insurance policy provides coverage for maternity related expenses such as delivery, vaccination, pre and post natal expenses etc.
What are the diseases covered under a health insurance policy?
Inclusions and exclusions of a health insurance policy varies from one insurance provider to another. Below mentioned are some common diseases covered under a health insurance policy:
- High Blood Pressure and High BMI
- Critical Illnesses
- Heart Ailments
- Brain Stroke
What are the diseases which are not covered under a health insurance policy?
Listed below are some common aspects which are not covered under a health insurance policy:
- Congenital Diseases/Genetic Disordered
- Cosmetic Surgery
- Health issues that may arise due to consumption of drugs, alcohol, and smoking
- IVF or Infertility Treatments
- Self-Inflicted injury
- Voluntary Abortion
- Sexually Transmitted Diseases
- Injuries caused due to war, riots or strikes.
I’m covered under my Employer’s Group Health Insurance policy, Do I need a separate health insurance policy?
It is advised to purchase a separate health insurance plan to be able avail higher coverage. Sometimes the employer’s group health insurance policy may not be sufficient and the health cover under the provided employer’s group health insurance shall only be valid till the time you are working with the organization. By having a separate health insurance policy for yourself, you can ensure that you and your family are protected from health emergencies no matter what.
Do health insurance policies cover robotic surgery & modern treatments?
According to the Insurance Regulatory and Development Authority of India (IRDAI), Health Regulations 2019, insurance companies have been directed to cover robotic surgeries as modern treatment. This shall be covered with or without sub-limit.
Does my health insurance policy cover health care expenses related to Covid-19?
Yes, your existing health insurance policy will cover health care expenses for the treatment of COVID-19. As COVID-19 is considered a disease the treatment expenses and hospitalization for the same shall be covered under an existing health insurance policy.
Are pre-existing diseases covered under a health insurance policy?
Most health insurance plans do not provide coverage for pre-existing diseases while purchasing a new health insurance policy. Some health insurance do provide coverage for pre-existing disease but the policies have a waiting period to be able to avail coverage for the same and may it also increase the premium of the health insurance policy.
Does my health insurance policy cover diagnostic charges?
Yes, health insurance policies provide coverage for the cost of diagnostic tests which include X-rays, blood tests, MRI’s etc. as it is associated with a patient's stay at the hospital for treatment for at least a minimum of 24 hours.
I have purchased a health insurance policy, when will I receive my health insurance card?
Health insurance card is provided when the health insurance policy is issued. As soon as you purchase the health insurance policy, the insurance provider will provide you with a medical insurance card and policy documents at the time of policy issuance.
Will health insurance cover lasik laser eye surgery?
Most of the insurance providers consider lasik laser eye treatment as an elective surgery and coverage for the lasik laser eye surgery was not provided under a health insurance policy. Earlier it was considered as a cosmetic treatment. However, the insurance company does provide coverage for lasik laser eye surgery under certain terms and conditions set by the insurance provider.
What happens to my health insurance plan after a health claim is filed?
After a health insurance claim is filed and settled by the insurance company, then the policy coverage tends to be reduced by an amount that has already been released during the settlement. For Instance, if your buy a plan with Rs. 5 lakh policy coverage and make a claim of Rs. 2 lakh, then you can avail of the health insurance of Rs. 3 lakh in the remaining policy year.
What if the insurance company refuses to settle my claim and I want to file a complaint?
If your insurance company refuses to settle your health insurance claim you can raise your complaint under the Insurance Ombudsman scheme if your insurer rejected the claim, has not resolved your concern to your satisfaction, paid no heed to it for 30 days, etc. After this, IRDAI can take your issue with the insurance company and ensure a re-examination of your complaint or resolution.
Does every network hospital provide a cashless claim facility?
The insurance companies list some hospitals in their network to offer the cashless facility to their health insurance policyholders, hence, all the hospitals in the network of an insurer provide the cashless facility. However, non-network hospitals do not offer cashless treatment and if you go to them for any type of treatment, then you will have to pay the bill on your own and can request reimbursement later.
What is the procedure for reimbursement settlement?
The health insurance reimbursement claim can be made if policyholders opt for a hospital that is not in the network of the insurance company. In such a case, a cashless facility is not applicable and you will have to pay for all your medical bills and then raise a reimbursement claim for it. To make the reimbursement claim, you will have to submit the required and relevant documents such as original medical bills to your insurer. The insurance company will evaluate your documents and pay you accordingly.
If I do not make a claim within a policy period, can I get a refund of my money?
Yes, if you have purchased a health insurance plan, it comes with a provision as per which you can return the policy within a specific period, which is known as Free-look Period, if you have made no claim. However, you will not get any refund of money after passing that period, even if you have not made any claim.
What is the maximum number of health insurance claims allowed in a year?
There is no specific limit on the number of claims which you can register during a policy year of your health insurance policy. You can keep making claims until the sum insured of your health insurance policy is exhausted.
