Health Insurance

To get a health insurance policy, an individual has to pay a premium amount at regular intervals as selected by him/her during the inception of the policy. From the commencement of the policy, if the insured person has any medical expenses to bear, the insurer will be liable to pay them as per the terms and conditions. Please note that few insurers have a waiting period within which no claims will be entertained. The waiting period differs from one insurer to another.

Health insurance is usually included in the benefits offered by an employer to the employees of an organisation. However, the extent of coverage under such a policy may be limited. So, it is advisable to buy a separate individual health insurance policy for extended coverage.

Health insurance plans are available for individuals, families, and senior citizens. The family floater plans protect the entire family under a single insurance policy, covering Out Patient Department (OPD) expenses and much more. Senior citizen health plans usually provide comprehensive health insurance cover for the elderly for treatment of accidental injuries and illnesses.

The following is a brief list of things you should and should not do when buying a health insurance plan:

Critical illness plan is a rider or add-on that can be attached to your base health insurance or life insurance policy. Under the critical illness rider, the insurer is bound to pay a lump sum amount to the policyholder if the life insured is diagnosed with any of the specified illnesses mentioned in the policy document. On the other hand, medical insurance is an insurance coverage against medical and surgical expenses incurred by the life insured while the policy is active. Insurers will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.

Life Insurance offers financial protection to your family at different stages of their lives in your absence whereas health insurance provides insurance coverage against medical expenses incurred by the insured members due to an illness or accidental injury when the policy is active.

Term plans are the purest form of life insurance plans which offers optimum life cover upon the death of the life insured without any maturity benefit. Health insurance provides insurance cover against medical and surgical expenses incurred by the life insured while the policy is active. The insurance company will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.

1. What is meant by ‘No-Claim Bonus’?

   ‘No-Claim Bonus’ is a benefit offered to the policyholder for every claim-free year. It is awarded upon renewal and comes in the form of discounts on premiums or enhancements in the chosen sum assured. Discounts/enhancement range between 5% - 50%.

2. What are family discounts?

   These are reductions in premiums, awarded to the proposer for covering additional members, usually more than two.

   This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).

3. What is ‘claim-settlement ratio’?

   This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).

4. Is it safe to buy insurance online?

   Yes, most insurers feature an online purchasing and renewal facility on their own website. There are, also, a number of financial services portals that provide this service. Leading portals drive business based on trust and security so it’s definitely a safe alternative to traditional methods.

5. Why is it cheaper to buy policies online?

   It is cheaper than going through an agent because the middleman viz. the agent does not play a part in the process and the cost of the policy is reduced by the amount of commissions paid (to the agent).

6. What is ‘switching’?

   This is when a policyholder moves or ports from his/her current provider to another. Policyholders are allowed to transfer the coverage and benefits from their current policies to a new insurer, subject to certain conditions. Health insurance portability gives policyholders flexibility in case they are not satisfied with their present provider or find more economic options.

7. Are there any tax benefits available on health assurance products?

   Yes, premiums paid on health insurance plans qualify for tax benefits as per Sec80D of the Income Tax Act.

8. What is a ‘Free look Period’?

   If a policyholder is not satisfied with the policy he/she has taken or the provider of the policy, he/she can cancel and return the policy within 15 days of receiving it. Premiums already paid will be refunded, subject to adjustments.

9. Is service tax applicable to premium payments?

   Yes, service tax and other charges are applicable at rates and conditions as prescribed by the law (subject to change). Consider this aspect when calculating premiums.

10. Will duplicate policies be issued if the original is lost?

    Yes, a duplicate can be obtained by following the procedure set in place by the insurer, usually on payment of charges for a copy.

11. Who are considered to be ‘dependents’?

    Anyone who depends on the primary member for their livelihood, commonly the proposer’s spouse, children and parents, are considered dependents. Children are often considered dependents beyond 18 years up to the age of 25 years if they are still students (sons) or unmarried (daughters) or mentally challenged. Dependent children are often covered only if a parent is concurrently covered under the same plan.

