Why is Health Insurance important?
All of us should buy health insurance and for all members of our family, according to our needs. Buying health insurance protects us from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings or even lead to indebtedness. Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advances, new procedures, and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.
What is the cashless facility?
Insurance companies have tie-up arrangements with several hospitals all over the country as part of their network. Under a health insurance policy offering the cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the Third Party Administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits allowed by the insurance policy or expenses not covered under the policy have to be settled by you directly with the hospital. The cashless facility, however, is not available if you take treatment in a hospital that is not in the network.
What are the factors that affect Health Insurance premiums?
Age is a major factor that determines the premium, the older you are the premium cost will be higher because you are more prone to illnesses. Previous medical history is another major factor that determines the premium. If no prior medical history exists, the premium will automatically be lower. Claim free years can also be a factor in determining the cost of the premium as it might benefit you with a certain percentage of the discount. This will automatically help you reduce your premium.
What does a Health Insurance policy not cover?
You must read the prospectus/ policy and understand what is not covered under it. Generally, pre-existing diseases (read the policy to understand what a pre-existing disease is defined as) are excluded under a Health Insurance policy. Further, the policy would generally exclude certain diseases from the first year of coverage and also impose a waiting period. There would also be certain standard exclusions such as cost of spectacles, contact lenses and hearing aids not being covered, dental treatment/surgery ( unless requiring hospitalization) not being covered, convalescence, general debility, congenital external defects, venereal disease, intentional self-injury, use of intoxicating drugs/alcohol, AIDS, expenses for diagnosis, x-ray or laboratory tests not consistent with the disease requiring hospitalization, treatment relating to pregnancy or childbirth including cesarean section, Naturopathy treatment.
Is there any Waiting Period for claims under a policy?
Yes. When you get a new policy, generally, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable to subsequent policies under renewal.
What is the pre-existing condition in health insurance policy?
It is a medical condition/disease that existed before you obtained health insurance policy, and it is significant because the insurance companies do not cover such pre-existing conditions, within 48 months prior to the 1st policy. It means pre-existing conditions can be considered for payment after completion of 48 months of continuous insurance cover.
If my policy is not renewed in time before the expiry date, will it be denied for renewal?
The policy will be renewable provided you pay the premium within 30 days (called Grace Period) of the expiry date. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.
Can I transfer my policy from one insurance company to another without losing the renewal benefits?
Yes. The Insurance Regulatory and Development Authority (IRDA) has issued a circular making it effective from 1st October 2011, which directs the insurance companies to allow portability from one insurance company to another and from one plan to another, without making the insured to lose the renewal credits for pre-existing conditions, enjoyed in the previous policy. However, this credit will be limited to the Sum Insured (including Bonus) under the previous policy. For details, you may check with the insurance company.
What happens to the policy coverage after a claim is filed?
After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement. For Example: In January you start a policy with a coverage of Rs 5 Lakh for the year. In April, you make a claim of Rs 2 lakh. The coverage available to you for the May to December will be the balance of Rs.3 lakh.
What is 'Any one illness’?
'Anyone illness' would mean the continuous period of illness, including relapse within a certain number of days as specified in the policy. Usually, this is 45 days.
What is the maximum number of claims allowed over a year?
Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However, the sum insured is the maximum limit under the policy.
What is a “health check” facility?
Some health insurance policies pay for specified expenses towards general health check-up once in a few years. Normally this is available once in four years.
What do you mean by Family Floater Policy?
Family Floater is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to a maximum of overall limit of the policy sum insured. Quite often Family floater plans are better than buying separate individual policies. Family Floater plans to take care of all the medical expenses during sudden illness, surgeries, and accidents.
