Frequently Asked Questions About Health Insurance

While buying health insurance, one may have many questions and queries regarding the coverage, claim settlement, etc. Some of the frequently asked questions are regarding emergency hospitalisation, documents needed, cashless policies, etc.

Health insurance is the one type of insurance which has now become a necessity. With time, costs of medical care have gone up drastically which has prevented many people from getting access to quality healthcare. With health insurance, you can preserve your savings which are likely to be spent on medical treatment at times of a medical emergency. However, when it comes to purchasing medical insurance, there are a lot of questions which possible buyers can have. If you are looking to purchase a health insurance plan but have a lot of unanswered questions regarding the whole affair, this article will help shed some light on the topic.

What is the Cashless Claim Settlement Facility?

The cashless claim facility can be availed by a policyholder at any of the insurer’s network hospital which offers this facility. Under the cashless, the policyholder can avail treatment at the network hospital, the bill for which will directly be settled between the insurer and the hospital. The policyholder will only have to pay for expenses which are not covered under the cashless facility or under the policy.

Will My Health Insurance Policy Cover me Across India?

Whether your policy covers you across the country or only within specified boundaries is something which you must clarify with your insurer before buying the policy. Typically, a health insurance policy will provide cover across India. Unless it is specified, the policy may not provide coverage for claims which arise outside the geographical boundaries of India.

Do Health Insurance Policies Provide Cover for Pre-existing Diseases?

Health insurance policies may or may not provide over for pre-existing diseases. Most often, if the policy does provide cover for a pre-existing condition, there will be a certain waiting period applicable on the coverage. Before taking the policy, do clarify the same with your insurer.

At the Time of an Emergency Hospitalization, Who Should I Call?

At the time of a medical emergency, the focus must be on getting the patient to a medical care facility. The first thing one must do is locate the closest network hospital to admit the patient. Only after the patient has been hospitalised, their family members must contact the insurer or TPA to inform them about the hospitalization. They will then be guided through the claim settlement process.

If I Have to Seek Treatment at a Non-Network Hospital, How Do I Make a Claim?

At the time of an emergency, it is often possible that the insured may end up getting hospitalised at a non-network hospital. In this case, they can file for a reimbursement claim after their treatment is over. A reimbursement claim is meant for times when the insured may not be able to get to a network hospital for getting emergency treatment. In this case, they can get treated, pay for the treatment and then file for a reimbursement claim. Such a claim will cover all expenses which are covered under the policy overage, except the ones which are not. To make a reimbursement claim, ask your insurer about the documents you need to submit.

What are the Documents Usually Required for Filing a Health Insurance Claim?

When it comes to health insurance, one question that many policyholders want to know the answer to is what documents they need to submit at the time of making a claim on their health insurance policy. It is helpful if the policyholder knows about this before they have to make a claim. Most health insurance providers will require the policyholder to submit the ID proof of the insured, health card issued by the insurer, and receipts/bills for the treatment taken. n case of cashless hospitalization, the insured will also be required to submit a pre-authorization form to the TPA. The insurer should ideally inform you in case additional documents are needed to process the claim.

What is the Claim Settlement Process Followed by Health Insurance Companies?

When it comes to health insurance, or any other type of insurance, the claim settlement process can make or break an insurer’s reputation. Before you purchase a health insurance policy, you must find out the details of the claim settlement process that the insurer has for claim filing. Usually, most insurers will require you to inform them about the claim as soon as possible. In case of cashless claims, the insured will submit a pre-authorization form to the TPA or the insurer, as the case may be. In case of a reimbursement claim, the insured must submit all bills/receipts pertaining to the treatment taken to the insurer. The insurer will bear all expenses which are covered under the policy, while the ones which aren’t’ will have to be borne by the insured.

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