Health Insurance FAQs Answered [Updated]
Insurance in India

Health Insurance FAQs Answered [Updated]

Health insurance in India is complex to understand and people do have many questions for which they look for answers online. Unfortunately, there is no single website that ensures all health insurance faqs answered on one page so that one doesn’t have to look somewhere else if they have more questions.

I have been an insurance writer and have worked in the insurance sector for many years. During this period, I got the opportunity to read, learn, and write a lot about health insurance.

Health Insurance FAQs Answered

In this very post, I have tried to answer all health insurance faqs to help you choose the best policy. In case you already have one, the questions you may have on your mind have been answered below:

What is Health Insurance in India?

Health insurance or medical insurance or mediclaim – these are three common terms related to health insurance in India, which are interchangeably used quite often by laymen.

Simply put, health insurance is an insurance policy or an agreement between an individual and an insurance firm, which states that the company is entitled to pay the insured or policyholder a certain sum assured in exchange for an annual premium, in case he or she falls sick or gets hospitalized due to a health condition that is covered by the policy.

What is an Insurance Premium?

The term Premium in relation to health insurance refers to the amount of money payable by an insurance-seeker in return for the assured medical or health coverage. Now, this premium could be payable as a one-time (annual) payment, quarterly payments, or semi-annually, depending upon the insurer.

What is the Sum Assured in Health Insurance?

The term Sum Assured refers to a particular amount of money that is payable to the policyholder when they file a claim for the same in case of inpatient or outpatient hospitalization. The sum assured is also known as the insurance coverage, which is selected while purchasing the insurance policy.

What is Inpatient Hospitalization?

The term Inpatient Hospitalization can be explained as when an insured individual avails medical treatment for a particular disease or ailment at a hospital that is listed among the network hospitals of the insurer as per the policy terms.

Inpatient hospitalization, in most cases, occurs whenever there is a medical emergency or it’s more of an unplanned hospitalization. In such cases, simply display the health card provided by the insurer for hospital admission to the concerned individual who shall contact the insurer in this regard.

What is a Health Card?

A health card is more or an insurance-holder’s identity card that eases hospital admission for cashless treatment. Once you display this card to the concerned person at the hospital, the treatment under the insurance policy shall commence without any hassle.

What is Cashless Hospitalization?

The term Cashless Hospitalization relates to an scenario wherein hospital admission and medical expenses are covered by the insurer as per the policy terms and conditions.

What is Outpatient Hospitalization?

The term Outpatient Hospitalization can be explained as when an insured individual avails medical treatment for an ailment that does not require hospital admission, typically at home.

An individual seeks outpatient hospitalization when he or she has already planned to avail the treatment for an existing ailment.

How to File a Reimbursement Claim on my Health Insurance?

There could be an instance wherein you have to pay for your hospitalization and medical expenses on your own. In such cases, you can file a reimbursement claim after 30 days of discharge from the hospital. 

To support your reimbursement claim, make sure to attach all the original medical certificates and bills, prescriptions papers, and other post discharge expenses with your hospital registration number mentioned on each paper. Also, keep a copy of all these documents with you.

Another document you need to submit to your insurer is the discharge card issued by the hospital, which confirms that you are medicall fit. Foll all post-hospitalization expenses to be reimbursed, you can provide these documents within 30 to 90 days, subject to your policy’s terms.

When should I buy Health Insurance in India?

When it comes to buying a health insurance policy in India, the earlier you secure your health, the better. Now, when I say better, I mean it’s good to have insurance coverage at a young age, as you would pay significantly less than you will pay later for the same coverage.

Besides, when you are young, you have no or less financial burden on your shoulders, compared to what you may have at some point later in life.

How much Health Insurance Coverage do I need?

This is one of the most common questions asked by insurance-seekers in India.

When it comes to how much health insurance coverage you need, nobody can answer this question in such a way that is appropriate, as the future is quite uncertain and anything can happen to anyone in the very next second.

Health insurance policies provide coverage in terms of sum assured, i.e. a certain amount of money payable to the policyholder when they file a claim for the same. Now, the question that how much a condition can cost remains unanswered. Therefore, the ideal answer to this question, in my opinion, should be to avail the maximum coverage possible.

Information Alert! You can easily avail of medical coverage twice your annual income.

What is Waiting Period in Health Insurance?

Health insurance policies do have a certain waiting period, ranging from 24 to 48 months in certain cases. For instance, you cannot claim coverage for a pre-existing ailment until this waiting period is over. By the way, the waiting period for all-pre-existing diseases starts right from the date of policy inception.

