Frequently Asked Questions on Health Insurance

Healthcare prices have recently skyrocketed. As a result, in the event of any medical emergency, people wind up spending a good amount of their savings, jeopardising their future goals. A health insurance plan provides financial support in the event of a medical emergency, making it beneficial. Aside from that, it provides extra advantages like health check-up coverage, ambulance coverage, and tax breaks.

Religare health insurance rebranded itself as Care health insurance on 1st September 2020.

There is no set ‘best health insurance in India’. Your best health insurance policy depends on your requirements and budget. Whichever medical insurance policy offers you the required coverage at a minimal premium rate is your best health insurance plan in India.

A co-pay in health insurance is a set proportion of the total claim amount paid by the customer. The insurer pays the remainder in accordance with the provisions of the policy. You may lower your insurance premiums by electing a co-pay policy.

The total premium amount paid for health insurance is tax deductible. That is, you can subtract the amount you spend as a health insurance premium for your active coverage from your overall taxable income up to a limit of INR 25,000 for policyholders under 60 years old and INR 50,000 for senior citizens.

The 1948 Employees' State Insurance Act (ESI Act) provides for medical treatment and financial benefits for workers in the event of illness, maternity, or injury in the workplace.

Yes. You can avail of income tax benefits under section 80D up to INR 50,000 for senior citizens and up to INR 25,000 for policyholders under the age of 60 years. Both scenarios include an INR 5,000 tax break on preventive healthcare.

There is a certain time frame after policy acquisition in which you cannot file any insurance claim. This period is called the waiting period in health insurance.

Health insurance is intended to give the insured financial support for a specified tenure if he or she incurs a qualified medical expense. In exchange, the policyholder must pay a specified premium amount on a regular basis. Medical expenditures are compensated up to the limit of the total sum insured by the policy, which is the insurance provider's highest claim amount under that policy.

A no-claim bonus, or NCB, is a financial incentive provided to policyholders through their health insurance plan. If you do not file any claim during the entire policy tenure of 1 year, you need a monetary benefit for the same. Depending on the insurer's terms and conditions, the reward might be an increase in the total insured sum or a reduction in the insurance premium.

No. Health insurance premiums are not totally tax-free. You can avail of income tax benefits under section 80D up to INR 50,000 for senior citizens and INR 25,000 for policyholders under 60.

The origins of health insurance may be traced back to the post-independence period. Government initiatives were implemented in 1948 and later throughout this time period. These schemes included the ESIS and CGHIS.

Best health insurance plans are a matter of personal preference and financial situation. In order to determine the best health insurance policy for your family, you should consider all of your requirements and budget constraints. Any insurance company's medical coverage will depend on these factors.

While most health insurance policies include maternity benefits as a component of their coverage, you can include a separate maternity add-on to make sure all of your maternity-related expenses are covered. Alternatively, you can also opt for a standalone maternity health insurance plan.

There is no universal best health insurance for senior citizens, as each person’s needs and budget will dictate the most appropriate coverage type. Regardless of your medical insurance policy, it should offer you the required coverage at a minimal premium rate.

Health insurance premiums rise in tandem with the risk component of the insured's health. As a result, increasing age, smoking habits, pre-existing medical issues, and a family history of critical illness all contribute to higher health insurance rates.

Yes, cataract surgery can be covered by your health insurance policy. However, certain health insurance policies may not cover it, while others may. As a result, it should be thoroughly reviewed in the policy documents before purchasing the insurance.

There are two types of health insurance claims – cashless and reimbursement. The former enables the insurer to settle the payment directly with the hospital, whereas the latter requires the insured to pay the costs upfront and then file for a refund.

Yes. You can request an increase in the sum insured of your existing medical insurance policy at the time of renewal. However, you will receive an additional waiting term as well as an increase in the policy premium as specified in the company's terms and conditions.

Yes. You can have multiple health insurance policies.

Yes. You can transfer your ongoing health insurance policies to another insurer by submitting a port application to your current insurer at least 45 days before your renew health insurance plan.

You can make as many claims as you like under your health insurance coverage as long as your policy's total sum insured amount is not depleted.

Suppose you are admitted to any network hospital under a cashless facility. In that case, you can submit medical invoices as well as other appropriate documentation to your health insurer, and the company will settle the bills directly with the hospital up to the total sum insured by your policy.

