Health Insurance FAQ’s

What is health insurance?

Health insurance is an agreement between the insurance company and the insured customer where the insurance company agrees to settle the claim in case of hospitalization due to an accident or illness in return for a considerable amount to be paid which is known as Premium. The agreement is valid only for a period of the mentioned policy term after which the policy has to be renewed.

Is health insurance important?

Health insurance is one of the most important financial planning tools available in the market. Without a health insurance you might be forced to dig out your savings and liquidate your assets in case of hospitalization. There are few people who take out personal loans to settle their hospital bills as there was no health insurance policy for them.

Is hospitalization always necessary to get a claim?

Health insurance is mainly taken in case of hospitalization due to an illness or accident. There is a provision in health insurance policy to get the claim without hospitalization; this provision is known as the domiciliary treatment where the insured customer can get treated for his/her illness or disease from one’s home. In health insurance there is provision for OPD also known as Out Patient expense which doesn’t require hospitalization. Hence, hospitalization is not necessary to get a claim in health insurance.

Is payment available for expenses incurred before hospitalization? Is payment available for expenses incurred after hospitalization? What are Pre & Post hospitalization expenses?

Yes, the expenses incurred before hospitalization are covered in your health insurance policy. Expenses incurred before the hospitalization are known as Pre hospitalization expenses while those incurred after hospitalization are known as Post hospitalization expenses. Every health insurance policy covers the pre and post hospitalization for at least 30 & 60 days. Pre and post hospitalization expenses are paid only if there is hospitalization involved due to an illness or disease which is covered under your health insurance policy.

Can the sum insured be increased at the time of renewal?

Yes. The sum insured can be increased at the time of renewal. A formal request is to be made to your insurance company to increase your sum insured at the time of renewal. It is to be noted that the extra premium for the increased sum insured should be paid to the insurance company and other conditions such as Pre existing waiting period, specific disease waiting period etc. should be satisfied for the increased sum insured.

Is there an age limit up to which the policy would be renewed?

Yes. In general there would be the minimum and maximum age limit for every type of health insurance policy. The maximum limit in general would be 60 or 65 years in most of the health insurance policies available in the market. There are several health insurance policies in the market which are known as “Senior citizen health insurance” which provide health insurance coverage to senior citizens. It is advisable to check with our agent before taking the health insurance policy.

Can the insurance company refuse to renew the policy?

No. Health Insurance Company cannot refuse to renew your health insurance policy unless there is a valid reason such as declaration of incorrect facts or activities of fraud. But health insurance companies may not send you your renewal notice in case of high claim ratio on your health insurance policy in the previous year. In case your health insurance policy is refused for renewal by the insurance company without a valid reason, you can file a complaint with the Insurance regulatory and Development authority.

Can I make a claim immediately after taking the policy?

Yes, you can make only an accident related claim immediately after taking the health insurance policy. Other claims for illness and diseases can be made only after satisfying the waiting period mentioned in the health insurance policy. There is a initial waiting period of 30 days for every health insurance policy which has to be satisfied by the insured before making a claim (except for accident related claims). In addition to the initial waiting period there is Specific disease waiting period and Pre existing disease waiting period which needs to be satisfied by the insured before making any claim.

What is Cashless hospitalization?

Cashless hospitalization is the process in which in the insured would get admitted in the hospital for treatment and the costs would be borne by the insurance company. The hospitalization cost would be paid to the hospital by the insurance company directly without the intervention of the customer. For this the insurance companies discuss packages with the hospitals and fix a price for a particular type of treatment. Cashless hospitalization is the best mode of claim settlement in a health insurance policy as the rising hospitalization costs are posing a serious threat to the people and causing a huge dent in their savings during hospitalization.

Can I change hospitals during the course of my treatment?

Yes. You can change the hospital during the course of your treatment and the claim would be payable under your health insurance policy. This should be intimated to your insurance company beforehand if possible to process the claim smoothly and avoid unnecessary ambiguity. But remember, the claim amount that can be paid would either be the claim amount or the sum insured whichever is less.

Can I change from group policy to an individual policy of new India at the time of renewal?

No. Group policy is different in terms and conditions when compared to the individual health insurance policy. Group policy is taken by the employer of a company for his/her employees and the premium is paid by the employer, but in case of individual health insurance policy the premium is to be paid by the insured customer. In short you cannot change from group policy to an individual policy at the time of renewal, but you can purchase a new individual policy at the time of renewal and opt out of group health insurance policy.