12. How are premiums calculated?

    Premiums are charged based on the age and location of the insured member and the sum assured chosen. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.

13. What are cashless claims?

    This is whereby claimants avail medical services at their network hospitals without making upfront payments (subject to approvals). This is different from reimbursement of claims whereby claimants make upfront payments for treatment and subsequently submit bills to the insurance company for compensation.

14. What is ‘Co-payment’? What are ‘deductibles’?

    Under some plans, the insurer and the insured are jointly liable to meet expenses. The policyholder will pay a certain percentage towards expenses incurred. If policyholders exercise this option, they are often given reductions in premiums.

15. What is ‘sum assured’? What are ‘sub-limits’?

    Sum assured is the overall amount within which all claims have to be made. Sub-limits are caps placed on different kinds of claims. For e.g. only a certain amount of the sum assured can be claimed for room expenses, or, ambulance charges will be reimbursed only up to a certain amount per hospitalisation.

16. What is meant by ‘restoration’ or ‘reinstatement’ of sum assured?

    If, during a particular year, a claim was made, the sum assured is reduced by that amount. The amount remaining as sum assured may not be sufficient to cover any future claims. In this case, some companies offer their clients the benefit of restoring the sum assured to the original amount so as to meet a subsequent claim. This is offered once during a policy period as an added benefit to enhance coverage.

17. What is the difference between health insurance and mediclaim?

    Although used interchangeably, mediclaim is technically not the same as health insurance. Broadly, the difference between the two types of health covers lies in the quantum and breadth of coverage offered. Even though it is considered a form of health insurance, mediclaim plans are more specific in their coverage i.e. it is usually only for hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans on the other hand can be customised to cover expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses etc.

18. What is day care health coverage?

    Day care procedures ate those medical treatments that do not require the patient to be hospitalised for a minimum of 24 hours. Day care treatments can be done in few hours so it is done as an outpatient procedure. There are many insurers who offer health insurance coverage specially designed for day care treatments.

19. What is the benefit of day care health insurance?
    • Day care health insurance comes with many benefits. Some of the benefits are:
    • Day care health insurance plan covers the expense incurred buying medicines.
    • It also covers like diagnostic tests which are otherwise will be covered only if the insured is hospitalised.
    • It covers various day care treatments like Tympanoplasty, middle ear reconstruction, incision of tear glands, cataract operation, ENT treatments, ophthalmology, and radiotherapy.
    • Day care health insurance plan gives you tax benefits.
20. What treatments do day care health insurance cover?

    Thanks to the sophisticated technology we have in the medical field! What took us days now takes us less than 24 hours. Many medical treatments can be given in few hours because of the advancement in the medical industry. If the treatment can be given to the policyholder as an outpatient, it will be termed as day care procedures. Some of the day care procedures are:

    • Tympanoplasty
    • Middle ear reconstruction
    • Incision of tear glands
    • Cataract operation
    • ENT treatments
    • Ophthalmology
    • Radiotherapy

    More on:day care procedures.

21. How to choose a health insurance plan on basis of day care procedure?

    Most of the insurance policy providers cover day care treatments. One has to research well while buying a health insurance plan on basis of day care procedure. Some of the factors you need to consider are:

    • Choose a health insurance plan that classifies their day care procedures department-wise like oncology, urology, or cardiology instead of companies that list the number of treatments that are covered. When an insurer lists many treatments it makes the reader feel like they are getting a lot. Well, this may not be the case in reality. Always check for broader classification of day care procedures.
    • Read the exclusions multiple times and compare it with other health insurance policies. It is very important to know what treatments are not covered.
22. What is domiciliary hospitalisation?

    Domiciliary hospitalisation means that the policyholder is being treated for a certain ailment within the confinement of his/her home and not in a hospital or a nursing set up. Usually, domiciliary hospitalisation is allowed when they aren’t able to move the patient from home to the hospital or when the patient cannot be taken to the hospital due to lack of accommodation. In other words, domiciliary hospitalisation refers to the treatment given to a patient for a certain disease or injury for more than 3 continuous days due to non-availability of accommodation in the hospitals or because the patient cannot be moved to the hospital.