Apart from the waiting period applicable to all pre-existing conditions, another type of waiting period is applicable to certain diseases diagnosed after policy inception. Such medical conditions can be a hernia, ENT disorder, osteoporosis, etc.

When should I Claim Health Insurance Coverage?

Health insurance claims are no different from car insurance. This also means that you earn NCB or no claim bonus at policy renewal if you did not make a claim in the previous policy year. Now, if you are getting hospitalized for just one day and the total expense is just INR 5000, then you must check on that NCB amount.

In case your NCB is going to be more than your current hospitalization bill, take a wise decision and don’t file a health insurance claim this time. Now, the answer to your question is clear here.

What is No Claim Bonus (NCB) in Insurance?

As you can predict, NCB is a discount given to you on the base premium of your health insurance policy at renewal, in case you didn’t make any claim in the previous policy term.

No Claim Bonus is usually provided in the form of discounted renewal premium or additional sum assured for the next policy year. NCB is offered in percentage and is quite a good amount.

Now, you can understand why buying health insurance at a young age is recommended. Let me remind you it’s because you are less prone to diseases and thus to claims as well. You can earn accumulate NCB for multiple years and get less at renewals.

Do Health Insurance Policies Cover Maternity?

While many health insurance policies don’t cover maternity by default, you can add maternity cover to your existing health plan to avail of the benefit. However, some companies offer their female employees maternity coverage in their group health insurance plan.

In case you are a working woman, make sure to confirm the same with the HR department in your company.

How much does a Health Insurance Policy Cost?

The cost of a health insurance policy for you can be different from your friend’s. This is because the calculation of insurance premium is subject to various factors, such as age, medical history, family medical history, current profession and risks (if any) associated with it, smoking/drinking habit, and many more.

So, on your way to purchasing a health plan, you are asked all these pieces of personal information to fill in the form.

Now, perhaps you can understand that a smoker individual is at higher risk of getting a lung condition in the future than others. Therefore, he gets to pay a higher sum of money as the premium.

Today, a non-smoker individual below 30 can get a health plan for an annual premium of INR 3,000 to 4,000. If they include one or more riders or add-ons, the annual premium rises by up to INR 1,500 to 2,000.

What all Riders/Add-ons can I add to my existing Health Insurace Policy?

Since a traditional health insurance policy does not cover critical illnesses, you need to add the critical illness rider to your policy to avail the benefit. Likewise, there are more such instances/events that require add-ons. The following is a list of all such add-on that you can opt for:

  • Critical illness rider – This rider/add-on includes coverage for critical illnesses, such as a heart attack, kidney failure, paralysis, cancer etc. in your existing health plan. Once such a condition is diagnosed, the insured gets the sum assured in the form of a lump sum.
  • Co-payment – This rider states that the insured will have to bear a certain share of the claim whenever they file any, which is in exchange for paying a reduced annual premium. This rider is beneficial for individuals who are young and therefore at low risk of an illness.
  • Top-ups – This rider allows you to increase your existing sum assured by a certain amount to cover ensure that any claim in the future covers the total expense. This option is way better than buying a separate health plan for additional coverage.
  • Deductibles – This rider states that a certain share of the expense claimed is to be borne by the policyholder. Unlike co-payment rider, the insured has to pay his share first and then the remaining amount is payable by the insurer. Now, since a small portion of the risk is shifted to the policyholder’s shoulders, the premium payable also lowers.
  • Hospital cash – This rider gets the insured a compensation for the loss of income and other petty expenses from the insurer during the hospital stay.

What is a pre-existing disease/ailment?

Any disease/ailment that is diagnosed before getting a health insurance policy is referred to as a pre-existing condition, which insurance companies are typically reluctant to cover to curb their cost of coverage.

Now, as your policy doesn’t cover a pre-existing condition, it should never keep you from having adequate coverage for the future. Moreover, after a certain waiting period applicable, such conditions are eligible for insurance coverage.

Should I buy a family health plan or an individual health insurance plan?

When it comes to the cost, purchasing a family health insurance plan turns out to be a more affordable option as compared to individual health plans for all family members. However, some family health plans lapse as soon as the eldest member in the family reaches the maximum age cover by the policy or dies. So, you need to check on that aspect as well.

Besides, you need to consider another aspect here, which states that the senior members in the family are more prone to hospitalization and therefore to making health claims. In such cases, other family members may not have sufficient coverage left for them.

This scenario does invite a top-up at any time; so, do confirm if top-ups are allowed or not.

What is Personal Accident Insurance?

A personal accident insurance policy entitles you or the nominee to receive compensation in the event of injuries, total or partial disability, or the death occured during road/rail/air transport or a visible and violent means.

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