How to get reimbursements in case of treatment in non-network hospitals or denial of cashless facility?

Reimbursement of your claim can be obtained by applying for reimbursement facility after the treatment is done. Below are the steps to avail reimbursement claim from your health insurance provider.

Step 1: Intimate the insurance company regarding the claim and take a note of the “Claim reference number”. Fill the claim intimation form with the maximum details which form the first hand information provided by the customer regarding hospitalization.
Step 2: Submit all the necessary documents for claim processing which include:-

• Duly filled and signed original claim form.
• Valid Identity proof and address proof
• Doctor’s prescription advising diagnostic tests, medicine and consultation
• Original pharmacy bills
• Diagnostic tests, surgery bills and consultation as prescribed by the treating doctor
• FIR as required
• Ambulance receipts
• Any other document required to assess the claim

Will the entire amount of the claimed expenses be paid?

In any health insurance policy, the amount settled by the insurance company would be the claim amount incurred or the sum insured mentioned in the policy whichever is less. The maximum liability of the insurance company in case of claim would be the sum insured mentioned in the health insurance policy copy. There are certain expenses which are incurred during hospitalization such as Laundry expenses, food expenses which are not paid by the insurance companies. Consumables expense is paid by certain health insurance policies, consumables include gloves, hand wash, sanitizers etc. The claim amount paid by the insurance company varies from case to case and it can neither be agreed nor denied that the entire claim amount being paid in case of hospitalization.

What is the income tax relief provided by the health insurance policy?

There are certain income tax deductions available for people purchasing health insurance policies. The income tax relief is provided by the GOI to encourage more number of people buying health insurance policies. Below are the income tax exemptions available if a health insurance policy is purchased.

As mentioned above the minimum tax exemption under your health insurance policy is Rs.25k and the maximum tax exemption is Rs.60k. Further tax exemption can be availed through family health checkups.

What can be the maximum coverage in health insurance?

There is no limit on the maximum sum insured that can be opted in a health insurance policy. Many health insurance policies offer up to Rs.1 Crore coverage, there are instances where the coverage is extended beyond Rs.1 Crore depending on the client profile. Any request for sum insured higher than that available with the insurance company product will be referred to the underwriter who will examine the client profile and the need for such exorbitant coverage and decide on the insurability.

Why not I take a Top UP Policy instead of New India’s Mediclaim Policy?

A top up policy is an additional coverage for people already having an individual health insurance plan or employer health insurance policy. It is useful in case of a single illness which consumes the entire sum insured in the base policy.  The top up policy triggers only after the sum insured in the base policy is exhausted and the deductible under the top up is crossed due to hospitalization. Having a top up policy without a base health insurance policy is like having a bike without an engine. A top up policy has a deductible amount which would be almost 20% of the top up policy sum insured. For example let us take a base policy with Rs.2 Lacs and Top up policy with Rs.5 Lacs, in case of hospitalization first the base policy sum insured will be utilised and then the top up policy kicks in.

How to calculate my premium using health insurance premium calculator?

Health insurance premium calculator can be used to find the premium to be paid by you for your health insurance policy. The best Health Insurance plans are available on our portal. The health insurance calculator takes into consideration the age of the proposer and the coverage required before displaying the premium. The online health insurance premium calculator is easy to use and the premium comes within a few seconds after entering the data. The online health insurance calculator displays premium from different health insurance companies and the best health insurance policy can be chosen by the proposer.

What is the best health insurance plan online?

The best health insurance plan online is the one which provides best coverage at affordable rates and has the most number of network hospitals. The best Health Insurance plans can be found on the portal which is the best portal for purchasing health insurance policy online. For best health insurance policy which suits your requirements please visit our portal and consult our agent before making the final decision.

Is it better to include parents in existing policy or take a separate policy for them?

Health insurance premiums are calculated on the basis of age, taking the age of the elder member into consideration. The premiums increase steeply once you cross 55-60 years of age due to the high claims ratio in that age group. To maintain the loss ratio insurance companies charge high premium from the customers and this increases the health insurance premium. It is not advisable to include parents in your health insurance policy as the premium would increase steeply. For better premiums, two policies can be taken; one for family and the other for parents.

What happens if I forget to renew my health insurance policy?

Most of the insurance companies offer 15-30 days of time after the expiry of the policy to renew the policy. The grace period is the time where the coverage is not applicable but the exemptions accumulated over a period of time would be safeguarded. If the policy is not renewed during the grace period, then your health insurance policy would lapse and all the exemptions accrued over the past few years would expire. In short if the renewal is not done on time, then it is considered as a new policy and all the other conditions needs to be satisfied before the coverage kicks in.