23. What are the benefits of domiciliary hospitalisation?

    If you have a health insurance policy that covers domiciliary hospitalisation, some of the treatments they cover are:

    • Expenses incurred to get blood, anaesthesia, and oxygen
    • Diagnostics tests and X-ray charges
    • Cost incurred to purchase medicines and drugs
    • Consultation fees, doctor charges, and specialist fees
    • Home nursing service expenses
24. Is dental treatment covered?

    Most of the health insurance plans do not cover dental treatments. Dental treatments are one of the common exclusions in India. Please check with your insurance provider if they do.

    Check various options here - Dental Insurance Coverage.

25. How to select the best health insurance plan?

    Listed below are some tips that you can follow to select the best health insurance plan:

    • Buy a comprehensive health insurance plan that suits your requirements.
    • Keep an eye on the exclusions.
    • Do not land up paying higher premium to get low co-pay.
    • Give importance to the incurred claim ratio and claim settlement ratio of the insurance company.
    • Choose an insurance plan which comes with high No-claim Bonus.
    • Research well about the plan and the insurance company.
    • Compare various health insurance plans online.
26. How to read the fine print of the policy document?

    There are no shortcuts when it comes to reading the fine print of your health insurance policy document. However, you can follow the steps below to which will help you read the fine print of your policy document:

    • Take the time out and pay attention to every detail and read every sentence mentioned in the policy document.
    • Read the exclusions mentioned in the policy document, as it tells you about the services that are not covered.
    • Insurance plans are filled with jargons. If you do not understand anything, get in touch with the customer service department of your insurer and ask them to explain it to you.
    • Check if all your personal information is correct.
27. What are some of the top myths about health insurance?

    There are many myths when it comes to health insurance in India. Some of the myths are as follows:

    • Many of us think that you are insured from day one as soon as you have purchased an insurance plan. However, most of the insurance plans have a waiting period within which period no claims would be entertained.
    • A low premium plan is not the best plan in the market.
    • Another myth that we have in India is that health insurance plan does not cover maternity expenses. Most of the health insurance plan comes with an option to attach maternity benefit rider which covers pregnancy-related expenses.
    • The number of day care procedures listed in your policy document matters. Always check for border classification when it comes to treatments covered instead of each minor medical treatment listed.
    • Buying a health insurance online is not secure.
28. What are the documents required when you submit a reimbursement claim?

    The below documents are required when you submit a reimbursement claim:

    • Duly-filed reimbursement claim form
    • Health card and identity proof of the insured
    • Original hospital bills
    • A copy of the discharge summary
    • Original pharmacy bills
    • A bill for ambulance charges, if it is covered by your insurer
    • Original cancelled cheque
    • Any medical investigation report like ECG, X-ray, MRI, CT scan, or any other reports.
29. What do you mean by floater option?

    A floater option means that under one single health insurance plan, the sum assured amount can be used by all the members covered under the particular policy. All family floater health insurance plans have this option. Unlike individual health insurance plan, the sum assured is not for a single person under floater option.

30. What do you mean by reimbursement?

    Health insurance providers in India offers cashless hospitalisation facility where they settle the medical bill directly with the hospital if the policyholder is admitted in any one of their network hospitals. However, if the policyholder is admitted in a non-network hospital due to an emergency, the policyholder will have to pay the bill and later get it reimbursed from the insurer. Based on the terms of the plan, the insurer will reimburse the amount spent by the policyholder.

31. What is the difference between individual and floater options?

    An individual insurance plan is designed to cater to the needs of one person. The sum assured is completely used by the individual person. However, in a floater option, the sum assured can be used by anyone of the members under the insurance plan. Floater options are perfect for families where more than one member require insurance coverage.

32. Which are the expenses that are included in sub-limit amount?

    Some of the expenses included in sub-limit amount are room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.

    More details on:Sub-limits.