If you are looking to compare health insurance plans, here are some pointers that you should look for:

• Plans offered
• Coverage benefits
• Network hospital coverage
• Claim settlement ratio
• Premium rate
• Claim process
• Customer support
• IRDA approved company
• Online reviews and ratings

Here are some of the documents that you will need to file a health insurance claim:

• Duly filled and signed claim application form
• Medical certificate
• Identity proof
• Diagnosis and investigation reports
• Discharge summary
• Hospital invoice
• Prescriptions and medical bills
• FIR report (in case of accidental hospitalisation)

There are certain factors which are considered when calculating your health insurance premiums. They are:

• Age of the insured
• Coverage of the policy
• Total sum insured of the policy
• The lifestyle of the insured
• Insurance history of the insured
• The current address of the insured
• Family medical background of the insured
• Other personal information

If you are admitted to a non-network medical facility, you can only file a reimbursement claim. Here is a step-by-step procedure for the same:

• Contact your insurance provider and offer your policy number.
• Once your treatment is done, settle the hospital invoices upfront and get a copy of all the invoices, medications, discharge summaries, and other required documentation.
• Now, you have to file a reimbursement claim
• Download and fill out the claim application form, which will be available on your insurance company's website.
• Send the paperwork to the insurance company, along with the medical bills, bank details and other documents which you received from the hospital.
• Once your claim is validated, the money will be refunded to you deducting any non-covered expenses or co-pay amounts.

In case the primary insured dies post hospitalization then the claimable health expenses would be reimbursed. If the primary insured is also eldest member in the family, then for the succeeding years after the death of primary insured the premium would be calculated on the basis of the age of next eldest member. For this to happen, the family should fill up change of request form provided by the insurer. Please note that in case there were only two members covered under the policy then the family floater plan would be converted to an individual plan.

If you already have a health insurance policy you can increase sum insured at the time of renewal.

Yes

No. As health insurance policy is designed to cover unforeseen medical expenses a normal health insurance policy does not cover maternity expenses. Coverage for maternity expenses is one of the additional features offered by some of the health insurance plans at a higher premium and waiting period. To know more about maternity health insurance.

While choosing a health insurance policy there are a few things which you should be ready with are:

• Number of members and relations to be covered- Because this will be the basis of buying policy.
• Type of coverage – Individual, Family floater or group.
• Sum insured or coverage amount – Ensure that you consider future expenses too.
• Room rent – Check for the capping amount or criteria defined if applicable.
• Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also check if the plan has co-pay feature.
• Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital.
• Policy wording – Most important thing to check before buying a policy. In case you are not sure about certain term or condition you can always contact the insurer for clarification.

Yes you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause you can cancel the policy and get a refund. Stamp duty, expenses on medical check-up and proportionate risk premium (the number of days that the insurance company was at a risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded. Note: For the refund to happen there should be no claim during the policy period.

Yes

There are four important types of exclusions in a Mediclaim policy they are:

• Number of members and relations to be covered- Because this will be the basis of buying policy.
• Type of coverage – Individual, Family floater or group.
• Sum insured or coverage amount – Ensure that you consider future expenses too.
• Room rent – Check for the capping amount or criteria defined if applicable.
• Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also check if the plan has co-pay feature.
• Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital.
• Policy wording – Most important thing to check before buying a policy. In case you are not sure about certain term or condition you can always contact the insurer for clarification.

The first or second year exclusions include list of diseases or ailments which have a waiting period. This may include ailments like Cataract, knee replacement, etc. (which are not pre-existing).

Yes. Some of the insurance companies have this concept of loyalty benefit under which they offer discount on renewal of policy from the same company.

Yes, your health insurance policy is very much applicable even if the hospitalization is less than 24 hours. This is known as Day Care Treatment. Here, 24 hours hospitalization is not required and you do have a scope of coverage too. Day Care refers to any treatment or surgical procedure that is performed under general or local anaesthesia in medical clinic/hospital or a day care centre requiring hospitalization for a period of less than 24 hours because of technological advancement. However, remember that OPD (out-patient department) are not a part of the Day Care treatments. The claim procedure too is nothing different than a normal regular hospitalization. The below treatments are covered under Day Care Treatment:

• Appendectomy
• Angiography
• Chemotherapy
• Colonoscopy
• Eye Surgery
• Radiotherapy
• Lithotripsy
• Hydrocele
• Piles / Fistula
• Prostate
• Sinusitis
• Liver aspiration
• Dialysis
• Sclerotherapy

Case 1: When you are hospitalized just before the policy expiry date and have intimated the insurance company about the same before policy lapses (where the policy lapses while you are still in hospital), the company will pay the benefit as per the plan, and its terms and conditions. Case 2: If the policy lapses and you are hospitalized during the grace period, on intimation during the grace period about the hospitalization, the company will pay the coverage as per the plan, and its terms and conditions.