Will my premium increase if I make a claim?

Health insurance premium are dependent on the age of the prospect and the coverage selected. But in some cases the health insurance premium could be increased at the time of renewal due to the heavy claim ratio that the insurance company has incurred over the past year. It means that the claims paid exceed the premium collected by the insurance company.

What is pre existing waiting period in health insurance?

A pre existing condition is a health condition which exists at the time of taking the health insurance. Conditions such as Diabetes, Blood pressure, Cancer etc come which are there prior to policy purchase are known as pre existing conditions. To prevent people from taking undue advantage of a health insurance policy, pre existing waiting period has been inserted in the policy terms and conditions. The pre existing waiting period ranges from 2 years to 4 years and depends on the type of health insurance policy and the insurance company. The pre existing waiting period needs to be satisfied before any claim can be made under your health insurance policy for pre existing conditions.

What is Specific disease waiting period in health insurance?

Specific disease waiting period is the time in which certain diseases or illness such as Knee replacement, Hernia etc would not be covered. The specific disease waiting period has a list of diseases which are not covered during the waiting period. In general the specific disease waiting period would range from 1 year to 2 years which differs from one company to other. The specific disease waiting period is inculcated in the health insurance to prevent people using health insurance only for treatment purpose.

What is initial waiting period in health insurance?

Initial waiting period or 30 day waiting period is the time where the customer has to wait before making a claim under the health insurance policy. Any accident related claims are exempt from this waiting period rule. This is also added to prevent people from taking health insurance only at the time of illness.

Can I transfer my health insurance policy from one company to another?

Yes. The process of transferring your health insurance policy from insurance company to the other is known as Portability. You need to submit an application to the target insurance company 45 days prior to the expiry of your health insurance policy for the company to act on your policy. The process of porting requires the new health insurance company to have the similar health insurance product and all the waiting period exemptions would also be applicable with the new insurance company.

How many times can I claim in a Health insurance policy?

You can claim any number of times in your health insurance policy as long as the sum insured is not exhausted. The sum insured in your policy is the maximum limit which can be utilised by you for claiming any number of times. There is no limit on the number of claims that can be made in your health insurance policy.

What is Family floater option in health insurance?

Family floater health insurance policy is the one where the sum insured can be utilised by any of the family members mentioned in the policy copy. In simple words, the sum insured floats and any member of the family can use it to get the hospitalization benefits. It is a kind of umbrella coverage available in the health insurance policy where the sum insured is not fixed on an individual basis. For instance if you take a floater health insurance policy of Rs.5 Lacs anyone in your family can use the whole sum insured without any capping on the sum insured per person.

Is medical test mandatory to take health insurance?

In normal circumstances health test is not mandatory to take a health insurance policy. But for people with prior health conditions insurance companies may ask for medical tests to determine the level of risk posed by the proposer to the insurance company.

I’m very young, do I need health insurance?

There was a perception that young people don’t need a health insurance policy as they feel that they are healthy and do not contract any diseases. But it is important to note that there can be certain diseases such as Corona which can attack any age person and cause fatality. It is better to have a health insurance policy at a very young age even though if the sum insured is less as the saying goes “Something is better than nothing”.

I have health insurance from office. Do I need another health policy?

Health insurance policy from office or employer health insurance is valid only as long as you serve in that company. Once you are out of job, you would be left without any coverage and any hospitalization during this time may cause a huge dent to your savings. Hence, it is advisable to have an individual health insurance policy even though you have health insurance from office.

Is Medical check-up Mandatory before taking Health Insurance Policy?

For most of the health insurance plans with Max Bupa (Nivi Bupa) health insurance, it is mandatory to avail pre policy check-up. But there might be a requirement to undergo few medical checkups in case of customers with pre-existing conditions which varies on a case to case basis.

Is maternity covered under health insurance?

Yes, maternity is also covered under the Health Insurance policy. It is important to discuss with our agent from before purchasing the health insurance policy to understand the waiting period in case of a maternity claim. The waiting period in case of maternity claim would range from 9 months to 2 years for different insurance companies and different health insurance plans.

Is Corona covered under health insurance?

Yes, Corona is covered under your health insurance policy. IRDA has made it mandatory to cover Corona virus pandemic under all the health insurance policies available in Indian market.

For any health insurance query please contact out agent or visit Our Portal and get the best health insurance policy online.