33. Does the health insurance policies cover homeopathy treatments?

    Generally, not all health insurance plans cover homeopathy treatments. You will have to check with your insurer if homeopathy is covered under the plan. However, if you are looking for insurers who offer health insurance plans that cover AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatments, visit - Medical insurance for AYUSH.

34. Do I get some additional benefit on hospitalisation due to an accident?

    The benefits you get when you are hospitalised due to an accident depends on the type of plan you hold. Generally, personal accident covers pays for your hospitalisation bill, over-the-counter drugs, consultations fees, and other such expenses. If the accident has left you permanently disabled, the agreed sum assured amount will be given immediately. In case of the unfortunate death of the insured, the death benefit according to the plan will be payable.

35. If I do not make a claim within a policy period, can I get a refund of my money?

    Unfortunately, that is not an option. If you have not submitted a claim in one policy year, you will be eligible to get a no-claim bonus (depending on the insurance provider). A no-claim bonus is a discount given on your premium amount, expressed in terms of percentage, and can be used while renewing your policy. Few insurers also increase the sum assured amount without any additional charge if you do not make a claim in a policy year.

36. What are the benefits of health insurance portability for the policy holders?

    When you switch your existing health insurance policy to a new insurance provider, you are entitled to the following benefits:

    • The sum assured on your new health insurance plan will be up to o more than the sum assured amount of your previous policy.
    • You will be allowed to change the type of your insurance plan from individual insurance plan to family floater plan and vice versa.
    • If you had maintained your insurance cover without any break, you may also be eligible to receive credits in terms of pre-existing conditions and waiting period from your new insurer.
37. What are the treatments or medical services that are covered under pre and post-hospitalization expenses?

    If you insurer covers pre-hospitalisation expenses, the following will be covered:

    • Doctor or physician consultation fees
    • Blood tests
    • X-rays
    • Urine tests
    • Scans
    • Pharmacy expenses
    • Others

    Post-hospitalisation cover usually pays for:

    • Pharmacy bills
    • Acupuncture
    • Physiotherapy
    • Cost of medicines
    • Consultation fees
    • Diagnostic charges and others

    More details on pre and post-hospitalisation expenses.

38. How is the premium for a family floater policy calculated?

    The premium for a family floater policy is calculated after considering various factors like age of the oldest member of the family, policy term, number of members covered under one plan, the health condition of the insured, type of plan selected, and the sum assured selected. There is no universal formula used by insurance companies to calculate the premium for a family floater plan. It differs from one insurer to another.

39. What do you mean by cashless hospitalisation?

    Most of the insurers today offer cashless hospitalisation benefit to their policyholders. Under cashless hospitalisation, if the insured is hospitalised in a network hospital for more than 24 hours, the hospital bill will be settled by the insurer directly with the hospital. The policyholder do not have to arrange for funds, pay the bill, and later file a reimbursement claim. The insurer will pay the bill as per the terms and conditions of the policy held by the insured and the policyholder will only be responsible for those items that are not covered under the insurance plan.

40. What is the minimum and maximum age at which one can enter and buy a health insurance policy?

    The entry age and the maximum age criteria of the insured differs from one plan to another. Generally, health insurance plan are available for individuals from 3 months old to 65 years. There are few senior citizen plans that cover senior citizens above 65 years as well.

41. What do you mean by pre-existing disease?

    As the name suggests, pre-existing disease are those medical conditions that an individual suffers from even before buying a health insurance policy. These are not the diseases that the insured developed after buying a health insurance policy. Some of the examples of pre-existing diseases are asthma, diabetes, blood pressure, cancer, or ulcers.

    More information on this page - pre-existing diseases.

42. What is the difference between a family floater and critical illness or hospital cash insurance?

    A family floater health insurance plan, as the name suggests, is an single health insurance policy that covers the entire family. The sum assured, in this case, is used by all the members of the family as and when a issue occurs.

    On the other hand, a critical illness insurance plan covers a list of pre-agreed critical illnesses like cancer, heart issues, tumours, or any such diseases. If an insured person is diagnosed with any one of the listed critical illnesses, the sum assured and other benefits under the plan will be paid immediately.