Can we claim a health insurance policy immediately?
In order to make any claim, the customers need to wait 30 to 90 days after the purchase of the policy. The initial waiting period completely varies from insurer to insurer, however, the minimum waiting period is at least 30 days. However, this is not applicable to any emergency hospitalization occurring due to an accident.
Does a claim have to be lodged in a specific time frame from the time of the accident under a health insurance policy?
In case of an accident it is essential to immediately notify the insurance provider of TPA. Some health insurance policies provide a window of 24 hours to 7 hours to notify the insurance provider in case of admission in hospital for treatment of injuries that may arise due to an accident. Under most health insurance policies one must immediately inform the insurance provider upon the admission of the insured person for the treatment of injuries caused during an accident.
What is a claim settlement ratio?
Claim settlement ratio is denoted to the ratio of number of claims settled against the total number of claims received. It shows the goodwill of the company and helps in making an informed decision. While purchasing a health insurance policy you should choose an insurance provider with a high claim settlement ratio.
What Is Cashless Hospital In Health Insurance?
The term "cashless hospitalisation" refers to the situation in which the insured person does not have to pay any money out of pocket for a hospitalisation or treatment, and the full hospital expense is paid directly by the insurance company.
How does the health insurance claim process work?
The process for filing a claim against your health insurance policy can vary depending on the policy you have purchased. There are two types of claims under a health insurance policy and how do they work:
- Cashless Claims: A cashless claim is one of the options for resolving disputes. Simple terms, a cashless claim process is a part of the health insurance claim settlement process in which the insurer pays the network hospital directly and you, the policyholder, just pays a nominal amount.
- Reimbursement Claims: A reimbursement claim, as the name implies, is a type of insurance settlement in which you pay for your own treatment or hospitalisation and the insurer reimburses you later.
How many times can medical insurance be claimed?
When you buy a Mediclaim Policy from us, you can make as many claims as you like under the policy but not more than the sum insured of the health insurance policy. If your basic sum insured is exhausted, however, you will not be covered for any medical expenses.
Can we claim medical bills in health insurance?
Yes, medical expenses incurred after hospitalisation for a period of 60 days from the date of discharge from the hospital are covered.
How long does it take to settle a mediclaim?
The insurance company will settle health insurance claims within 30 days of receiving all required documents and after thoroughly evaluating your claim. In case further investigation is required it may take a little longer to settle a mediclaim.
How to check medical insurance claim status?
You can easily check your medical insurance claim status online and offline. You can check your medical insurance status by visiting the insurance company’s official website, the claim status can be checked by your policy details such as policy number, registered email ID or mobile number. You can also call the helpline number of the insurance company, write an email or visit the nearest branch office to know the claim status of your medical insurance claim.
Why Do Health Insurance Claims Get Rejected?
Non-disclosures, partial disclosures, and inaccurate disclosures of important facts such as age, nature of occupation, income, current insurance plans, major ailments, or pre-existing medical conditions are all common reasons for claims being rejected under a health insurance company.
Will my travel history abroad affect the admissibility of claim under the policy?
As long as the hospitalisation takes place in India, the travel history will have no impact on the insurance claim's validity.
What do you mean by No claim bonus in health insurance plans?
In health insurance, the insurance provider may offer a No Claim Bonus to the policyholder if certain terms and conditions are met. The policyholder must not have made a claim during the previous policy period in order to qualify for the No Claim Bonus.
Does a normal health insurance policy cover critical illness?
Not all health insurance policies have inbuilt critical illness cover but there are some regular health insurance policies that provide coverage for critical illness. Usually a regular health insurance policy does not cover critical illness but you always choose to purchase a critical illness add-on cover for your health insurance policy which will provide coverage for critical illness.
Is it worth purchasing a Critical Illness Insurance policy?
With rising health issues and expensive treatment critical illness insurance policy becomes a necessity. Critical illness insurance policy provides coverage for specific life threatening diseases that require funds and regular visits to the hospitals for the treatment. Treatment for such life threatening diseases can be very expensive and this is where a critical illness insurance policy comes in handy.
*Standard T&C Apply. All savings/offers are provided by the Insurers, which are subject to modification .For more details on risk factors, terms and conditions, please read the sales brochure of respective insurers carefully before concluding a sale. Tax benefits are subject to changes in applicable tax laws. Girnar Insurance Brokers Private Limited, (CIN: U66010RJ2016PTC054811, Regd .Off: Girnar 21, Govind Marg, Moti Doongari Road, Dharam Singh Circle, Jaipur, Rajasthan- 302004; Corp. Off: Second and Third Floor, Plot no.301, Phase-2, Udyog Vihar, Gurugram-122022, Haryana, India. IRDAI License no 588. Direct Broker (Life & General) valid till 19th March 2023. Email - email@example.com ; Helpline number: 7551196989.
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