    When a family member or loved one is hospitalised, apart from the hospital bills many out of pocket expenses are incurred. Some of the out of pocket expenses are money spent for food, travel, and non-admissible items. To help people meet these expenses, a hospital cash insurance offers a fixed daily cash benefit or allowance if the insured is hospitalised.

43. Do I need to undergo a medical check-up while buying a health insurance policy?

    Some insurance providers would ask you to undergo a medical check-up before you buy a health insurance policy. However, there are many who do not require it. This differs from one insurer to another.

44. How do I cancel my health insurance policy?

    If you already have an health insurance policy, please check if you have an option to surrender the plan to your insurer. At times, insurers provide certain benefits if a policyholder surrenders the plan after completing certain number of years.

    If you have just purchased a health insurance plan, please check for the free-look period or the cooling-off period. Most insurance give free-look period within which the policyholder can return the policy back to the insurer.

    You will also have an option to cancel the policy while renewing it. However, this depends on your insurance.

45. Why is medical insurance important?

    Increasing number of illnesses, unhealthy lifestyle, and poor health habits have forced many to contemplate about buying a comprehensive health insurance plan. No one can predict when an illness will knock us down. That's exactly why having a health insurance is very important these days. Some of the other reasons why health insurance is important are:

    • You employer-provided insurance cover might not be sufficient
    • Cashless hospitalisation benefit
    • Cost of medical treatment in India is increasing and you would not be able to afford it with your savings
    • Tax benefits.
46. What are the illnesses covered under critical illness?

    Some of the illnesses that are usually covered under a critical illness plan are:

    • Cancer of specified degree
    • First heart attack
    • Open chest CABG
    • Coma of specified severity
    • Deafness
    • Major burns
    • Loss of speech
    • Organ transplant
    • Bone marrow transplant
    • Others
47. What parameters are considered for calculating the premium?

    Some of the parameters that an insurer considers while calculating the premium for your health insurance plan are:

    • Age of the insured
    • Sum assured selected
    • Type of the plan chosen
    • Gender of the insured
    • Medical history
    • Pre-existing illnesses and others

    For a comprehensive list of factors that are considered while calculating premium, please visit this page.

48. What is the procedure for reimbursement settlement?

    If a insured person is hospitalised in a non-network hospital, they will have to pay the hospital bill and later file a reimbursement claim. Generally, the procedure to file a reimbursement claim is as follows:

    • The insured pays the medical bill from his/her pocket.
    • Collects all the necessary documents from the hospital.
    • Within the time period mentioned by the insurer, the insured has to submit a duly-filled reimbursement claim form with all the necessary documents. Generally, the documents asked would be:
      • Duly-filled application form
      • Discharge summary from the hospital
      • All lab reports like scan, X- rays, and blood tests taken
      • Payment receipt
      • Pharmacy prescriptions and bills
    • Once the insurer receives the documents, they will verify it and ask you for additional documents if required.
    • Upon receiving all the documents, the insurer will pay for those items and expenses that are covered under the plan.
    • The payment will be reimbursed to the insured.
49. What are the steps for cashless settlement?

    To avail cashless settlement benefit, the process is as follows -

    In case of planned hospitalisation:

    • In case of planned hospitalisation, the insured should keep the insurance provider informed about the hospitalisation few days prior.
    • The insured should choose a network hospital in which the treatment they are looking for is available.
    • The insured should get in touch with the TPA(Third-party Administrator) desk in the network hospital and fill the authorisation form.
    • The TPA will send this form to the insurer for approval.
    • Upon receiving the approval, the insured can go ahead and get admitted to avail the treatment.
    • When the insured is being discharged, a final bill will be generated and sent to the insurer.
    • Upon final approval, the insurer will pay the bill directly to the hospital and the insured will be free to go.

    In case of emergency hospitalisation:

    • In case of an emergency, the insured person should locate the nearest network hospital and get hospitalised.
    • Once the insured is hospitalised, a family member or a loved one should get in touch with the TPA desk in the hospital with the health card of the insured.
    • The family member should fill the authorisation form.
    • The TPA will send this form to the insurer for approval.
    • When the insured is being discharged, a final bill will be generated and sent to the insurer.
    • Upon final approval, the insurer will pay the bill directly to the hospital and the insured will be free to go.
50. What if I want to renew my health insurance policy after one year?

    Most insurers allow you to reinstate your health insurance policy within 2 years from the date of the first missed payment or the discontinuance date. However, this differs from one insurer to another. Please check the renewal procedure for your policy with your insurer.

51. What is a health card?

    A health card is like an identity card given by the insurer to the policyholder. It contains information like the policyholder’s insurance account number, the name of the insured, the age of the insured, gender, policy expiry date, and other such vital information. It is mandatory for an insured person to show the health card at the hospital in case of hospitalisation.

52. What are the benefits of a health card?

    A health card is very important because:

    • Without a health card, you would not be allowed to be hospitalised in any network hospital.
    • Without submitting a copy of your health card, your cashless or reimbursement claim may be rejected.
    • You may have to pay your medical bills if you do not have a health card provided to you by your insurer.
    • When you are hospitalised, it helps your family or a loved one to process the claim using your health card. Otherwise, they would not have any information about your insurance policy.
53. What are the best health insurance companies in India?

    There are many leading health insurance companies in India. However, the best health insurance company differs from one person to another. It depends on the type of insurance coverage you are looking for and who cater your needs better.

54. How to select the best health insurance plan in India?

    If you are looking for a best health insurance plan, please consider the following:

    • Always choose an insurance plan that suits your requirements.
    • Choose a plan that can be personalised to match your needs.
    • Compare the benefits and features of the plan with other similar plans in the market.
    • Shop online for the best insurance plans. You will find many plans that you can compare.
    • Choose a insurance plan that if offered by reputed insurance providers. The brand name matters.
55. What is the procedure for change of address for medical insurance?

    Most insurers have a change request form that you will have to fill to change the address. Some of the insurance also allow you to change the address online by filling a virtual form. Please note that you will have to submit the form along with your new address proof.

56. I am already having health insurance and want to increase sum insured, what should I do?

    Most insurance providers allow you to increase your sum assured at any time during the policy. Insurers these days also offer top-up health insurance plans. A top-up insurance plan allows you to attach additional cover to your existing insurance plan at a nominal cost. Please check with your insurer for this option.

    For more details: Top-up health insurance plans.

57. Can a person have more than one health policy?

    Yes. A person can have more than one health policy. In case of hospitalisation and claim settlement, each insurer will pay as per the ratio agreed by them.

    More details: Claim settlement procedure for multiple health policies.

58. If my policy is not renewed in time before expiry date, will I be denied the option for renewal?

    The policy can be renewed if you pay the premium dues within the grace period which is 15 days from the expiry date. The policy will lapse if the premiums are not paid within the grace period. There is no insurance coverage available during the grace period.

59. Can I transfer my policy from one insurance company to another without losing the renewal benefits?

    Yes, as per the Health Insurance Portability and Accountability Act, you can transfer your health insurance policy from one insurer to another without losing the policy benefits.

60. What happens to the policy coverage after a claim is filed?

    After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.

61. What is 'any one illness’?

    'Any one illness' means the continuous period of illness which includes the relapse period within a certain number of days as specified in the policy document. Usually, this is 45 days.

62. What is the maximum number of claims allowed over a year?

    Any number of claims can be made during the policy term unless there is a specific limit mentioned in the policy document. The sum insured is the maximum limit one can claim under the policy.

63. What is ‘health check’ facility?

    Once in 4 years, some insurers pay for health check-ups of the life insured. This is called ‘health check’ facility.

64. Who is our Health TPA?

    Some insurers appoint a Third Party Administrator (TPA) to process all the claims of their policies. The contact details of the TPA will be available on your health card.

65. Do I have to undergo any medical examination?

    Based on the age of the life insured and certain medical conditions, a medical examination may be required.

66. Do I have to undergo a medical check-up every year?

    No, you don't have to undergo a medical check-up every year if you ensure to renew the policy continuously without fail and there are no changes in the policy terms and conditions.

67. Who pays for the medical examination?

    You have to pay for the pre-policy check-up. Some insurer will reimburse 50% of the cost.

68. Who is a medical practitioner?

    A medical practitioner is a person who is registered with the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction. It can be a physician, specialist, surgeon, etc.

69. What do you mean by medical expenses?

    Medical expenses are the expenses incurred by the life insured for medical treatment received during the policy period on the advice of a medical practitioner due to an illness or accident.

70. How can I indemnify or claim benefits under the policy?

    The expenses can be indemnified through reimbursement claims or availing cashless services at a network hospital.

71. Is cashless facility available across all hospitals?

    Cashless facility is available only at your insurer’s network hospitals.

72. Are all the major corporate hospitals on the network?

    Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.

73. Will I get cashless at government institutions like AIIMS/TMH/ARMY Referral hospitals?

    Cashless facility may not extend to government institutions.

74. If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?

    Yes, the insurer will pay the entire amount for the medical expenses incurred subject to the sum insured. You may have to pay for the non-medical expenses and those that are not covered by the policy to the hospital before your discharge from the hospital.

75. In case of cashless treatments, in whose favour are cheques settled or who gets the payments?

    In case of cashless treatments, the cheque will be sent to the network hospital where the life insured availed treatment.

76. What is co-payment?

    Co-payment is a cost-sharing requirement wherein the life insured will bear a specific percentage of the admissible costs. Co-payment doesn't reduce the sum insured but it reduces the insurance premium.

77. What is a waiting period?

    It is the specified period of time from the date of policy inception, after the completion of which the full or partial insurance cover will begin or become active. The waiting period for a senior citizen health insurance plan is higher, from 1 to 4 years for certain illnesses.

78. Why should I take a health policy if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

    The group insurance provided by your employer will offer only the basic cover. Employers offer group insurance as a liability cover. It doesn’t fully cover your needs. If you were to shift organizations, the insurance cover from the previous employer will cease. In addition to your group insurance policy, it is advisable to have an individual health insurance plan to adequately cover you and your family.

79. What is the basic difference between individual and group health insurance coverage?

    Group insurance package is purchased by an organization for the benefit of its employees. Individual insurance is bought by individuals for themselves or their families. The differences between the 2 insurance are as follows:

    • A group health insurance policy can be availed at a low or no cost to the employee. Therefore, the cost is less compared to an individual insurance plan. The premium for group insurance is deducted directly from the employee's salary.
    • Everyone who is an employee of the organization is granted approval for group insurance. In the case of individual insurance, there are possibilities of rejection.
    • Group insurance cover lasts only as long as you work with that employer.
    • Individual insurance can be customized to suit your medical needs.
    • You can benefit from No Claim Bonus only in the case of individual insurance.
80. Why should I buy overseas travel insurance?

    Most countries insist on seeing a valid travel insurance policy upon entry. Receiving healthcare in a foreign country can prove to be a costly affair. When you make travel plans, it is advisable to be prepared for unforeseen, unfortunate events like a medical emergency or a personal accident during the duration of your trip.

    Be well-prepared by purchasing an overseas travel insurance policy that offers adequate medical cover against medical expenses including ambulance fees, medical treatment, medical evacuation, and hospitalization. The insurer will settle the claim once the insured person has returned to India except in the case of hospitalization.

81. Why should I buy a critical illness cover?

    Lifestyle diseases like diabetes, hypertension, and obesity have become prevalent among the younger generation. Treatment for critical illness is expensive without an insurance cover. A Critical Illness Rider will provide medical coverage against specified illnesses. Most policies cover 10 to 25 critical illnesses. Heart attack, cancer, stroke, and sclerosis are some of the illnesses covered by this rider.

    The insured person must survive minimum 30 days from the date of diagnosis to make the critical illness claim. The waiting period is 60 to 90 days under most policies. You can also get tax deductions on premiums paid towards a critical illness rider under Section 80D of the Income Tax Act, 1961.